Recognizing Breast Disorders
Evaluation of breast complaints and screening for breast cancer make up a significant part of primary care practices. The most common complaints seen include breast pain, lumps, and nipple discharge. It is essential that all women receive accurate evaluation for breast disorders. Studies have shown that 16 percent of women aged 40 to 69 years visited their doctor with some type of breast complaint over a 10 year period. In the U.S., breast cancer is diagnosed in approximately 213,000 females every year. Fortunately, breast cancer mortality rates have decreased to around 41,000 cases per year since 1990. The majority of breast complaints are due to benign conditions. Most lumps result from normal fibrocystic breast changes rather than fibrocystic breast abnormalities. Breast pain can be caused by fibrocystic breast syndrome, which is breasts that feel lumpy, thickened, and tender, or from mastitis, which is an infection in the tissue of the breast.
Overview of Breast Disorders
The two most common breast disorders are fibrocystic breast syndrome (FBS) and mastitis. With FBS, the woman experiences lumpy, tender breast tissue around the time of menstruation. Mastitis is a painful condition that involves inflammation and/or infection of the breast tissue.
Fibrocystic Breast Syndrome
At times, the vast majority of adult women have breasts that feel thick, lumpy, and tender, particularly just before their menstrual periods. Medical professionals now refer to this as fibrocystic breast syndrome (FBS) instead of fibrocystic breast disease. Since fibrous breast symptoms are part of a condition, fibrocystic breast disease is actually a misnomer. These breast changes are normal and harmless. They are not breast cancer. However, fibrocystic breast changes can make it more difficult to detect fibrocystic breast abnormalities. This can be of particular concern if there is a genetic predisposition for breast cancer. It is believed fibrocystic breast syndrome is strongly linked to hormonal changes that normally occur during menstrual cycles. Every month, a female's body readies itself for pregnancy by releasing hormones, which trigger the breasts to produce milk. The mammary glands get bigger, making the breasts feel lumpy and tender. Fibrocystic breast symptoms go away once a period begins. A woman is much more likely to have fibrocystic breast syndrome if her mother or sisters do. Most women notice fibrocystic breast changes starting at around 30 years of age, as hormonal levels vary more at this age than previously.
Signs and Symptoms
The signs and symptoms of breast changes that can develop, on one or both sides and under the armpits include:
- Swollen, tender, and painful breasts.
- Generalized breast lumpiness. These thick lump(s) move when pushed.
When a woman notices a new lump, she should wait for one more menstrual cycle to pass before going to her doctor. If it is still there after that, she should go for a breast examination. If she does not get periods, a doctor should be seen right away when a new lump is discovered. Her doctor will send her for a mammogram and perhaps other tests.
Fibrocystic breasts do not generally require treatment. However, remedies for bothersome breast pain include the following:
- Taking an over-the-counter pain medication, such as Tylenol or Advil. If this does not help, a nonsteroidal anti-inflammatory topical cream can be helpful.
- Stronger prescription pain killers are another option but carry more side effects.
- Wearing a good supportive bra.
- Inquiring about low dosage birth control pills. They can reduce premenstrual breast soreness and/or swelling.
- Avoiding caffeine and/or eating a low fat diet can also be beneficial.
Mastitis is an infection of the breast tissues normally caused by common bacteria, known as Staphylococcus aureus. Occurring on normal skin, these microorganisms can enter the fatty breast tissue through a crack or break on the nipple, causing swelling and inflammation. This swelling pushes on the milk ducts resulting in pain and lumps in the affected breast(s).
Most cases of mastitis develop in breastfeeding women. Any breast infection, not related to breastfeeding, may be a rare type of breast cancer. Hence, it should be examined immediately by having a mammogram or possible breast biopsy.
Signs and Symptoms
Signs and symptoms of mastitis include:
- One-sided breast enlargement.
- Breast lump and/or pain.
- Nipple discharge, possibly containing pus.
- Redness, warmth, swelling, and tenderness within the breast.
- Enlarged and tender lymph nodes in the armpit, on the same side.
- Fever and other flu-like symptoms.
In the case of a severe infection, an abscess may develop, which will require drainage by a health care provider.
Treatments for breast infections may include:
- Hot compresses. Applying hot compresses to the affected breast(s) for 15 to 20 minutes four times daily offers some relief of pain and reduce swelling.
- Oral antibiotics. If infection is present, antibiotics are warranted.
- Incision and drainage. In the case of a severe infection, an abscess may develop, which will require incision and drainage by a health care provider.
The following measures can decrease the chances of developing a breast infection:
- Careful care of the nipples. This is done to prevent cracking and irritation.
- Proper breastfeeding techniques. These include frequent feedings, pumping to prevent breast engorgement, and weaning the baby off the breast gradually, rather than stopping abruptly.
- Cleveland Clinic (2013). Breast disorders and cancer screening. Retrieved from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/breast-disorders-and-cancer-screening/
- Medline Plus (2013). Breast infection. Retrieved from:http://www.nlm.nih.gov/medlineplus/ency/article/001490.htm
- WebMD (2013). Fibrocystic breasts. Retrieved from:http://women.webmd.com/tc/fibrocystic-breasts-topic-overview
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