Breast Disorders

Breast disorders may be noncancerous (benign) or cancerous (malignant). Most are noncancerous and not life threatening. Often, they do not require treatment. In contrast, breast cancer can mean loss of a breast or of life. Thus, for many women, breast cancer is their worst fear. However, potential problems can be detected early when women regularly examine their breasts themselves and have mammograms.

Symptoms
Common symptoms include breast pain, lumps, and a discharge from the nipple. Breast symptoms do not necessarily mean that a woman has breast cancer or another serious disorder. However, if a woman has any of the following symptoms, she should see her family physician:

• a lump that feels distinctly different from other breast tissue or that does not go away
• swelling that does not go away
• puckering or dimpling in the skin of the breast
• scaly skin around the nipple
• changes in the shape of the breast
• changes in the nipple, such as turning inward
• discharge from the nipple, especially if it is bloody
  

Breast Pain:
Many women experience breast pain (mastalgia). Breast pain may be related to hormonal changes. For example, it may occur during or just before a menstrual period (as part of the premenstrual syndrome) or early in pregnancy. Women who take oral contraceptives or who take hormone therapy after menopause commonly have this kind of pain. The pain is due to growth of breast tissue. Such pain is usually diffuse, making the breasts tender to touch. Pain related to the menstrual period may come and go for months or years.
Other causes of breast pain include breast cysts, infections, and abscesses. In these cases, breast pain is usually felt in a particular place. Fibrocystic breast disease can also cause breast pain. Breast pain is occasionally due to breast cancer, but breast cancer does not usually cause pain. Breast pain that persists for more than 1 month should be evaluated. Mild breast pain usually disappears eventually, even without treatment. Pain that occurs during menstrual periods can usually be relieved by taking acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). For certain types of severe pain, danazol (a synthetic hormone related to testosterone) or tamoxifen (a drug used to treat breast cancer) may be used. These drugs inhibit the activity of estrogen and progesterone, which affect the breast. Because long-term use of these drugs causes side effects, the drugs are usually given for only a short time. Tamoxifen has fewer side effects than danazol. Tamoxifen is used mainly for postmenopausal women but may benefit younger women. If a specific disorder is identified as the cause, the disorder is treated. For example, if a cyst is the cause, draining the fluid from the cyst usually relieves the pain.

Breast Lumps:
Lumps in the breasts are relatively common and are usually not cancerous. But because they may be cancerous, they should be evaluated by a family physician without delay. Lumps may be fluid-filled sacs (cysts) or solid masses, which are usually fibroadenomas. Other solid breast lumps include hardened glandular tissue (sclerosing adenosis) and scar tissue that has replaced injured fatty tissue (fat necrosis). Neither is cancerous. However, these lumps can be diagnosed only by biopsy. They require no treatment.

Nipple Discharge:
One or both nipples sometimes discharge a fluid. A nipple discharge occurs normally during milk production (lactation) after childbirth or as a result of mechanical stimulation of the nipple by fondling, suckling, or irritation from clothing. During the last weeks of pregnancy, the breasts may produce a milky discharge (colostrum). A normal nipple discharge is a thin, cloudy, whitish or almost clear fluid that is not sticky. However, during pregnancy or breastfeeding, a slightly bloody discharge sometimes occurs normally.
Several disorders can cause an abnormal discharge. Abnormal discharges vary in appearance depending on the cause. A bloody discharge may be caused by a noncancerous breast tumor (such as a tumor in a milk duct, called an intraductal papilloma) or, less commonly, by breast cancer. Among women who have an abnormal discharge, breast cancer is the cause in fewer than 10%. A greenish discharge is usually due to a fibroadenoma, a noncancerous solid lump. A discharge that contains pus and smells foul may result from a breast infection. A large amount of milky discharge in women who are not breastfeeding may result from galactorrhea. Tumors of the pituitary gland or brain, encephalitis (a brain infection), and head injuries can also cause a nipple discharge. Taking certain drugs, such as antidepressants and certain antihypertensives, can cause a nipple discharge. Taking oral contraceptives may cause a watery discharge.
A discharge from one breast is likely to be caused by a problem with that breast, such as a noncancerous or cancerous breast tumor. A discharge from both breasts is more likely to be caused by a problem outside the breast, such as a pituitary tumor, or by drugs.
If a nipple discharge persists for more than one menstrual cycle or seems unusual to the woman, she should see a family physician. Postmenopausal women who have a nipple discharge should see a family physician promptly. Family physicians examine the breast, looking for abnormalities. Mammography and blood tests to measure hormone levels may be performed. Computed tomography (CT) or magnetic resonance imaging (MRI) of the head may be performed. The woman is asked for a complete list of drugs she is taking. Sometimes a specific cause cannot be identified. If a disorder is the cause, the disorder is treated. If a noncancerous tumor is causing a discharge from one breast, the duct that the discharge is coming from may be removed.
(Merck)