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Overview of Breast Disorders

By

Mary Ann Kosir

, MD, Wayne State University School of Medicine

Last full review/revision Oct 2019| Content last modified Oct 2019
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NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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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

Inside the Breast

The female breast is composed of milk-producing glands (lobules) surrounded by fatty tissue and some connective tissue. Milk secreted by the glands flows through ducts to the nipple. Around the nipple is an area of pigmented skin called the areola.

Inside the Breast

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:

  • A lump that feels distinctly different from other breast tissue

  • A lump that is stuck to the skin or chest wall

  • A lump that does not go away

  • Swelling that does not go away

  • Pitting, puckering, reddening, thickening, or dimpling in the skin of the breast

  • Scaly skin around the nipple

  • Changes in the shape of the breast

  • Changes in the nipple, such as being pulled inward

  • 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)

Table
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Common Breast Symptoms

Symptom

Causes

Comments

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.

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.

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)

A nipple discharge occurs normally sometimes—for example, during milk production after childbirth.

Abnormal discharges vary in appearance depending on the cause.

* Breast infections are very rare except during the first few weeks after childbirth.

Evaluation

Doctors ask the woman about the symptoms she is having and other information related to possible causes, including

  • What the symptoms are

  • How long the woman has had the symptoms

  • Whether the symptoms occur at certain times of the month (related to the menstrual cycle)

  • Whether she is pregnant

  • What drugs she is taking

  • Whether she or a family member has had breast cancer

  • 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

1. While standing in front of a mirror, look at the breasts. The breasts normally differ slightly in size. Look for changes in the size difference between the breasts and changes in the nipple, such as turning inward (an inverted nipple) or a discharge. Look for puckering or dimpling.

How to Do a Breast Self-Examination

2. Watching closely in the mirror, clasp the hands behind the head and press them against the head. This position helps make subtle changes caused by cancer more noticeable. Look for changes in the shape and contour of the breasts, especially in the lower part of the breasts.

How to Do a Breast Self-Examination

3. Place the hands firmly on the hips and bend slightly toward the mirror, pressing the shoulders and elbows forward. Again, look for changes in shape and contour.

How to Do a Breast Self-Examination

Many women do the next part of the examination in the shower because the hand moves easily over wet, slippery skin.

How to Do a Breast Self-Examination

4. Raise the left arm. Using three or four fingers of the right hand, probe the left breast thoroughly with the flat part of the fingers. Moving the fingers in small circles around the breast, begin at the nipple and gradually move outward. Press gently but firmly, feeling for any unusual lump or mass under the skin. Be sure to check the whole breast. Also, carefully probe the armpit and the area between the breast and armpit for lumps.

How to Do a Breast Self-Examination

5. Squeeze the left nipple gently and look for a discharge. (See a doctor if a discharge appears at any time of the month, regardless of whether it happens during breast self-examination.)

Repeat steps 4 and 5 for the right breast, raising the right arm and using the left hand.

6. Lie flat on the back with a pillow or folded towel under the left shoulder and with the left arm overhead. This position flattens the breast and makes it easier to examine. Examine the breast as in steps 4 and 5. Repeat for the right breast.

How to Do a Breast Self-Examination

Women who choose to examine their breasts should do so at the same time each month. For menstruating women, 2 or 3 days after their period ends is a good time because the breasts are less likely to be tender and swollen. Postmenopausal women may choose any day of the month that is easy to remember, such as the first.

Adapted from a publication of the National Cancer Institute.

Testing

Imaging tests are used to

  • Check for breast abnormalities before they are noticed (called breast cancer screening)

  • 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

  • When it should start

  • How often it should be done

  • When (or if) it should be stopped

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:

  • Provide images of any abnormalities (such as a tumor or an abscess) and the tissues around the abnormality

  • Provide images of lymph nodes to check for abnormalities

  • Help doctors place a biopsy needle into abnormal tissue

  • After surgery, help doctors determine whether all the cancer was removed

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:

  • Help diagnose breast abnormalities

  • Provide more information about abnormalities detected by mammography—for example, ultrasonography can show whether lumps are solid or filled with fluid (fluid-filled lumps—called cysts—are rarely cancerous)

  • Help doctors place a biopsy needle into abnormal tissue

  • Identify abnormal lymph nodes that may require biopsy

Magnetic resonance imaging (MRI) can be used to do the following:

  • 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)

  • After breast cancer is diagnosed, determine the size and number of the tumors

  • 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.

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