Breast Disease

Introduction

When dealing with breast diseases I find that most patients want one of two questions answered. One question is, "Do I have cancer?" The second is, "Can you prove to me that I do not have cancer?" Although these questions sound similar they are very different in how you approach the patient and in the patient's expectations. Patients will request surgical consultation for abnormalities identified on a physical examination, radiographic evaluation, or because of family history concerns. These problems may be acquired or congenital. They may involve males or females. Different disease entities can affect patients at different times of their lives. Adolescence, pregnancies, other diseases, new medications, and generalized aging all can contribute to specific breast abnormalities.

Breast Diseases

Most women experience breast changes at some time. Your age, hormone levels and medicines you take may cause lumps, bumps and discharges. If you have a breast lump, pain, discharge or skin irritation, see your health care provider. Minor and serious breast problems have similar symptoms. Although many women fear cancer, most breast problems are not cancer. Some common causes of breast changes are

• Fibrocystic breast condition - lumpiness, thickening and swelling, often associated with a woman's period
• Cysts - fluid-filled lumps
• Fibroadenomas - solid, round, rubbery lumps that move easily when pushed, occurring most in younger women
• Intraductal papillomas - growths similar to warts near the nipple
• Blocked or clogged milk ducts
• Milk production when a woman is not breastfeeding
• Injury

Signs And Symptoms

Mastodynia
Breast pain, the most frequent reason for breast consultation, may or may not be mass related, may be related to menstrual cycles, may be on one side only or both.
Nipple Discharge
May be physiologic or pathologic, may range from clear to bloody, may be spontaneous or induced, may be a unilateral or bilateral, may be associated with a mass
Palpable Mass
These may be benign or malignant, size, irregularity, fixation to other tissues, associated dimpling or edema of skin are all important characteristics.

Risk Factors

Endogenous Estrogen
This is estrogen produced by your own body. Excess amounts typically come from pregnancy and obesity. Having your first pregnancy after the age of 30 seems to elevate the risk of breast cancer. Family history of breast cancer.
Exogenous Estrogen
This is extra estrogen taken in as a medication orsupplement. This is usually in the form of birth control pills or estrogen replacement therapy for the symptoms of menopause. Diet - Diets high in fats seem to be a risk factor for the development of breast cancer. Alcohol Benign Breast Conditions- Certain conditions of the breast can predispose a woman to breast cancer.

When To Seek Medical Advise

Whenever there is a concern, you should seek medical advice. This may seem rather broad in nature but it goes back to our original two questions. If there is a concern about a mass, discharge, or pain, of course they should be evaluated. But our concern goes beyond that. Trying to prove that someone does not have cancer is just as important as trying to prove that someone does. Routine breast exams and radiology studies are very important in the early detection of this disease. Both self-examination and examination by a trained medical professional should be done on a regular basis beginning between 35 and 40 years of age. A baseline screening mammogram should also be performed between 35 and 40 years of age. Between 40 and 50 years of age a mammogram should be obtained every one or two years. After 50 years of age it should be done yearly. Routine mammograms beyond 75 years of age are controversial. Certainly evaluation should be sought at any age for any abnormality suspected.

Screening And Diagnosis

Physical examination, mammograms, ultrasonography, magnetic resonance imaging, fine needle aspiration, stereotactic biopsy and surgical biopsy are all helpful in the diagnosis and treatment of breast diseases. Breast diseases in general these can be divided into two groups, benign and malignant. Benign causes of breast disease include cysts, fibroadenomas, fibrocystic changes, etc. Malignancies are usually either ductal or lobular in nature. Lobular Carcinoma In Situ (LCIS) or Lobular Neoplasia and Ductal Carcinoma In Situ (DCIS) should be considered a marker for an increased risk of developing cancer or a premalignant condition respectively.

Treatment Options

There is a range of treatment options based on the underlying problem. Observation, aspiration, needle biopsy, excisional or incisional biopsy, partial mastectomy, sentinel lymph node biopsy, and modified radical mastectomy's are all considerations in the treatment of breast disease.

Do It Yourself

Do not ignore breast problems! An aggressive form of breast carcinoma called inflammatory carcinoma can be confused with breast infections. If a breast infection does not seem to be responding to antibiotics this should be a consideration. Not all breast disease involves the deep breast tissues. A scaly sore of the nipple could represent a cancer called Paget's disease. Breast masses do develop in men and could represent carcinoma. A family history of breast and ovarian carcinoma should be discussed with your primary care provider. For more comprehensive information please visit the National Institutes of Health website.