Breast Tuberculosis (TB) is a rare but significant form of extrapulmonary tuberculosis. The rarity and nonspecific clinical presentation of breast tuberculosis often lead to misdiagnosis, resulting in delayed treatment. We spoke to our expert Dr Smita B Kalappa, MBBS, MS OBGY, DNB(OBG), MRCOG(UK), Fellowship in Gynecological Endoscopy (ICOG), Apollo Cradle and Children's Hospital, Jayanagar, Bengaluru, who explained this health condition and listed its causes, symptoms, and treatment.
“Breast TB commonly manifests in women of reproductive age, but it can affect any woman. The causative agent is Mycobacterium tuberculosis, the same bacterium that causes pulmonary TB or TB of the lungs,” said Dr Kalappa. The bacteria can invade the breast tissue through the blood vessels, lymphatics, or through direct invasion from an organ which has become infected.
According to a 2012 study, Breast TB is an uncommon form of the disease occurring outside the lungs, comprising less than 0.1% of breast conditions in developed nations but rising to 3-4% in regions with high tuberculosis prevalence like India and Africa. It primarily affects women of reproductive age who have given birth and are lactating.
Causes And Risk Factors Of Breast Tuberculosis
There exist several ways to contract breast tuberculosis. Here are some of them as listed by Dr Kalappa:
- Hematogenous spread which is the most common and results in lung infection
- Lymphatic spread via dissemination to more specifically axillary lymph nodes
- Direct spread from the chest wall or pleura
“Breast TB is common among people with compromised immunity levels; these include HIV-positive individuals or those taking immunosuppressive medications,” highlighted Dr Kalappa.
Also Read: Tuberculosis in Children: Expert Lists Its Risk Factors And Treatment Challenges
Symptoms Of Breast Tuberculosis
Breast TB presents with clinical signs and symptoms that are ill-defined and can be easily mistaken for similar conditions, such as breast cancer, or pyogenic breast abscess. Some of its common symptoms, as listed by the expert include:
- A painless, firm lump is the most common presentation
- Some people may feel pain or even tenderness at some point
- Nipple discharge which may be bloody or purulent
- The overlying skin may show ulceration, dimpling, or sinus tract formation
- Swelling of the axillary lymph nodes
Challenges in Diagnosis
The diagnosis of breast tuberculosis is not easy because the disease is rare and presents with symptoms that mimic other breast conditions.
This diagnostic procedure is normally performed by:
- Conducting a clinical examination of the breast together with an evaluation of the lumps and other related symptoms.
- Mammography and ultrasound both are imaging modalities that can detect the masses but are not confirmatory for TB
- In certain circumstances, based on suspicion, a biopsy may be needed to confirm the diagnosis of breast TB
- Another test that might be useful is fine needle aspiration or FNA to establish the presence of tuberculosis bacteria in the breast
Treatment Options For Breast Tuberculosis
The treatment should be directed towards eradicating the tuberculosis bacterium and avoiding further destruction of the breast tissue.
- Breast TB is treated with the use of drugs and sometimes surgery to remove affected breast tissues.
- Surgery is rarely needed but may be required if the abscess is large, sinuses are present or if there is no response to medical treatment.
- These may extend from simple aspiration and drainage to more extensive surgical procedures, such as excision.
- Regular follow-up is essential to monitor response to therapy and manage any potential complications or recurrences.
Importance Of Early Diagnosis And Treatment
Dr Kalappad concluded, “Breast TB, when diagnosed in its early stages, is treatable and may not lead to complications like abscess formation, chronic sinuses or major tissue loss. It also decreases misdiagnosis because breast cancer or other ailments can cause the patients to undergo the wrong treatment and suffer from stress.”
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your own professional if you are dealing with any health issues to avoid complications.]