and Treating Breast Problems
breasts are always changing. They change during the
menstrual cycle, pregnancy, breastfeeding and menopause
(when menstrual periods end). Along with these normal
changes, problems can arise. Most of the problems are
minor, but a few can be severe. One major problem, breast
cancer, remains one of the leading causes of death in
page tells you about:
Screening tests that are used to find breast problems
Changes that may occur in the breasts and what the
changes may mean
Breast self-exams and how to do one
for Breast Problems
tests are used to find a health problem early. If they
are done on a routine basis, they may detect a problem
even before symptoms appear. There are three screening
exams for breast problems that can be done by you or
Doctor's exam of the breasts
the best results, all three should be done. If any one
of these tests shows a problem, even if the other results
are normal, it should be checked out.
mammogram is an X-ray of the breast. Two smooth, flat,
plastic plates are placed around one of your breasts.
The plates flatten the breast so that the most tissue
can be examined with the least radiation.
is a way to detect changes in the breast tissue by X-ray.
It is useful for finding tiny lumps before they can
be felt. The test is more useful in women over 40. Older
women's breasts are less dense, so it is easier to detect
lumps. Also, breast cancer is more likely to occur as
a woman gets older. Women ages 40 to 50 should have
mammography done every 1 to 2 years. Women age 50 and
older should have it done each year. The results of
the first exam are compared with later ones to detect
changes. If you have an increased risk of breast cancer
(see box), your doctor may suggest you have this test
done more often or before age 40. Mammography is vital
for all women, regardless of breast size or if you have
women feel slight discomfort during mammography. If
you still menstruate, you may find that having your
exam right after your period is more comfortable. Mammography
should be used with other screening tests. If you have
felt a lump in your breast, it should be checked even
if your mammography exam is normal. If your exam shows
a lump or if the results are not clear, more tests may
be needed. Mammography may show a spot that should be
removed by a procedure known as biopsy.
your doctor may suggest a repeat mammogram. This does
not always mean that there is a problem - your doctor
may just want to get a second look.
That Affect the Risk of Breast Cancer
Breast cancer in the family, especially mother, daughter
No pregnancies or pregnancy later in life (after age
Early menarche - the time in a young woman's life
when menstrual periods begin
Obesity, especially in older women
Pregnancy early in life (before age 20)
Ovaries removed before age 40
Early menopause (before age 50)
factors are not found in all women who have breast cancer.
Many women have none of them.
women worry about a link between breast cancer and the
hormones that are used in oral contraceptives (birth
control pills) and hormone replacement therapy. It does
not appear that oral contraceptives increase the risk
of breast cancer in most women. It appears that the
benefits of hormone replacement therapy, when taken
in moderate doses to replace hormones no longer produced
after menopause, greatly outweigh the risks.
breast lumps (about 90 percent) are found through breast
self-exams. That is why it is key to examine your breasts
every month. Self-exams help you learn the normal feel
and shape of your breasts and make it easier to notice
any changes (see box). It is best done a few days after
your menstrual period starts, when your breasts are
not tender or swollen. It may help to do the exam at
the same time each month.
breast self-exam is one of the best things you can do
for your health. Keep doing the self-exam even after
you've reached menopause. Routine exams become even
more important after menopause because the risk of breast
cancer increases with age. About 85 percent of women
with breast cancer are over age 40.
you have breast implants of any type, you still need
to do a breast exam, especially around the chest wall.
Ask your doctor how to examine your breasts.
To Do a Breast Self-Exam
self-exam should always be done in good light. Stand
or sit in front of a mirror. Place arms at your sides.
Look for dimpling, puckering, or redness of the breast
skin, discharge from the nipples, or changes in breast
size or shape.
for the same signs with your hands pressed tightly
on your hips and then with your arms raised high.
flat on your back. Place a folded towel or a pillow
under your left shoulder and place your left hand
under or over your head.
With your right hand, keeping the fingers flat and
together, gently feel your left breast without pressing
too hard. Use small, circular motions.
Picture your breast as the face of a clock. Begin
your small circles at 12:00 - at the very top of your
breast. Repeat the circular motion at 1:00, 2:00,
and so on. Do this in smaller and smaller circles
until you have examined all the breast tissue.
Lower your right arm and do the exam on your other
breast. Place the folded towel or pillow under your
right shoulder, put your right hand under or over
your head, and use your left hand to feel your right
4 to 6 also can be done when you are taking a shower
or bath. It is easier to examine your breasts when they
are smooth and wet with soap and water.
Doctor's Exam of the Breasts
doctor will examine your breasts during your routine
checkups. Most women should be examined at least once
a year. A breast exam by a doctor takes only a short
time. The breasts are first checked for any changes
in size or shape. The doctor also looks for puckering,
dimpling or redness of the skin. You should tell your
doctor if you have noted any discharge from your nipples.
He or she then will check each breast for signs of a
If you have noticed a change in your breasts at any
time, you should have your doctor examine them. He or
she will review when you started having symptoms and
how long they have lasted. Then your doctor will look
at your medical past to check for other factors that
could point to an increased risk of breast cancer.
Problems in Women
breast problems, especially in younger women, are benign
growths (not cancer). This includes lumps (which may
be felt in one exact place or throughout the breast),
discharge from the nipple, and tender places.
most common breast problem is a benign condition called
fibrocystic changes. These changes include lumpy breasts
and thickened (fibrous) and tender areas. They may include
cysts. A cyst is a small sac filled with fluid. It can
be almost any size, from a fraction of an inch to about
the size of a golf ball. Cysts occur most often in women
between the ages of 25 and 50.
cysts will vary in size, changing with the menstrual
cycle. In many cases, they decrease in size after a
menstrual period or at the time of menopause. Most women
who have fibrocystic changes do not have a greater chance
of getting breast cancer.
of fibrocystic change include pain and tenderness, often
in both breasts. It occurs most often in the upper,
outer part of the breast and is most severe 7 to 14
days before a menstrual period. You should inform your
doctor of any symptom of breast problems right away.
women are bothered by caffeine. Some find that cutting
out or cutting down on drinks that contain caffeine
(for instance, coffee, tea and colas) may help.
are another common type of breast lump. They are solid,
benign lumps that occur most often in young women.
cancer is the leading cause of death from cancer in
women aged 34 to 50. If breast cancer is found and treated
early, most women can be cured. This is why routine
breast self-exams, mammography, and checkups by your
doctor are vital.
you have found a lump in your breast or the results
of your mammography are not normal, other tests may
be used to help diagnose breast problems. Sometimes,
these tests are done by your doctor. Other times, you
will be referred elsewhere.
ultrasound, sound waves are used to create pictures
of the inside of some body organs or tissues, like the
breast. This painless method can tell your doctor about
certain types of breast lumps. These pictures can show
whether the lumps are solid or filled with fluid, such
as with a cyst.
when the doctor suspects you have a cyst, fluid or tissue
is withdrawn through a needle to be examined. This is
called needle aspiration. If the fluid is clear and
the cyst goes away, it is likely that no more tests
will be needed. Aspiration also can be used to drain
a cyst. Ultrasound may be used to help guide the needle.
The sample may be sent to a lab to be checked.
only way your doctor can find out the exact nature of
a lump is to study cells from it or take a sample of
it. To check a solid mass or a suspicious area, your
doctor may advise a biopsy. A biopsy may be done if
a lump feels abnormal, even if a mammogram is normal.
In a fine-needle biopsy (aspiration biopsy), a small
sample of cells from the mass is withdrawn through a
other types of biopsy involve a surgical incision (cut).
With a portion biopsy, part of the mass is removed.
In an excisional biopsy, all of it is removed.
a fine-needle biopsy is needed, it often can be done
in a doctor's office. A surgical incision biopsy most
often is done in a surgical clinic or a hospital. After
the breast lump is removed, cells taken from it are
looked at under a microscope. Results will be negative
(no cancer) or positive (cancer). Your doctor will discuss
the results with you and determine what type of treatment
breast disease often goes away on its own over time.
If not, it often can be treated with medication or minor
surgery. The treatment of breast cancer depends a great
The type of cells
The size and location of the tumor
How much the cancer may have spread.
first treatments include either removal of the lump
(lumpectomy) plus radiation treatment (with X-rays)
or complete removal of the breast and the lymph nodes
in the armpit (modified radical mastectomy). Treatment
with either lumpectomy and radiation or modified radical
mastectomy is now standard for breast cancer in early
stages. Radical mastectomy, in which the chest muscles
are also removed, is rarely done.
some cases, cancer also may be treated with medication
(chemotherapy) once the lump has been removed. For instance,
some patients may receive chemotherapy after surgery
and radiation are complete. This is especially true
in younger women whose cancer has spread to the lymph
nodes in the armpits.
than one treatment may be needed. Chemotherapy may help
prevent the cancer from coming back. Sometimes, hormones,
such as tamoxifen, may be used.
woman who has all or part of a breast removed will begin
a program of exercise to help her return to daily tasks.
Some women consider having plastic surgery.
breast problems are benign. Still, you should be aware
that breast cancer can occur. Examine your breasts every
month. Use this pamphlet as a guide to doing the self-exam.
Visit your doctor promptly at the first sign of any
problem. Follow your doctor's advice about having routine
mammograms. Breast problems can be treated with success
if they are found early.
excerpt from ACOG's Patient Education Pamphlet is provided
for your information. It is not medical advice and should
not be relied upon as a substitute for visiting your
doctor. If you need medical care, or have any questions,
please contact your obstetrician-gynecologist. Copyright
(c) 2000 The American College of Obstetricians and Gynecologists.
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