Breast Lump Assessment: Why Triple Assessment Comes Before a Diagnosis

Yes, definitely. An electrolarynx is an external prosthesis: once the device is attached to the skin it creates vibrations at high speed and the patient can vocalise using it.

Tumour markers can be used, but it is important to understand the patient's age, family history and smoking status first. At a basic level, a mammography for women, an ultrasound of the whole abdomen for endometrial or ovarian cancer, a serum PSA blood test for men with suspected prostate cancer, and a CT scan of the chest for smokers can be recommended. The frequency varies: colon cancer screening can be a colonoscopy every ten years, or a sigmoidoscopy with a faecal occult blood test.

This is a real issue even in India, where processing time for biopsies can be high in some regions. One workaround is relying more on FNAC, which is not the best strategy but can guide treatment decisions in select situations where a diagnosis is otherwise delayed. A second option is a frozen section facility, which gives some confirmation quickly but is resource-intensive and usually only available at high-volume cancer centres. Short of that, it is best to refer to an oncologist who can guide where a biopsy should be taken from for the best results.

The most important myth is patients' hesitancy to get a biopsy done, fearing it will cause the cancer to spread. A biopsy is one of the most crucial tests a cancer patient needs, and if planned and performed correctly it will not cause the cancer to spread. Another myth is that patients believe cancer is their own fault, from dietary habits or indulgences like tobacco or alcohol. More cases are now understood to happen because of environment or genetics rather than a patient's own fault, and it is important to destigmatise patients suffering from cancer, since stigma is what keeps them from seeking timely treatment.

Definitely. Breast conservation surgery is one of the advanced techniques for treating early breast cancer and is routinely discussed as a possibility with patients. It offers a definite cosmetic advantage, but it needs to be followed up with radiotherapy, and there are strict criteria on imaging and family history that must be met before it is offered. It is now combined with oncoplasty, which improves how the scars are closed for a better cosmetic outcome.

It combines a clinical examination with radiological imaging (mammography, ultrasound or MRI depending on availability) and a pathological test such as a biopsy or FNAC, giving a specific enough picture to understand the lump and its likely course.

An unexplained lump in the breast or armpit in a patient over 30 years of age is a warning sign, as is one-sided nipple discharge or retraction in a patient over 50.

Options include oncoplasty and whole breast reconstruction for good cosmetic outcomes, along with sentinel lymph node biopsy, lymphovenous anastomosis and reverse axillary mapping, and robotic mastectomy with immediate reconstruction for prophylactic or very early cases.