While it can be frightening to discover a new breast problem, most breast problems are not caused by breast cancer.
Breast problems, such as breast lumps, breast pain or tenderness, nipple discharge or inversion, and changes in the skin of the breast, are common in women of all ages, from adolescents to older women.
Common Breast Problems
- Breast lump: If you or your doctor may find a breast lump by looking at or feeling your breast. It is difficult to determine by examination alone if a lump is caused by breast cancer. Although most breast lumps (approx 90 %) in women in the age group of 20 to 50 are not cancerous, all new breast lumps should be evaluated by a doctor to determine if further testing is needed.
- Breast pain: The most common type of breast pain is caused by the hormones that control the menstrual period. These hormonal changes can cause pain in both breasts several days before the menstrual period begins. Because the pain can come and go with the menstrual cycle, it is called "cyclical" breast pain. Cyclical breast pain is not usually caused by breast cancer or other serious breast problems.
Less commonly, a woman can have breast pain that does not come and go with the menstrual cycle (also called noncyclical breast pain). This type of pain is not related to the menstrual cycle and might occur in only one breast or one area of the breast. Noncyclical breast pain is usually caused by a problem outside the breast, such as muscle or connective tissue strain, skin injury, spinal conditions, or problems in another organ system (eg, heart burn, chest pain). Noncyclical breast pain is caused by breast cancer in only a very small percentage of women
- Nipple discharge: Having a milky-colored discharge (also called galactorrhea) from both nipples is common, especially during the first year after giving birth. Nipple discharge from both breasts can also occur in women with an underactive thyroid (hypothyroid), as a side effect of certain medications, or because of a growth in the pituitary (a part of the brain), causing an increase in a hormone called prolactin.
As with other ducts in the body, breast ducts make and carry secretions. Many women can express (squeeze out) a small amount of yellowish, greenish, or brownish discharge. This is often called "physiologic" discharge and is not a cause for concern. Physiologic discharge is not bloody. Spontaneous nipple discharge (discharge that occurs without squeezing) or nipple discharge that is clear or bloody may be caused by an abnormal growth within the breast or, less commonly, by breast cancer. Any woman with nipple discharge should be evaluated by a doctor. A mammogram, breast ultrasound, and/or exam of the breast ducts (ductogram) may be recommended in some cases.
- Nipple inversion: The nipple is the central projection in the areola. Many women are born with nipples that naturally invert (pull in) at times and evert (poke out) at other times. Other women find that this happens after breast feeding. Nipple inversion of this type is not cause for concern.
If your nipples have always been everted, however, and begin to invert for no obvious reason, this should be evaluated by your doctor. Most causes of nipple inversion are not a cause for concern, but occasionally this is the first sign of a breast cancer. New nipple inversion is usually evaluated with a breast examination and mammogram as a first step. Nipple inversion can affect one breast or both, and can be congenital or acquired. Acquired nipple inversion can be due to benign or malignant causes. Benign nipple inversion is usually a gradual process, occurring over a few years. When nipple inversion occurs rapidly, a complete breast examination and radiologic evaluation with mammogram and ultrasound should be performed to look for the underlying cause.
- Skin changes: Skin problems can develop on or near the breast, some of which cause itching, scaling or crusting, dimpling, swelling, redness, or changes in skin color. While most of these changes are not caused by a serious breast problem, it is important to be evaluated if a skin problem on your breast does not resolve within a few days. More serious causes of skin changes on the breast can include less common forms of breast cancer, such as Paget disease or inflammatory breast cancer. Other, more common skin problems, such as rashes, moles, cysts, or skin infections can occur on the skin of the breast, as well. The evaluation of breast skin changes usually includes a breast examination and may include a mammogram. A skin biopsy may be needed to confirm the diagnosis.
- Abnormal mammogram: Many women have an abnormality diagnosed on screening mammogram and have no physical complaints or findings. The radiologist will indicate whether the abnormality requires follow-up, additional imaging or biopsy. If the abnormality is a mass, an ultrasound is performed to see if the abnormality is cystic or solid. The radiologist can usually perform an aspiration for a cystic lesion or core biopsy of a solid lesion with ultrasound guidance. A clip should always be placed to guide any subsequent surgery that may be required if the biopsy is positive. The clip also provides confirmation that the proper area on the mammogram was targeted for biopsy.
In age 20s: If any lump is detected before your menstrual period, you may be advised to have a repeat breast examination after your period has ended. In this age group, breast lumps are often caused by hormonal changes and will resolve after your menstrual cycle. Fifroadenoma and cysts are more common in this age group. If any lump is persisting, ultrasound of the breast should be done. Needle biopsy may be required to rule out cancer. Mammography is usually not done. If any abnormality not being diagnosed on ultrasound, a Breast MRI may be required.
In age 30s: Nipple discharge and infections are more common in this age group. Self breast examination should be done every 3 months to check any abnormality in the breast. If any lump is palpable, diagnostic mammography should be done along with ultrasound breast. Needle biopsy may be required to rule out cancer.
In age 40s: All above mentioned abnormalities can occur and treatment depends upon the condition. Self breast examination should be done every 3 months to check any abnormality in the breast. If any lump is palpable, diagnostic mammography should be done along with ultrasound breast. Needle biopsy may be required to rule out cancer. Women who are at high risk of breast cancer sometimes need to begin screening at a young age. This might include women who:
- Carry genes that increase their risk of breast cancer, such as the “BRCA” genes
- Have close relatives who got breast cancer at a young age
Screening mammography can be done to detect any abnormality and repeated every year till the age of 50.
In age 50s onwards: All above mentioned abnormalities can occur and treatment depends upon the condition. Self breast examination should be done every 3 months to check any abnormality in the breast. If any lump is palpable, diagnostic mammography should be done along with Ultrasound Breast. Needle biopsy may be required to rule out cancer. Screening mammography should be done every one – two year depending upon the risk of patient to detect any abnormality.
Dr. J.B. Sharma is a Senior Consultant, Medical Oncology, Action Cancer Hospital, Delhi.
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