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Understanding Breast Problems -- The Basics

The female breast is an organ that changes with puberty, with the monthly menstrual cycle, and with pregnancy. It also continues to change with age. Most changes in your breasts are perfectly normal and no cause for concern. However, you may experience any of several conditions that require medical attention. Chief among these are breast pain and lumps.

Breast Lumps

Breast lumps come in many forms, including cysts, adenomas, and papillomas. They differ in size, shape, and location, as well as in causes and treatment. About half of all women have lumpy breasts, or fibrocystic change. They are more common during the premenstrual period and usually disappear after menopause. Most lumps are benign and do not signal cancer; however, any time you find a new or unusual lump, have your doctor check it to make sure it is not precancerous or cancerous.

Researchers are studying the incidence of breast lumps in women taking birth control pills or using hormone replacement therapy (HRT). In HRT, women take varying amounts of the hormones estrogen and progestin to alleviate the symptoms of menopause. In July 2002 a study called the Women’s Health Initiative discovered that HRT resulted in more risks than benefits and discouraged its use for long-term management of menopause. Combined HRT was shown to increase a woman's risk of breast cancer and change the breast's structure, increasing breast density and making mammograms harder to read and evaluate. This could make detecting cancer more difficult.

Cysts, which can be large or small, are benign, fluid-filled sacs. They sometimes occur cyclically, and they may be painful.

With the onset of menopause, many cystic lumps diminish or disappear; therefore, you should immediately have your doctor check any lumps that form after menopause.

Fibroadenomas are the most common benign breast tumors seen in women under 25 and occasionally in adolescents. These tumors are usually round, several centimeters across, and mobile. They can sometimes go away on their own. Your doctor may recommend removal if the lump persists, gets larger, or if you are anxious about it. Tests will be done to check for cancer when it is removed.

Nipple adenomas are tumors of the nipple area. They vary in appearance, sometimes recur after surgical removal, and are sometimes, but not usually, associated with cancer. An intraductal papilloma is a relatively uncommon small growth in the lining of the milk ducts near the nipple. Usually seen in women over 40, papillomas produce a discharge, which may be bloody.

Breast Self-Exams

Doctors should discuss the benefits and limitations of breast self-exams with their patients. If you are interested in doing breast self-exams, your doctor should go over how to perform it with you. Premenstrual changes can cause temporary thickening in breast tissue that disappears after your period, so your doctor may advise not performing the exam until a few days after your period.

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