Common Breast Problem

admin — Wed, 24 Aug 2011 18:40:23 +0000

Breast Lumps

Most breast lumps are not cancers

A lump that can be felt can be:

1. Fibrocystic Change

Fibrocystic changes occur in the majority of women as they progress through various stages of life.

a. Breast pain
b. Lumpiness or a “breast lump”
c. Calcifications
d. Abnormal densities on the mammogram

Breast tissue changes before the menstrual cycle causing more lumpiness and pain.
Fibrocystic change is NOT a disease-just normal occurring changes.A definitive diagnosis can be made with a combination of mammography, ultrasound, and sometimes a biopsy – core or mammotomy. There is no further treatment necessary!
Fibrocystic changes do not raise the risk of developing breast cancer.
However, it is very important to continue regular breast self-examination and routine yearly mammography from the age of 40.

Microcalcifications

Abnormal Density ( Mass )

2. Fibroadenoma

A fibroadenoma is a benign (non-cancerous) growth in the breast that is made up of breast cells and fibrous tissue.

a. More common in younger women
b. Feels hard to the touch
c. Can grow within a few months
d. Does not become cancerous
e. Does not increase the risk of breast cancer.

A definite diagnosis can be made with a combination of breast ultrasound and a breast biopsy using a core or mammotome technique. Surgery is not usually required.

Mammogram

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A cyst is a little pocket of fluid occurring when a milk duct becomes blocked not allowing the normal breast fluid to flow through the ducts.

a. Varies in size
b. Can be multiple
c. May cause discomfort
d. May or may not be felt

Mammography and ultrasound provide an accurate diagnosis. If the cyst is painful, it can be drained (aspirated) using ultrasound to guide the tiny needle.
Cysts do not become cancerous, do not need to be surgically removed, and don’t need to be drained unless they are painful.

A lipoma is a growth in the breast, which is fat and is surrounded by a fibrous band.
a. May or may not be felt
b. Does not become cancerous
c. Does not need to be removed surgically
The diagnosis can be made with ultrasound and sometimes a biopsy.

A papilloma is a tiny growth in a milk duct, which may cause a nipple discharge.
a. Cannot be felt
b. Spontaneous yellow/bloody nipple discharge usually
c. Is not cancerous
d. May or may not need to be removed
The diagnosis can be made with a ductogram followed by mammography, ultrasound and a needle core biopsy or surgery.

Breast cancer is a cancerous growth starting in the milk duct.

a. May or may not be felt
b. May have dimple in the skin of the breast
c. May have inverted nipple
d. May or may not have pain
e. May be seen only by mammography or ultrasound

a. A firm lump often felt at the edge of breast tissue, or deep in a breast is a rib, pectoralis muscle, or a ridge of fibrous tissue. Remember, there are ribs and muscle behind all the breast tissue.

b. Pregnancy -
1. More lumpiness and fullness normal
2. Specific lump different from surrounding lumpiness-Have evaluated.

Usually associated with the pregnancy and not cancer. However, cancer can occur in rare instances.

3. Cyst

4. Lipoma

5. Papilloma

Breast Cancer

6. Other lumps

Mammography is able to detect abnormalities that may not be felt. Most of these abnormal areas are benign – not cancer.

1. Mammographic Density

a. Specific shape-round, oblong, or spiculated (crab-like)
b. Very white on the mammogram
c. White lines are breast and fibrous tissue

Abnormal Mammogram

Mammographic Abnormalities

With an abnormal appearing density, extra mammographic views are recommended such as cone compression (compressing a small area of the breast where the density is located) to determine if this is overlapping normal breast tissue or a definite abnormal area. If there is truly an abnormal density, it remains on this image and is usually more clearly defined.

A breast ultrasound will then be used to provide more information.
The normal breast tissue is usually similar in both breasts. When an area appears that looks different in one breast from the other, or changes from one year to the next, this is referred to as an asymmetric density or architectural distortion

a. Tiny specks of calcium
b. Scattered-usually benign fibrocystic change
c. Clustered-usually benign-small chance of very early breast cancer called duct carcinoma in situ.
d. Cannot be felt
e. Seen only on mammography-not ultrasound
f. Magnifications views to provide more detail
g.Clustered calcifications-even slightly suspicious- can be biopsied with stereotactic core biopsy.
h. Hot all calcifications need to be biopsied or removed surgically

Usually caused by interaction of hormones (estrogen and progesterone) and breast tissue.-Cyclic pain.

After menopause, hormone replacement therapy can cause pain.

Seldom associated with breast cancer.

Pain can increase during stress or certain times of the year.

Caffeine, mushrooms, nuts, cheese, red wine, bananas, and chocolate in excess can increase breast discomfort.

Suggestions:

1. Limit caffeine
2. Wear a supportive bra
3. Vitamins E, A and C in appropriate doses. Not megadoses!
4. Adequate exercise and sleep.

It is always important to discuss breast changes and / or pain with your physician, have yearly mammograms beginning at age 40, and continue regular breast self examination.

2. Calcifications

Breast Pain

Nipple secretions or discharge is experienced by many women.

Further evaluation necessary when the discharge is:

1. Spontaneous – Comes out by itself without vigorous squeezing or nipple manipulation.
2. Comes out of only one hole in the nipple – not multiple holes.
3. Bloody, clear, or yellow in color. To check the color, place discharge on a white tissue.
4. Green, gray, or milky discharge does not usually need further breast diagnostic studies. These secretions may be caused by hormonal stimulation, fibrocystic changes, some medications, and rarely a pituitary gland dysfunction.

1. A tiny catheter is placed in nipple opening where discharge is seen.
2. A few drops of contrast material is injected.
3. A mammogram is performed.
4. An ultrasound may be performed if an abnormality is seen.
5. A needle core biopsy (ultrasound mammotomy) can usually remove and diagnose the problem. The discharge is usually gone.
6. Most women have minimal discomfort with this procedure.

Nipple discharge can be caused by

* Fibrocystic changes -common
* Intraductal Papilloma -a tiny benign growth in the milk duct, which is also common

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Common Breast Problem