mastopathy

Breast diseases include various conditions and changes in your breast. Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges of fluids that are not breast milk.

Although many women fear cancer, most breast changes are benign, meaning they are not cancer. These breast changes are known as benign breast disease. See your health care provider if you have a breast lump, pain, discharge, or skin irritation. Minor and serious breast problems often have similar symptoms and may need treatment.

Common breast changes and conditions can include:

• Fibrocystic breast changes can include lumpiness, thickening, and swelling, often just before your period. Your breasts may feel painful, swollen, or tender.
• Cysts are fluid-filled lumps that may be tender.
• Fibroadenomas are solid, round, rubbery lumps that easily move when pushed, occurring most in younger women.
• Intraductal papillomas are wart-like benign tumors that grow in the milk duct of the breast.
• Blocked milk ducts.
• Milk production when you're not breastfeeding.

Symptoms depend on the type of breast disease. Benign breast diseases may not have any symptoms, or they could include:

• A lump or firm feeling in your breast or under your arm
• A change in the size or shape of your breast
• Nipple discharge
• Skin changes such as itching, redness or darkening, dimples, scaling, or puckering on your breast or nipple
• Painful, swollen, or tender breasts

See your provider if you're noticing any of these symptoms or other unusual changes. Some symptoms may be warning signs or symptoms of breast cancer.

Some breast changes may be felt or seen. You may notice a change in your breast, or your provider may notice it during a clinical breast exam. Other breast changes may only be found during a screening mammogram or other imaging tests such as an MRI or ultrasound. Your provider may also recommend a breast biopsy to check a suspicious change in your breast.

Some benign breast changes may increase your risk of breast cancer in the future and may need treatment now. Treatment depends on the type of breast disease that you have. Some breast changes may go away without treatment, while others may require monitoring, biopsy, or surgery.

NIH: National Cancer Institute

Breast cancer is a cancer that starts in breast tissue. It happens when cells in the breast change and grow out of control. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor.

Sometimes the cancer does not spread any further. This is called "in situ." If the cancer spreads outside the breast, the cancer is called "invasive." It may just spread to nearby tissues and lymph nodes. Or the cancer may metastasize (spread to other parts of the body) through the lymph system or the blood.

Breast cancer is the second most common type of cancer in women in the United States. Rarely, it can also affect men.

There are different types of breast cancer. The types are based on which breast cells turn into cancer. The types include:

• Ductal carcinoma, which begins in the cells of the ducts. This is the most common type.
• Lobular carcinoma, which begins in the lobules. It is more often found in both breasts than other types of breast cancer.
• Inflammatory breast cancer, in which cancer cells block lymph vessels in the skin of the breast. The breast becomes warm, red, and swollen. This is a rare type.
• Paget's disease of the breast, which is a cancer involving the skin of the nipple. It usually also affects the darker skin around the nipple. It is also rare.

Breast cancer happens when there are changes in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.

But sometimes these genetic changes are inherited, meaning that you are born with them. Breast cancer that is caused by inherited genetic changes is called hereditary breast cancer.

There are also certain genetic changes that can raise your risk of breast cancer, including changes in the BRCA1 and BRCA2 genes. These two changes also raise your risk of ovarian and other cancers.

Besides genetics, your lifestyle and the environment can affect your risk of breast cancer.

The factors that raise your risk of breast cancer include:

• Older age
• History of breast cancer or benign (noncancer) breast disease
• Inherited risk of breast cancer, including having BRCA1 and BRCA2 gene changes
• Dense breast tissue
• A reproductive history that leads to more exposure to the estrogen hormone, including:
  • Menstruating at an early age
  • Being at an older age when you first gave birth or never having given birth
  • Starting menopause at a later age
• Taking hormone therapy for symptoms of menopause
• Radiation therapy to the breast or chest
• Obesity
• Drinking alcohol

The signs and symptoms of breast cancer include

• A new lump or thickening in or near the breast or in the armpit.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast. It may look like the skin of an orange.
• A nipple turned inward into the breast.
• Nipple discharge other than breast milk. The discharge might happen suddenly, be bloody, or happen in only one breast.
• Scaly, red, or swollen skin in the nipple area or the breast.
• Pain in any area of the breast.

Your health care provider may use many tools to diagnose breast cancer and figure out which type you have:

• A physical exam, including a clinical breast exam (CBE). This involves checking for any lumps or anything else that seems unusual with the breasts and armpits.
• A medical history.
• Imaging tests, such as a mammogram, an ultrasound, or an MRI.
• Breast biopsy.
• Blood chemistry tests, which measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Some of the specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), and an electrolyte panel.

If these tests show that you have breast cancer, you will have tests that study the cancer cells. These tests help your provider decide which treatment would be best for you. The tests may include:

• Genetic tests for genetic changes such in the BRCA and TP53 genes.
• HER2 test. HER2 is a protein involved with cell growth. It is on the outside of all breast cells. If your breast cancer cells have more HER2 than normal, they can grow more quickly and spread to other parts of the body.
• An estrogen and progesterone receptor test. This test measures the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly.

Another step is staging the cancer. Staging involves doing tests to find out whether the cancer has spread within the breast or to other parts of the body. The tests may include other diagnostic imaging tests and a sentinel lymph node biopsy. This biopsy is done to see whether the cancer has spread to the lymph nodes.

Treatments for breast cancer include:

• Surgery such as
  • A mastectomy, which removes the whole breast
  • A lumpectomy to remove the cancer and some normal tissue around it, but not the breast itself
• Radiation therapy
• Chemotherapy
• Hormone therapy, which blocks cancer cells from getting the hormones they need to grow
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells
• Immunotherapy

You may be able to help prevent breast cancer by making healthy lifestyle changes such as:

• Staying at a healthy weight
• Limiting alcohol use
• Getting enough exercise
• Limiting your exposure to estrogen by
  • Breastfeeding your babies if you can
  • Limiting hormone therapy

If you are at high risk, your provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy (of their healthy breasts) to prevent breast cancer.

It's also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.

NIH: National Cancer Institute

If you need a mastectomy, you have a choice about whether or not to have surgery to rebuild the shape of the breast. Instead of breast reconstruction, you could choose to wear a breast form that replaces the breast, wear padding inside your bra, or do nothing. All of these options have pros and cons. What is right for one woman may not be right for another.

Breast reconstruction may be done at the same time as the mastectomy, or it may be done later on. If radiation therapy is part of the treatment plan, your doctor may suggest waiting until after radiation therapy.

If you're thinking about breast reconstruction, talk to a plastic surgeon before the mastectomy, even if you plan to have your reconstruction later on.

A surgeon can reconstruct the breast in many ways. Some women choose to have breast implants, which are filled with saline or silicone gel. Another method uses tissue taken from another part of your body. The plastic surgeon can take skin, muscle, and fat from your lower abdomen, back, or buttocks.

The type of reconstruction that is best for you depends on your age, body type, and the type of cancer surgery that you had. A plastic surgeon can help you decide.

NIH: National Cancer Institute

A mammogram is an x-ray picture of the breast. Health care providers use mammograms to look for early signs of breast cancer that can't be felt during a breast exam. There are two types of mammograms: screening mammograms and diagnostic mammograms.

A screening mammogram is a mammogram usually done for women who have no signs or symptoms of breast cancer. Regular screening mammograms can help reduce the number of deaths from breast cancer among women ages 40 to 74. This is because they can find breast cancer early and treatment can start earlier, maybe before it has spread.

But screening mammograms can also have risks. They can sometimes find something that looks abnormal but isn't cancer. This leads to further testing and can cause you anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes you to radiation. You should talk to your provider about the benefits and drawbacks of mammograms. Together, you can decide when to start and how often to have a mammogram.

A diagnostic mammogram takes a little longer to do than a screening mammogram. It's done for people who have a lump or other signs or symptoms of breast cancer. The signs can include breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape. But these signs can also be caused by a breast condition that is benign (not cancer). A diagnostic mammogram may also be used if you have breast implants or if there are other reasons it's difficult to view your breast tissue.

When you have a mammogram, you stand in front of an x-ray machine. The person who takes the x-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable, but it helps get a clear picture.

You will get both breasts x-rayed from the front and from the side. Afterwards, a radiologist (a doctor with special training) will read the mammogram. The doctor will look at the x-ray for early signs of breast cancer or other problems. You will usually get the results within a few weeks, although it depends on the clinic or medical office that you went to. If your results are not normal, you should hear back earlier. Ask your provider when and how you will receive your results.

An abnormal (not normal) mammogram does not always mean that there is cancer. You will need to have additional mammograms, tests, or exams before your provider can tell for sure. You may also be referred to a breast specialist or a surgeon. But it does not necessarily mean you have cancer or need surgery. You would see one of these doctors because they are experts in diagnosing breast problems.

Women have unique health issues. And some of the health issues that affect both men and women can affect women differently.

Unique issues include pregnancy, menopause, and conditions of the female organs. Women can have a healthy pregnancy by getting early and regular prenatal care. They should also get recommended breast cancer, cervical cancer, and bone density screenings.

Women and men also have many of the same health problems. But these problems can affect women differently. For example:

• Women are more likely to die following a heart attack than men
• Women are more likely to show signs of depression and anxiety than men
• The effects of sexually transmitted infections (STIs) can be more serious in women
• Osteoarthritis affects more women than men
• Women are more likely to have urinary tract problems

NIH: National Institute of Child Health and Human Development