Breast Cancer Awareness Month – What you need to know about your breast

The development of these parts of the breast begins at puberty and is dependent on hormones such as estrogen and progesterone. Women may have many changes in their breasts at any point in their life. Some are dependent on their menstrual cycle. Others are linked to birth control pills, hormone replacement therapy, family history, or lifestyle changes. Most breast conditions are not cancer. They arise from an abnormality in the normal development and ageing of breast tissue.

October is breast cancer awareness month. In a spirit of raising-awareness, we’re giving you a two-part series on breast changes in – Premenopausal women and Post-menopausal women

Part 1 – Premenopausal women
Breast pain
The most common complaint amongst younger women is pain linked to the menstrual cycle. This is called “Cyclical mastalgia”. It is almost always due to our hormones (estrogen and progesterone). As the pain does not always affect both the breasts, there might be other causes of pain in a single breast. This type of pain might begin at ovulation and last all through the menstrual cycle. Pain that involves both the breasts and is cyclical is generally not harmful. When the breast pain does not correlate with her menstrual cycle, it is called “Non-cyclical breast pain”. It is advisable to chart the breast pain to understand the link better. The pain might be minimal too so severe that you can’t wear tight clothes or move around freely.

They can be soft or hard. They may be felt by the hand or seen on imaging with a mammogram. They are generally observed or aspirated with a small needle.

Tumors (Benign)

Fibroadenomas (FA) are benign lumps that occur commonly in younger women, especially teens. They however can occur at any age group. They are mobile and slip when being felt. Women generally feel them when examining their breasts. If they are small and not growing, they maybe observed. However, if they are increasing in size or are symptomatic, simple removal is suggested. They very rarely turn cancerous (Complex fibroadenomas) Phyllodes tumors are generally seen in the third and fourth decades of life and are prone to growing rapidly, changing the shape of the breast. The treatment is relatively complicated compared to a FA. Based on the nature of the tumor, radiotherapy might be required in certain cases and recurrences are common unless they are removed completely.

When you experience such pain, wear a good bra with adequate support. Maintaining a healthy lifestyle but limiting alcohol, caffeine and increasing greens in your diet are helpful. Pain killers such as Paracetamol may be taken in recommended doses if the pain is severe. Vitamin E capsules and massaging breasts with EPO (Evening primrose oil) have shown some benefit in patients.

Fibrocystic breast changes

These changes are what you feel in your breast prior to your menstrual cycle, commonly in the third and fourth decades of life. Breasts may feel heavy, sore, or lumpy. These changes occur due to an overdrive of estrogen and a deficiency of progesterone. Although these are not cancerous, having certain pathologically proven lesions of the breast which fall under the “fibrocystic” category increases the risk of cancer three-fold.

Infections
Infections are common in breastfeeding mothers, smokers, and women with systemic illnesses. They may present with lumps, nipple discharge, pain, or fever. It is very important to identify and treat these symptoms which may range from simple medical management to surgical treatment.

Cysts

Women who develop a cyst complain of a sudden development of a lump in the breast overnight. Cysts are fluid-filled structures in the breast that occur due to a blocked duct or hormonal changes. They are most commonly benign. However, certain cysts may have a small component of a cancerous or precancerous lesion. They are generally seen in the third or the fourth decades of life.

Breast Cancer
Currently, in India, the rates of cancer have increased in women between the ages of 25-40. The reasons for this might be lifestyle changes, similar to the West. If women under the age of 35 develop cancers, they tend to have a strong family history of ovarian or breast cancers. It is important to get counselled with a professional genetic counsellor.

Remember that ‘Breast Self-Examination” is the most important technique of identifying early breast diseases. It has to be done every month. Make sure you reach out to a doctor if you find any abnormality in your breasts.

Part 2 – Post-Menopausal Women
Breast symptoms in the post-menopausal period are similar to those in the premenopausal period, especially for women on hormone replacement therapy. Although, cancers are relatively more common in this group, they can be diagnosed with benign diseases or pre-cancerous conditions. Clinical examination and imaging are usually easily interpreted due to the density of the breasts in older women (fatty >glandular tissue). The common conditions in post-menopausal women are-

Breast Pain

Non-cyclical breast pain (mastalgia) is not linked to menstruation and does not follow a definitive pattern. It can be either constant or intermittent, affecting one or both breasts. Either a part of the breast or the whole breast maybe involved. It can be referred pain from the chest wall, oesophagus, neck or upper back. Conditions such as infection, trauma, injury, certain medications, size of the breast, cancer or inflammatory conditions such as costochondritis or arthritis may be the causative factors. Some researchers suggest a deficiency of fatty acids with in the cells to cause breast pain.

Management would include identifying the condition and treating the cause. A short course of anti-inflammatory drugs (NSAID’s) should suffice for pain due to inflammatory conditions. Lifestyle approaches like wearing a well fitted bra, a sports bra for exercise usually help. Other treatments include medication, EPO, ice packs, warm compresses or a massage. Avoiding caffeine and nicotine have showed symptomatic relief in a few women.

Nipple Discharge
This can be due physiological or pathological. Causes for nipple discharge in this age group are duct ectasia, papillomas, pre-cancerous or cancerous lesions. It could be clear/green/yellow/brownish in colour. Duct ectasia can be due to age related changes or blocked ducts, which may in-turn to an inverted nipple, nipple discharge when swollen. This may lead to a condition called periductal mastitis which is painful and the breast might turn red. It is commonly seen in smokers. There is no increased risk of cancer.

Fibrocystic Disease
Although this is common in pre-menopausal women, it can occur in post-menopausal women as well, especially in those who are on hormone replacement therapy (HRT). This is because of the constant source of Oestrogen, which affects the breast. They are not cancerous but certain types of pathologically proven lesions might have a malignant potential.

If you develop a lump suddenly overnight, it might be a cyst. Image confirmation and a simple needle aspiration might suffice.

Breast Cancer
A lump in the post-menopausal woman needs to be evaluated as they are generally more prone to a cancer. It should however be noted that all lumps are not cancerous. Symptoms such as breast lumps with or without pain, nipple inversion, nipple discharge, skin thickening, redness, dimpling, swelling in the arm pit, change in the shape or size of breast should be evaluated. If diagnosed with breast cancer, you will require a multi-modality approach of management including surgery, radiation, chemotherapy, hormone therapy, targeted therapy, rehabilitation, nutrition and counselors.

Occasionally, cases might be screen detected. Hence, annual clinical examination and mammograms are suggested. Obesity and hormone replacement therapy in this age group increase the risk of breast cancer.

Remember that ‘Breast Self-Examination’ is the most important technique of identifying early breast diseases. It has to be done every month. Make sure you reach out to a doctor if you find any abnormality in your breasts.