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What Are Breast Problems?

The female breast is an organ that changes with puberty, with the monthly menstrual cycle, and with pregnancy; it also continues to change with age. Most changes in your breasts are perfectly normal and no cause for concern. However, you may experience any of several conditions that require medical attention. Chief among these are breast pain and masses or lumps.

Lumps

Breast lumps come in many forms, including cysts, adenomas and papillomas. They differ in size, shape and location, as well as in causes and treatment. About half of all women have lumpy breasts, or fibrocystic change. They are more common in the premenstrual period and usually resolve after menopause. Most lumps are benign and do not signal cancer; however, any time you find a new or unusual lump, have your doctor check it to make sure it is not cancerous or precancerous.

Researchers are studying the incidence of breast lumps in women taking birth-control pills or using hormone replacement therapy (HRT). In HRT, women take varying amounts of the hormones estrogen and progestin to alleviate the symptoms of menopause. In July 2002 a study called the Women’s Health Initiative discovered that HRT resulted in more risks than benefits and discouraged its use for long term management of menopause. Combined HRT was shown to increase a woman’s risk of breast cancer and change breast structure, increasing the breast density and making mammograms harder to read and evaluate. This could make detecting cancer more difficult.

Cysts, which can be large or small, are benign, fluid-filled sacs. They sometimes occur cyclically, and they may be painful.

With the cessation of menstruation at menopause, many cystic lumps diminish or disappear; therefore, you should immediately have your doctor check any lumps that form after menopause.

Fibroadenomas are the most common benign breast tumors seen in women under 25 and are occasionally seen in adolescents. Fibroadenomas are usually round, several centimeters across, and mobile. They can sometimes resolve on their own. Your doctor may recommend removal if it persists, get larger or if you are anxious about it. Tests will be done to check for cancer when it is removed.

Nipple adenomas are tumors of the nipple area. They vary in appearance, sometimes recur after surgical removal, and are sometimes but not usually associated with cancer. An intraductal papilloma is a relatively uncommon small growth in the lining of the milk ducts near the nipple. Usually seen in women over 40, papillomas produce a discharge, which may be bloody.

Breast Self-Exam

Starting around age 20, you should examine your breasts every month so that you are familiar with their structure and can detect any new masses or lumps. Premenstrual changes can cause temporary thickening that disappears after the period, so it is best to check your breasts about a week after your period. If you are no longer menstruating, examine your breasts monthly. If breast self-exam makes you anxious or you have questions how to perform it, consult your healthcare provider.

A breast self-exam is easiest in the shower, using soap to smooth your skin. Look for dimpling. Using light pressure, check for lumps near the surface. Use firm pressure to explore deeper tissues. Squeeze each nipple gently; if there is any discharge — especially if it is bloody — consult your doctor.

Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancerous or precancerous. Most lumps are benign and do not signal cancer. The best test for distinguishing a cyst from a solid tumor is ultrasound; a needle biopsy may also be done.

Mammograms — detailed X-ray pictures of the breasts — can reveal tumors too tiny to be felt by hand. There is disagreement and no small controversy as to when a woman should begin getting routine mammograms: Some doctors say between ages 35 and 40; others say not until age 50. Many are now recommending yearly mammograms starting at age 40. A typical pattern is an initial mammogram at the age of 35 then every other year beginning around age 40, and then increasing the frequency to once a year at age 50. If you have a family history of breast cancer, especially in your mother or sister, your doctor may advise a different schedule.

Breast Pain

Breast pain can have many causes, including the normal swelling of breast tissue during the menstrual cycle. Other causes include infection or injury; growths, including cancer; and perhaps diet.

The general swelling of breast tissue with the menstrual period can be painful, but it is not dangerous, and no treatment is necessary if you can tolerate the discomfort. Each monthly cycle brings about hormonal changes, including increases in estrogen and progesterone, that bring more fluid into the breasts, expanding tissue, stretching nerve fibers, and producing pain. Some women experience this painful swelling just before their periods, with symptoms subsiding near the end of the menstrual flow. Others experience it as a side effect of birth-control pills.

Trauma and infection in the breast produce the same symptoms you would see elsewhere in your body, except that in your breast, infections tend to become walled off from surrounding tissue, producing small abscesses. This may give them the appearance of cysts. If you suspect you have an infection, see your doctor. Your doctor will usually prescribe antibiotics, although many times the infection will reoccur and may require the removal of the infected tissue.

Cysts may produce pain, but breast cancer rarely does — although pain does not rule out the possibility of cancer.

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