Breast disorders

ANATOMY OR SYSTEM AFFECTED: Breasts, glands, lymphatic system

DEFINITION: A variety of benign breast conditions, including fibrocystic disease and mastitis, which cause discomfort and anxiety and can make self-examination and diagnosis of cancer difficult.

CAUSES: Hormones, bacterial infection, trauma

SYMPTOMS: Swelling and tenderness, lumps or cysts, pain, infection and inflammation, nipple discharge, fibroadenomas

DURATION: Acute to chronic

TREATMENTS: Surgery, antibiotics, hormonal treatment

Causes and Symptoms

Because of fear of and discomfort, noncancerous breast disorders often cause women a great deal of and distress. The most common breast concern of women is the presence of fibrocystic breasts, which can feel nodular and tender. Other, less common breast conditions include mastitis, fat necrosis, nipple discharge, and a variety of benign breast tumors.

Common symptoms of fibrocystic breast condition include a dense and lumpy texture, which is usually more evident in the upper and outer quadrants of the breast. Intermittent or persistent dull pain, tenderness, and of the nipples often occur premenstrually, lessening after begins. This condition is so common, occurring in an estimated 60 percent of women between thirty and fifty years old, that it is considered a variation of normal. The lumpy tissue often causes significant discomfort, and its presence can terrify women checking for cancer during breast self-examination and make the diagnosis of cancer more difficult.

The cause of fibrocystic breasts is unknown, although the associated discomfort fluctuates with the menstrual cycle and rarely occurs after menopause, so ovarian hormones are likely involved. A family history of fibrocystic breasts increases risk, and excessive dietary fat and intake may exacerbate the condition.

After breast lumps and pain, nipple discharge is the third most common breast complaint. Clear, milky, yellow, or green discharge occurring from both nipples does not usually indicate cancer, and a significant percentage of women will experience such discharge at some point while performing a self-examination. Women should see a doctor if the nipple discharge is bloody, watery, sticky, persistent, occurs on one side, or appears spontaneously without squeezing the nipple, although only about 10 percent of such discharges are the result of cancer.

Mastitis is an infection caused when the Staphylococcus aureus found normally on the skin enters the breast and causes swelling in the fatty breast tissue. It is most common in breast-feeding women. The symptoms include pain; lumps; irregular breast enlargement; breast swelling, redness, or warmth; nipple discharge and itching; enlarged lymph nodes; and fever. In rare cases, severe infections may cause abscesses.

Four types of benign tumors commonly occur in the breast. Galactoceles are noncancerous cysts filled with breast milk that occur in pregnant and lactating women. Fibroadenomas are round tumors comprised of connective and glandular breast tissue that develop in young adult women, most commonly African Americans. They occur singly and in clusters, are marblelike, and are diagnosed by needle biopsy. Intraductal papillomas are branching, stalklike growths in the milk ducts near the nipple. They can cause bloody nipple discharge. Duct ectasia, which typically affects women aged forty to sixty, is a hardening of the that can cause a thick, dark green discharge. A lump can develop around the duct and be mistaken for cancer.

Fat necrosis often occurs after the breast has been injured and the injured area is replaced with firm scar tissue or oil-filled cysts.

Treatment and Therapy

The diagnosis of is made by physical examination. Fibrocystic lumps are usually rounded, smooth, and malleable, although they can mimic hard and stationary cancerous lumps. The density of fibrocystic tissue makes physical examinations and less effective, and ultrasound scans and needle biopsies are often necessary to rule out cancer. Although synthetic androgen (male) can be prescribed in severe cases and oral contraceptives can lessen symptoms, reducing dietary fat and caffeine intake are good first steps. Homeopathic treatments such as soy, vitamin E, vitamin B₆, and evening primrose oil are controversial.

For mastitis, application of a hot, moist compress to the infected area can relieve symptoms, and the infection usually responds well to antibiotics. Lactating women should continue to breast-feed or pump while undergoing treatment. For women who are not breast-feeding, should be differentiated from a rare form of breast cancer through mammography or biopsy.

Galactoceles are generally left untreated unless they cause discomfort. They can be drained by fine needle if necessary. Fibroadenomas usually stop growing without treatment, but they need to be surgically removed if they continue to grow. Intraductal papillomas are treated by removing the affected duct. Duct ectasia can be treated with heat compresses, by antibiotics, or, in severe cases, by removal of the duct.

For fat necrosis, fine needle aspiration, often used for diagnosis, usually relieves the symptoms and serves as the primary treatment.

Perspective and Prospects

Like most disorders that primarily affect women and are associated with sex differentiation, noncancerous breast disorders were rarely discussed and were not well understood before the mid-twentieth century. In the nineteenth century, breast disorders were surrounded by myth and social stigma, and mastitis often went untreated for weeks, causing tremendous discomfort. The invention of mammography in the mid-1960s, as well as that decade’s increased sexual openness, made it easier to talk about breast disorders as well as to diagnose them accurately. Fibrocystic breast condition, originally called fibrocystic disease, is now accepted as normal for many women, and testing procedures are beginning to adapt to this norm. Over time, mammography, the collection of data from two generations of women, and the generally increased awareness of women’s health issues have improved the diagnosis and treatment of these disorders.

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