Womens Health -Types of Breast Changes

Breast changes occur in almost all women. Most of these changes are not cancer. However, some breast changes may be signs of cancer. Breast changes that are not cancer are called benign.

Lumpiness
Most women have some type of lumpiness in their breasts. Some areas may be more dense than others and can feel lumpy in an exam. What you are feeling may be glandular breast tissue.

Breast Changes Due to Your Period
Many women have swelling, tenderness, and pain in their breasts before and sometimes during their periods. You may also feel one or more lumps during this time because of extra fluid in your breasts.

Because some lumps are caused by normal hormone changes, your health care provider may suggest watching the lump for a month or two to see if it changes or goes away.

Single Lumps
Single lumps can appear at any time and come in various types and sizes. Most lumps are not cancer, but your health care provider should always check the lump carefully. He or she may do more tests to make sure the lump is not cancer.

Check with your health care provider if you notice any kind of lump. Even if you had a lump in the past that turned out to be benign, you can't be sure that a new lump is also benign.

Nipple Discharge
Nipple discharge is common for some women. It is fluid that comes from the nipple in different colors or textures. Usually, it is not a sign of cancer. For example, birth control pills and other medicines, such as sedatives, can cause a little discharge. Certain infections also cause nipple discharge. However, for women who are going through or have passed menopause, nipple discharge can be a sign of cancer.

See your doctor if you have nipple discharge for the first time, or a change in your discharge's color or texture. He or she may send a sample of the discharge to be checked at a lab

Adapted from National Cancer Institute

Finding Breast Changes

There are two ways to find breast changes:
1. Clinical breast exams--a breast exam done by your health care provider
2. Mammograms --an x-ray of your breasts


One way to find breast changes is with a clinical breast exam done by your health care provider. He or she will check your breasts and underarms for any lumps, nipple discharge, or other possible changes. This breast exam should be part of a routine medical check-up.
The best tool for finding breast cancer is a mammogram. A mammogram is a picture of the breast that is made by using low-dose x-rays. It is currently recommended that women over age 40 receive a mammogram every 1 to 2 years.


Some women check their own breasts for changes. If you find a change, it's important to call your health care provider for an appointment. Make sure to watch the change you found until you see your provider. But a breast self-exam and a clinical breast exam are not substitutes for mammograms.


Questions to ask your health care provider about a breast change
How can I tell the difference between my usual lumps and lumps I need to do something about?
How will you be able to tell what kind of breast change I have?
What should we do to watch this change over time?


Mammograms
Mammograms are used for both screening and diagnosis.
A screening mammogram is used to find breast changes in women who have no signs of breast cancer. Most women get two x-rays of each breast.


If your recent screening mammogram revealed a breast change since your last one, or if you or your health care provider noticed a change, he or she will probably recommend a diagnostic mammogram. More x-rays are taken during a diagnostic mammogram than a screening mammogram to get clearer, more detailed pictures of the breast. It is also used to rule out other breast problems.


Tip
Take your original mammogram and copy of the medical report with you if you change doctors or centers or need a second opinion.


A digital mammogram is another way to take a picture of your breasts. The procedure for having a digital mammogram is the same as a screening mammogram, except that it records the x-ray images in computer code instead of on x-ray film. It is important to see your doctor and get a mammogram every 1 to 2 years after age 40 to find breast changes.

Mammograms and Breast Implants


When you go for your mammogram, tell staff if you have a breast implant. A technologist who is trained in x-raying patients with implants will do your mammogram. Breast implants can hide some breast tissue and make it harder to read your mammograms.


If you got implants for cosmetic reasons:
You still need to get screening mammograms, with extra pictures to help get an accurate reading.


If you got an implant after having a mastectomy for breast cancer:
You should continue to get mammograms of your other breast. Ask your doctor if you still need mammograms of the breast with the implant.


Getting Your Mammogram Results



Ask your doctor when you will get your results. You should get a written report of your mammogram results within 30 days of getting the x-ray. This is the law. Be sure the mammogram facility has your current address.
If your results were normal, it means the radiologist did not find anything that needs follow-up.
If your results were abnormal, it means the radiologist found:
A change from a past mammogram
A change that needs more follow-up


What a Mammogram Can Show
The radiologist will look at your x-rays for breast changes that do not look normal. The doctor will look for differences between your breasts. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.

Lumps (or "mass")
The size, shape, and edges of a lump sometimes can give doctors more information about whether or not it is cancer. On a mammogram, a growth that is benign often looks smooth and round with a clear, defined edge. On the other hand, breast cancer often has a jagged outline and an irregular shape.


Calcifications
A calcification is a deposit of the mineral calcium in the breast tissue. Calcifications appear as small white spots on a mammogram. There are two types:


Macrocalcifications are large calcium deposits often caused by aging. These are usually not cancer.



Microcalcifications are tiny specks of calcium that may be found in an area of rapidly dividing cells. If they are found grouped together in a certain way, it may be a sign of cancer.


Depending on how many calcium specks you have, how big they are, and what they look like, your doctor may suggest that you:
Have a different type of mammogram that allows the radiologist to have a closer look at the area
Have another screening mammogram, usually within 6 months
Have a test called a biopsy.




Are Mammogram Results Always Right?
No. Although they are not perfect, mammograms are the best method to find breast changes. If your mammogram shows a breast change, sometimes other tests are needed to better understand it. Even if the doctor sees something on the mammogram, it does not mean it is cancer.


Changes That Need More Follow-Up
Sometimes your doctor needs more information about a change on your mammogram. Your doctor may do follow-up tests such as an ultrasound or more mammograms. The only way to find out if an abnormal result is cancer is to do a biopsy. It is important to know that most abnormal findings are not cancer.

Adapted from National Cancer Institute

Breast Cyst Aspiration

A breast cyst is a fluid-filled sac (like a tiny balloon) inside the breast. Breast cysts are common in women. They can cause a little pain, but they are usually benign (not cancer).

What is breast cyst aspiration?
In breast cyst aspiration, your doctor uses a small needle to drain fluid from a cyst.

When is breast cyst aspiration used?
A breast lump that you can feel might hurt or make you worry about cancer. Breast cyst aspiration can help your doctor find out if the lump you feel is a cyst. Aspiration gives you this information right away, so you don't have to wait for the results of a mammogram or an ultrasound exam.

How is breast cyst aspiration done?
Your doctor might numb your skin first. Then, your doctor will insert a small needle into the breast lump. Using a syringe, your doctor will try to drain fluid from the lump.
If the lump is a cyst that contains watery fluid, and the cyst goes away after it is drained, you will not need other tests.

If the lump contains bloody fluid, your doctor will send the fluid to a lab to find out what it is. If the lump is solid, your doctor may need to remove a tiny bit of the lump and send it to a lab to be examined. At the lab, the fluid or sample from the lump can be examined under a microscope to look for cancer cells.

What are the benefits of breast cyst aspiration?
Your doctor may be able to diagnose your breast lump on the same day that you get the aspiration. If the lump is clearly a cyst, you will know right away, and you might not need to get other tests.

What are the risks of breast cyst aspiration?
Before you have breast cyst aspiration, your doctor will talk to you about possible problems. You might have some discomfort where the needle goes in. You might have a little bruise on your breast. You might get an infection where the needle goes in.

Do I need to see my doctor again after I have breast cyst aspiration?
Yes. If the lump in your breast is a cyst and the cyst is drained successfully, your doctor will want to check the area in 4 to 6 weeks to make sure that the cyst has not filled up with fluid again. This follow-up visit is important. A cyst that refills with fluid can be a problem. If you have a cyst that refills at any time, call your doctor.

Adapted from American Academy of Family Physicians

Galactorrhea

Sometimes a woman's breast makes milk even though she is not breast feeding a baby. This is called galactorrhea (say: "gal-act-tor-ee-ah"). The milk may come from one or both breasts. It may leak with no stimulation or it may leak only when the breasts are touched.
Men can have galactorrhea, too, but it is less common.

Causes
Galactorrhea has many causes. Here are some of them:
Medicines such as hormones, antidepressants, blood pressure medicines and others
Herbs such as nettle, fennel, blessed thistle, anise and fenugreek seed
Street drugs such as marijuana and opiates
Hormone imbalance
Tumors (usually benign), especially tumors of the pituitary (say: "pit-too-it-terry") gland, which is in the brain.
Pregnancy
Clothing that irritates the breasts (like scratchy wool shirts or bras that don't fit well)
Doing very frequent breast self-exams (daily exams)
Stimulation of the breast during sexual activity

Sometimes the cause can't be found.
Galactorrhea produces a white fluid. If the fluid coming from your breast is reddish, your doctor will check you for cancer.

Signs
Tell your doctor if you have any of these signs:
No menstrual periods or periods that are not regular
Headaches or trouble seeing
Less interest in having sex
Increase in hair growth on your chin or chest
Acne

Test
Your doctor might order blood tests to check your hormone levels and to see if you are pregnant. Or, your doctor might want you to have an MRI (magnetic resonance imaging) scan of your head to see if you have a tumor.

Tests are not always needed if you and your doctor can figure out what caused your galactorrhea.

Treatment
Most tumors that cause galactorrhea are not cancer. They can be treated with medicine or surgery.

In many cases, there is no treatment, and the breast milk goes away with time. Until it goes away, here are some things you can do to help:

Avoid stimulating your breasts.
Avoid touching your nipples during sexual activity.
Don't do breast self-exams more than one time a month

Adapted from American Academy of Family Physicians

Mastitis

Mastitis means inflammation (injury from infection or irritation) of the breast tissue. Mastitis may occur in up to a third of women who are lactating (forming breast milk) after giving birth and is then called lactation mastitis. When lactation mastitis is due to an infection, it is usually caused by bacteria, although fungal (yeast) infections can also be the cause. Most cases of lactation mastitis occur during the first 3 months postpartum (after giving birth), but it may occur any time as long as a woman is breastfeeding. When mastitis is severe, an abscess (collection of pus from an infection) may develop in the breast. The April 2, 2003, issue of JAMA includes an article about lactation mastitis.

SYMPTOMS
Malaise (feeling tired and unwell)
Fever
Reddened area of the breast, usually wedge-shaped
Warmth or tenderness of the breast
Pain with nursing (can also be caused by sore or cracked nipples without mastitis)

POSSIBLE RISK FACTORS

Mastitis after a previous pregnancy
Nipple cracks or sores
Using only one position to breastfeed so the entire breast does not empty
Tight-fitting bra that obstructs milk flow

TREATMENT
Continue nursing and use different feeding positions
Complete, frequent emptying of the affected breast
Warm compresses or warm shower
Increase fluid intake
Bed rest
Pain medication
Antibiotics if prescribed by your doctor
Drainage of any abscess that may form

If you think you have mastitis, see your doctor. In most cases, mastitis is easily treated. Continuing to breastfeed while you have mastitis will not hurt your baby.

Mastitis can occur in older women who are not lactating. This form of mastitis is called periductal mastitis. The milk ducts near the nipple become inflamed, causing breast pain. There may also be a breast mass near the nipple, retraction of the nipple, or discharge. Because breast cancer can also cause these symptoms, it is important to see your doctor if you have any of them. Treatment of periductal mastitis may include antibiotics or surgery if the periductal mastitis is severe.

There is a form of breast cancer called inflammatory breast cancer that can be confused with mastitis. Because inflammatory breast cancer is fast-growing, aggressive, and deadly, it is important to detect it early. Fever usually occurs with mastitis but rarely occurs with inflammatory breast cancer.

Adapted from Journal of the American Medican Association

Mammary duct ectasia

Your breasts are made up of connective tissues that include a system of milk ducts — tiny passages that carry milk to the nipples. Mammary duct ectasia occurs when a milk duct beneath the nipple becomes dilated and filled with fluid. The milk duct can then become blocked or clogged with a thick, sticky substance. Though it's normal to worry about any changes in your breasts, mammary duct ectasia is not a sign of or a risk factor for breast cancer. However, it's always best to see your doctor if you aren't sure what's causing your symptoms.

Mammary duct ectasia occurs most often in women in their 40s and 50s and affects as many as one in four women during or after menopause. It often causes no symptoms, but some women may have nipple discharge and breast tenderness.

Mammary duct ectasia usually improves without treatment. However, if symptoms persist despite self-care measures, you may need surgery to remove the affected milk duct.

Signs and symptoms
Mammary duct ectasia is one of the most common causes of abnormal nipple discharge. Although it often doesn't cause signs and symptoms, some women may experience:

A dirty white, greenish or black nipple discharge
Tenderness in the nipple or surrounding breast tissue
Redness
A lump or thickening
An inverted nipple

A bacterial infection such as mastitis also may develop in the affected milk duct and cause inflammation and fever. Signs and symptoms of mammary duct ectasia usually improve on their own.

Causes
Mammary duct ectasia occurs when a milk duct beneath the nipple becomes dilated and inflamed. Possible causes include:

Hormonal changes. Changes in your hormone levels may cause mammary duct ectasia. Hormonal changes are normal and often cause different kinds of breast changes, especially as you age.
Smoking. Studies show that nicotine may have a toxic effect on your milk ducts, causing them to become dilated and inflamed.
Inverted nipple. Repeat occurrences of inverted nipple can lead to mammary duct ectasia. A newly inverted nipple also may obstruct milk ducts, causing inflammation and infection. A nipple that's newly inverted also could be a sign of a more serious underlying condition, such as cancer.
Lack of vitamin A. A lack of vitamin A may cause abnormal changes in your breasts, such as mammary duct ectasia.

Risk factors
Factors that may increase your risk of mammary duct ectasia include:

Smoking. Women who smoke have an increased risk of mammary duct ectasia. The use of nicotine has been shown to cause abnormal changes in the milk ducts of the breast. The longer you've smoked, the higher your risk of mammary duct ectasia.
Number of pregnancies. The more pregnancies you've had, the higher your risk of mammary duct ectasia.
Infection. If you have a history of breast infection (mastitis), your risk of mammary duct ectasia may be increased.
Mammary duct ectasia does not affect your risk of breast cancer.

Complications
Complications of mammary duct ectasia are usually minor and often more bothersome than serious. These may include:

Nipple discharge. Nipple discharge caused by mammary duct ectasia can be frustrating. Fluid leaking from your nipples can cause embarrassing wetness and staining on your clothes.
Breast discomfort. Mammary duct ectasia can cause the tissue around your nipples to be red, swollen and tender.
Infection. A bacterial infection such as mastitis may develop in the affected milk duct, sometimes causing you to feel ill and have a fever.
Concern about breast cancer. You may worry about any changes in your breasts being a sign of breast cancer. Although mammary duct ectasia can sometimes cause scar tissue to form around the affected milk duct that feels like a hard lump, it's rarely linked to

Treatment
Mammary duct ectasia often improves without treatment. If your symptoms are bothersome, however, treatment options may include:

Antibiotics. Your doctor may prescribe a 10- to 14-day course of antibiotics to treat any infection caused by mammary duct ectasia. Even if your symptoms greatly improve or disappear altogether, it's important to take the entire course of medication. While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) as needed for breast discomfort.

Surgery. If antibiotics and self-care methods don't work, the affected milk duct may be surgically removed. This procedure is done through a tiny incision at the edge of the colored tissue around your nipple (areola). However, surgery rarely is needed for mammary

Self-care
Certain self-care remedies can help to reduce discomfort and alleviate signs and symptoms associated with mammary duct ectasia. Take these steps:
Apply warm compresses. A warm compress applied to your nipple area can reduce the pain and swelling often caused by mammary duct ectasia.
Wear a bra pad. If you have nipple discharge, wear a bra or nursing pad to keep the fluid from leaking through your clothing. These pads are available at local pharmacies and retail stores.
Wear a support bra. Wear a bra with good support to keep your breasts more secure and help reduce breast discomfort. Also, a support bra can help keep bra pads in place if you have nipple discharge.
Sleep on the opposite side. Try not to sleep on the side of your affected breast. This helps to prevent further discomfort and to keep any swelling down.

Adapted from Mayo Foundation for Medical Education and Research

Breast Pain in Women

Breast pain is a common problem in younger women who are still having periods (menstrual cycles). It is less common in older women. The pain can be in one breast or in both. It may come and go each month, or it may last for several weeks, or even months.

Causes
Many things can cause pain or tenderness in your breasts. Here are some of them:

Hormone changes during your period
Water retention, which may happen during your period
Injury to your breast
Pregnancy
Breast-feeding (nursing)
An infection in the breast
Breast cancer (not a usual cause of breast pain)

If you have breast pain that lasts for a long time or keeps coming back, it's probably a good idea to talk to your doctor about it.

How can my doctor find the cause of my breast pain?
Your doctor will ask you questions to find the cause of your pain and decide if you need treatment. He or she may ask you to describe the pain and where in your breast area you feel it. Your doctor will also check to see if you have lumps in your breasts.
If you're younger than 35 years of age and don't have a breast lump, your doctor might decide that you don't need any tests. If you're older than 35 years of age and don't have a breast lump, your doctor may still want you to get a mammogram. A mammogram is a special x-ray of the breasts.

If you do have a lump (or several lumps) in your breast, your doctor might decide that you need one or more of these tests:

A mammogram
A breast sonogram. This painless test uses sound waves to make a picture of the lump.
A breast biopsy. For this test, some tissue is taken out of your breast and looked at under a microscope.

How is breast pain treated?
There are different treatments for breast pain depending on what is causing it. You and your doctor can talk about these treatments and choose one or more that might work for you. Here are some possible treatments for breast pain:

Wearing a support bra
Taking an over-the-counter pain medicine
Taking danazol (brand name: Danocrine) -- for severe pain

Other treatments for breast pain are sometimes used. However, there is no proof that these treatments work:

Avoiding caffeine
Using less salt
Taking vitamin E or vitamin B6
Taking a "water-pill" (a diuretic)

Most of the time, breast pain goes away on its own after a few months

Adapted from American Academy of Family Physicians