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| Breast Health Breast Lumps Breast lumps are very common and account for more than half the referrals seen at breast clinics. They can occur in women of any age, and most are benign in nature. The most common types of lump are:
When assessing a breast lump, certain clinical features are important. These can help to determine which type of pathology is present. The likelihood of certain conditions depends mainly upon age. Most breast disorders, whether benign or malignant, can occur in women of any age, but certain patterns are well known:
Shape of the Lump
Consistency The texture of a lump can suggest its nature.
Mobility The mobility of a breast lump is an important clinical feature.
Size Size is not quite so reliable as a clinical feature, especially with regard to cancer, because cancer can manifest as a lump of any size.
The one type of pathology that is known to be associated with large size is the Phyllodes Tumour. These lesions, sometimes referred to as "giant fibro adenomas", can reach enormous proportions. However, these days most women will alert their doctor before such a size is reached. It should be noted however, these tumours are very rare. Number
Associated Pain Lumps can be painful (mastalgia). As a general rule it is often said that benign lumps are more likely to be associated with pain than cancers. This is true, especially for fibrocystic lumps. Fibro adenomas and cysts can also be painful. It should also be noted that breast cancer can present as a painful lump and such lumps should never be presumed to be benign until proven otherwise. Breast pain is extremely common and most women, at some stage or another, will experience breast pain as a symptom. Breast pain can be due to a number of problems, but is best understood as cyclical or non- cyclical in terms of its relationship to normal menstruation. Cyclical Breast Pain There is a clear relationship with the menstrual cycle. Obviously therefore, it occurs in women before the menopause at an average age of about 35. Most women experience some discomfort and lumpiness in the breasts in the week leading up to the start of a period. Cyclical breast pain that is "abnormal" is different from this in that it is usually much more severe, lasts longer and often causes a certain degree of impairment - e.g. in terms of marital relations, playing sports etc. Some women are affected so much by these symptoms that their quality of life is impaired. Non-cyclical mastalgia A number of other conditions can give rise to non-cyclical pain in the breast. In these conditions, the pain is present most of the time at varying levels of intensity, but is not related to the menstrual cycle. Such conditions include inflammation of the costochondral junctions (Tietze's syndrome), trauma, "trigger point" mastalgia, fat necrosis as well as fibro adenomas and breast cysts. Nipple Problems Inversion of the nipple (either on one or both sides) can be normal for some women, and in most cases it is not a problem. Occasionally difficulties can be experienced during breast feeding. Inversion When a nipple that was previously normal becomes inverted, there is often an underlying condition. In most cases the cause will be benign such as diseases affecting the 20 or so large ducts immediately under the nipple. Breast cancer can also cause inversion or retraction of the nipple, but there are often other clinical features such as a lump, distortion of the skin, nipple eczema and bleeding. Discharge Nipple discharge is also common. Once again in most cases it is benign.
For this reason, nipple discharge should be investigated, normally by taking a smear of the discharge for microscopic examination as well as investigation of any associated lumps. Inflammation The breast, or one part of it, can become inflamed showing typical signs of redness, heat, swelling and thickening of the tissues including the skin. This can be found in a number of conditions, most of which are benign. They include breast abscesses and periductal mastitis. Breast cancer can occasionally present as an inflammatory mass. For this reason most patients are followed up to ensure that their condition is settling. Family History It is thought that breast cancer in Western countries may be genetic in origin in 10 % of all patients. A number of genes have been identified as being associated with breast cancer including the BRCA1 and BRCA2 genes on chromosomes 17 and 13 respectively. Another important gene in the development of breast cancer is the p53 gene. All of these can be transmitted through either sex during the development of the foetus. It is by no means certain however that a carrier of these will go on to develop breast cancer. The risk of breast cancer is higher in women with a first degree relative (daughter, mother or sister) who developed the disease when young (pre-menopausal, <50). Women who develop breast cancer in older age (e.g. over 70's) do not confer a higher risk. In these patients it is presumed that the cancer arises spontaneously rather than from a genetic abnormality. Conversely, if a woman is in a family that is affected by breast cancer, but has not developed breast cancer herself by the age of 65, it is unlikely that she has the gene. Families in whom breast cancer is common, are also more likely to have other types of cancer such as ovarian cancer. Back to top |
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