Breast disorders may be noncancerous (benign) or cancerous (malignant). Most are noncancerous and not life threatening. Often, they do not require treatment. In contrast, breast cancer can mean loss of a breast or of life. Thus, for many women, breast cancer is their worst fear. However, potential problems can often be detected early when women regularly examine their breasts themselves, are examined regularly by their doctor, and have mammograms as recommended. Early detection of breast cancer can be essential to successful treatment.
Symptoms
Symptoms related to the breast are common. They are the reason for more than 15 million visits to the doctor each year. These symptoms include
Breast symptoms do not necessarily mean that a woman has breast cancer or another serious disorder. For example, monthly breast tenderness that is related to hormonal changes before a menstrual period does not indicate a serious disorder.
However, women should see their doctor if they observe any change in a breast, particularly any of the following:
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A lump or thickened area that feels distinctly different from other breast tissue
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A lump that is stuck to the skin or chest wall
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A lump that does not go away
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Swelling that does not go away
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Pitting, puckering, reddening, thickening, or dimpling in the skin of the breast
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Scaly skin around the nipple
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Changes in the shape of the breast
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Changes in the nipple, such as being pulled inward
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Discharge from the nipple, especially if it is bloody and/or occurs spontaneously (that is, without the nipple's being squeezed or stimulated by other means)
Common Breast Symptoms
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Symptom |
Causes |
Comments |
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Hormonal changes related to menstrual periods, pregnancy, or use of hormonal drugs Large breasts that stretch supporting tissues Very rarely, breast cancer |
Pain that occurs throughout both breasts is usually caused by hormonal changes related to menstrual periods. |
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Breast infections, including abscesses* Cysts Fibrocystic changes Galactocele (a clogged milk duct) Scar tissue that develops after an injury Breast cancer |
Lumps in the breasts are relatively common and are usually not cancerous. Because cancerous and noncancerous lumps are hard to distinguish during a physical examination, tests are usually done. |
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Most commonly, noncancerous milk duct tumors (intraductal papilloma) Breast cancer Breast infections, including abscesses* Fibrocystic changes Other disorders, such as pituitary, brain, or thyroid disorders) Certain drugs (see table Some Causes and Features of Nipple Discharge) |
A nipple discharge occurs normally sometimes—for example, during milk production after childbirth. Abnormal discharges vary in appearance depending on the cause. |
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* Breast infections are very rare except during the first few weeks after childbirth. |
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Evaluation
Doctors ask the woman about the symptoms she is having and other information related to possible causes, including
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What the symptoms are
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How long the woman has had the symptoms
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Whether the symptoms occur at certain times of the month (related to the menstrual cycle)
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Whether she is pregnant
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What drugs she is taking
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Whether she or a family member has had breast cancer
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When she had her last mammogram and what the results were
Breast examination
A breast examination is done. With the woman sitting or lying down, the doctor inspects the breasts for irregularities in shape, a nipple that turns inward (inverted nipple), and lumps. The doctor also checks for dimpling, thickening, redness, or tightening of the skin over the breast. The nipples are squeezed to check for a discharge. The armpits are checked for enlarged lymph nodes.
The doctor may examine the breast and armpits with the woman in different positions. For example, while sitting, she may be asked to press her palms together in front of the forehead. This position makes the chest muscles contract and makes subtle changes in the breast more noticeable.
The doctor may review the technique for breast self-examination with the woman during the examination. Techniques for the doctor's examination and self-examination are similar.
How to Do a Breast Self-Examination
Testing
Imaging tests are used to
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Check for breast abnormalities before they are noticed (called breast cancer screening)
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Evaluate abnormalities that have been identified, such as a breast lump found during the doctor's examination
Mammography involves taking x-rays of both breasts to check for abnormalities. A low dose of radiation is used. Only about 10 to 15% of abnormalities detected by mammography result from cancer. Mammography is more accurate in older women because as women age, the amount of fatty tissue increases, and abnormal tissue is easier to distinguish from fatty tissue than other kinds of breast tissue.
Experts agree that all women should be screened for breast cancer. However, experts disagree about
Screening mammography is usually recommended for all women starting at age 50, but some experts recommend starting at age 40 or 45 (see sidebar Breast Cancer: When to Start Screening?). Mammography is then done every 1 or 2 years. Experts have different recommendations about when to start routine mammography because the benefit of screening is not as clear in women aged 40 to 49. Routine mammography may be stopped at age 75, depending on the woman's life expectancy and her wish for continued screening.
Mammography can be used to do the following:
Mammography may also be done if a woman or doctor finds a lump while examining the breasts or if a woman has breast pain or a discharge from the nipple.
Ultrasonography can be used to do the following:
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Provide the first image of abnormalities that were detected during a breast examination in women under 30
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Provide more information about abnormalities detected by magnetic resonance imaging or mammography—for example, ultrasonography can show whether lumps are solid or filled with fluid (fluid-filled lumps—called cysts—are rarely cancerous)
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Help doctors place a biopsy needle into abnormal tissue
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Identify abnormal lymph nodes that may require biopsy
Magnetic resonance imaging (MRI) can be used to do the following:
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Diagnose abnormalities in the breast, especially in women with dense breast tissue or a gene mutation that increases the risk of breast cancer (a BRCA gene)
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After breast cancer is diagnosed, determine the size and number of the tumors, especially in women with dense breast tissue
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Identify abnormal lymph nodes and thus help stage breast cancer
This information can help doctors plan surgery or other treatments for breast cancer.
MRI is done at the same time as mammography to screen women if they have an increased risk of developing breast cancer—for example, if they have a mutation in the gene for breast cancer.
