Breast Disease

There are few things that are more fearful and panic provoking than finding a lump or a change in your breast. Your immediate thought will probably be of cancer. Everyone reacts differently when this happens to her. Some will call their doctor at once, others might be afraid of confirming their fears and delay making an appointment.

It is only normal for you to feel upset and fearful if you find a lump in your breast. But fear will not make the lump disappear. The earlier you find a lump in its development and the smaller it is, the greater the chance it is curable if it is cancer. Not all breast lumps are malignant. Only a doctor can accurately diagnose if a breast lump is benign (not cancerous) or malignant (cancerous). Do not try to diagnose it yourself.

Benign Breast Lumps

Breasts are made up of ducts, lobes, fibrous tissue, and underlying bone; therefore, they can feel lumpy or uneven. Before your menstrual period begins, and sometimes during your period, you can have some tenderness, pain, or lumps in your breasts. This could be due to the extra fluid that collects in the breast tissue (cyst) as well as changes in the body's hormonal levels. This is normal. But if the lumps do not disappear before your next period, contact your doctor as soon as possible.

Any noticeable change, thickening or localized swelling in your breast that was not there before may be a lump. Eighty-five per cent of all breast lumps found are benign. Some common benign breast problems that appear as lumps are

  • Cystic Disease (fibrocystic breast disease) is the most common cause of breast lumps in women. These lumps or cysts are fluid-filled sacs that enlarge and become tender and painful before the menstrual cycle. This condition is responsible for at least half of all breast biopsies performed. It tends to involve both breasts. These lumps are movable, and if large may feel round and firm. Cystic disease usually disappears after menopause.
  • Lipomas develop as single, painless lumps. They can vary in size. Lipomas consist of fatty tissue and are commonly found elsewhere in the body.
  • Fibroadenomas, single solid tumors, appear most often in young women. They occur twice as often in African American women as in others. These breast lumps are firm, rubbery, movable, often oval-shaped, and usually painless.
  • Papillomas are small, wart-like growths in the lining of a mammary duct near the nipple. These can produce a bloody discharge of the nipple.
  • Injury to the breast, or trauma, may result in blood accumulation (hematoma) or destruction of fatty tissue (fat necrosis). Both conditions can appear as lumps. Sometimes the skin around these areas appears red or bruised. No evidence exists that traumas can cause breast cancer.

There are other, not as common benign breast lumps caused by a variety of breast problems such as sclerosing adenosis, etc.

Nipple Discharge

Many women will have during their lifetime a nipple discharge. It can be either in one breast or both. Most nipple discharge are not serious. A clear nipple discharge is considered normal and most of the time will not require further work-up. If it persists or increases, your physician will probably want to investigate the matter further. A bloody nipple discharge is different. Although most women with a bloody nipple discharge will be found to have a benign tumor inside one of the milk duct (intraductal papilloma), it has to be proven. A bloody nipple discharge can occasionally be the symptom of a breast maligancy and should be thouroughly investigated. Some surgeons will first order a Galactrography which is an Xray of the ductal system of the breast. This may help clarify the cause of the discharge. Most of the time a breast biopsy is warranted to obtain the diagnosis.

Malignant Breast Lumps

Malignant lumps develop most often from mammary ducts or lobules. Unlike benign lumps, malignant lumps continue to grow in an uncontrolled manner and in time, if left untreated, will spread beyond the breast.

The basic structure of the breast is composed of

  • lobules, which when appropriately stimulated will produce and secrete milk,
  • ducts, which carry the milk from the lobules to a network of ducts and then eventually to the nipple, and
  • supporting tissue : Breast cancer can arise from each of these structures. The most common site is the ducts, and secondarily is the lobules. The terminology of ductal carcinoma and lobular carcinoma is derived from the location of their origin.

When breast cancer begins within the ducts of the breast, this is referred to as intraductal carcinoma in situ (DCIS), and it is considered to be the earliest, detectable stage of breast cancer. The most common progression of DCIS is that it may, and in most cases, will become an invasive carcinoma. It will go beyond the duct into the breast tissue. Once this has spread through the breast, it will spread to the lymph nodes. From the lymph nodes it may spread to other parts of the body, such as the bones, lungs, liver or brain.

If the breast cancer originates in the lobules of the breast it is called lobular carcinoma in situ (LCIS). The evolution of this cancer is similar to DCIS, but it has specific characteristics. These characteristics are

  • It is not as aggressive as DCIS, and
  • It is viewed as a marker for breast cancer. This means that in patients found with LCIS they are at increased risks of developing cancer in both breasts.

There are other forms of breast carcinoma that are not discussed at this setting because of their rare occurrence.

Early breast cancer can be a nonpalpable lesion or a very small tumor located within the breast. A breast cancer most likely has been growing for several years before it is large enough to be felt. Women who examine their breasts each month, go to their doctor for routine breast examinations, and after age thirty-five have a baseline (your first) mammogram, are more likely to detect an early breast cancer.

Advanced breast cancer is a tumor that has spread beyond the breast to the lymph nodes or to another part of the body. Cancer cells break off from the primary tumor and are carried in the lymphatic system and/or the bloodstream to a distant part of the body where they will grow into a new tumor or metastasis.