Published on Mar 09, 2016 and last reviewed on Dec 26, 2022 - 3 min read
This is a patient information article about common breast diseases and how to evaluate it.
For females, an easy way to assess their breast problems is the need of the hour. A female should do a simple checkup at home. If they notice any change then they should bring it to the doctor's attention immediately.
Majority of women who come to the surgical outpatient department complain of either pain or lump in the breast or discharge from the nipple.
Lump: If there is a lump, then duration, size and rate of growth of the lump has to be considered. A long duration and slow growth is a benign condition. Whereas, short duration and fast growth could be a malignancy.
Pain in Breast: Breast cancer is a painless condition. Pain is the main complaint of acute mastitis. Pain associated with menstruation is seen with fibroadenosis.
Discharge from Nipple: Bloody discharge could either be a duct papilloma or cancer. Greenish discharge may be associated with duct ectasia.
So, how should a woman proceed with a breast problem?
The steps of breast self-examination (BSE) that every woman should do every month are as follows.
Special Investigations Done by a Doctor:
These are mainly done to differentiate breast cancer from other benign condition, to detect an early cancer and finally to know the stage of cancer.
Differential Diagnosis - What Could It Be?
1) Acute Mastitis: This is infection of the breast which is commonly seen in lactating women. Symptoms are pain in the breast with redness. Breast is warm to touch. Treatment is by antibiotics and if no relief is seen, a simple procedure to drain the pus formed is done.
2) Fibroadenosis: It is the most common breast disease. It is an estrogen dependent condition where pain increases just prior to menstruation. Treatment is not usually required. Evening primrose oil is used in cases of moderate pain.
3) Fibroadenoma: It is a benign tumor seen in females below 30 years. It presents with painless swelling in one area of the breast. Treatment is removal of the tumor if large, multiple or recurring. Otherwise it can be left alone with regular follow up.
4) Duct Ectasia: It is associated with greenish discharge from the nipples which may be associated with pain. It is common in smokers. Treatment involves antibiotics and removal of the affected duct.
5) Ductal Papilloma: Blood stained discharge from the nipple is common. It can be premalignant so further investigations are needed. Treatment is to remove the affected duct.
6) Breast Cancer: The most common symptom is a breast lump. But 90% of the breast lumps are not cancers. However it is important to evaluate a case of breast lump since earlier the detection, better the survival. The second most common presentation is nipple discharge.
Breast self-examination plays a major role in early detection and intervention process. Hence, should be done monthly by all women ideally. Triple assessment is done by the doctor who includes clinical assessment, radiological imaging and biopsy analysis. Treatment is a combined approach involving surgery, radiotherapy, hormone therapy and chemotherapy.
For doubts, queries and clarifications regarding breast problems, consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist
The following steps should be taken to examine breasts at home:
- Visual Examination- In front of a mirror, sit or stand without a shirt or bra. Check for puckering, dimpling, or alterations to size, form, or symmetry.
- Manual Breast Examination- By applying varying amounts of pressure, you may feel the breast tissue at various depths. For example, to feel the tissue closest to the skin, apply light pressure; to feel a bit deeper, apply medium pressure; and to feel the tissue closest to the chest and ribs, apply firm pressure.
The three methods to conduct breast self-examination are as follows -
- Circular Method- Use the hand that is not touching the breast you are inspecting. Press the flat parts of your second, third, and fourth fingertips into your breast, starting at the top of your breast closest to your body. Work toward the nipple by carefully rotating your breast in little circles. For deep tissues, press firmly; for subcutaneous tissues, press lightly. Make sure to cover the breast, avoiding any omissions altogether. Repeat on the other breast.
- "Wheel Spokes" Method- Start at the breast's outermost top. The flat parts of your fingertips should be pressed into your left breast, first toward the nipple and then away from it. When you are finished with that place, move your fingers to the next one and repeat the procedure, slowly working your way around your entire breast. Next, repeat on the other breast.
- Grid Method- In the innermost part of the breast, close to the breastbone, start. Press firmly and gently down your breast using the flat parts of your fingertips. Move your fingers up, down, and around your breast until you thoroughly explore the entire area with your fingertips. Repeat with the other breast.
Screening mammography or a clinical breast check by the doctor is still preferable to breast self-examination. Knowing how your breasts usually feel and appear can complement but not replace breast cancer screening.
It might be challenging to distinguish between an actual lump and just normal breast tissue because breast tissue can feel lumpy and sponge-like on its own. In addition, a breast lump will feel different from the rest of the breast tissue and noticeably more firm.
A cancerous lump can appear anywhere in the breast tissues and feel spherical, mushy, and painful. The lump might even hurt in some circumstances. Additionally, some women have thick, fibrous breast tissue. If so, it could be more challenging to feel any changes or lumps in their breasts.
Each month throughout the menstrual cycle, the hormone levels alter, which affects the breast tissue. When the period starts, swelling starts to go down. The week following the end of menstruation is usually the best time to conduct a self-examination for breast awareness.
These malignant lumps, which frequently originate from the mammary glands or ducts, typically (approximately 50 % of the time) grow in the upper outer quadrant of the breast and expand into the armpit, where tissue is denser than elsewhere.
Blood tests can assess a person's general health but are not used to diagnose breast cancer. Instead, they can be used, for instance, to decide if a person is healthy enough to undergo surgery or specific kinds of chemotherapy.
A doctor or nurse will feel a woman's breasts during a breast examination to look for lumps and bumps and determine whether there have been any changes since the previous examination. Breast examinations by doctors typically do not begin until a woman is in her 20s.
Any new breast or nipple pain has to be evaluated by a medical professional, preferably your gynecologist or primary care physician. Even though most breast pain instances are minor and manageable, one should never put off a breast cancer diagnosis or a more dangerous non-breast-related cause, such as heart disease.
Most medical organizations do not advise routine breast self-examinations for breast cancer screening. This is due to the lack of evidence that breast self-examinations help to prevent cancer or extend breast cancer patients' lives.
Last reviewed at:
26 Dec 2022 - 3 min read
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