Breast cancer is a serious, potentially-deadly health threat for women. But a host of other non-cancerous breast conditions can cause pain and serious health problems for millions of women in Thailand and around the world.

Breast cancer is a serious, potentially-deadly health threat for women. But a host of other non-cancerous breast conditions can cause pain and serious health problems for millions of women in Thailand and around the world.

Young women may worry more about breast size than breast health. As menopause and middle age approach, many women must confront more fearful thoughts about their risk of breast cancer. Women’s breasts undergo many changes during adulthood that can lead to other breast problems that women need to know about. With the help of Dr. Pongnares Purasiri, a certified surgeon with many years’ experience dealing with breast health issues, we explore the steps women of all ages can take to understand and prevent a number of serious breast problems.
 

BREAST STRUCTURE EXPLAINED

Inside a woman’s breast are about 15 to 20 lobes formed by groups of milk glands called lobules. At the tip of each lobule are dozens of tiny bulbs capable of producing breast milk. The lobes, lobules and bulbs are linked by thin, tube-shaped ducts which lead to the nipple. The space between the lobules and ducts is filled with fat. The muscles located under each breast extend over the ribs.

During her lifetime, a woman’s breasts undergo a number of important changes; these changes are usually related to the aging process or result from specific events such as menstruation, pregnancy, breast feeding, use of oral contraceptives, and menopause.
 

SELF-EXAMINATION

Performing breast self-examination on a regular basis is one of the most important steps every woman should take to help spot potential problems earlier, when treatments are more successful and less traumatic.

“Women should begin doing breast self-examination by age 20 and continue the practice regularly,” says Dr. Pongnares. “Self-exams help spot lumps and masses. The best time is seven to ten days after the end of the menstrual period.”

Dr. Pongnares continues: “Feel your left breast with your right hand, and vice versa. Using your finger tips, check each breast by firmly and thoroughly pressing the tissue in clockwise circles. Then check the underarms in the same way. If you feel an abnormality, see your doctor; your doctor has a number of diagnostic tests to confirm or rule out the presence of an abnormality.”
 

COMMON BREAST CONDITIONS

Most breast abnormalities fall into one of two categories: benign (non-cancerous) or malignant (cancerous).

Benign Breast Lump: Benign breast lumps are common and typically found in women age 30 and older. Here are the most common conditions.

• Fibrocystic Disease Fibrocystic changes usually result from the way breast tissue responds to a woman’s monthly hormone level changes. Women with fibrocystic breasts usually develop fluid-filled cysts. As the fluid builds up, the breast can become painful as each menstrual period approaches. Fibrocystic disease can affect one or both breasts. Symptoms usually subside after each period ends. Most cases involving fibrocystic changes don’t require medical treatment, and the condition does not affect post-menopausal women.
• Fibroadenoma describes small benign breast lumps (one to five cm.) that have a solid, smooth and rubbery feel and move inside the breast. Fibroadenomas are made up of both glandular and stromal (connective) breast tissue and typically affect women during their reproductive years. Though usually painless, the lumps may feel tender as a woman’s period approaches. The most common treatment involves surgical removal of the fibroadenoma.
• Fat necrosis is often triggered by trauma to the breast, such as a bruise or blow strong enough to cause internal bleeding. This condition is more common in large-breasted women and those who suffer some type of injury or accident. The lumps are formed by scar tissue that becomes inflamed or damaged. In some cases the skin around a lump appears red or bruised. Fat necrosis usually heals without treatment or is removed surgically.
• Cysts are fluid-filled sacs. They are sometimes tender to the touch and usually occur just prior to the onset of menstruation. Your doctor may perform a fine-needle aspiration to drain the cyst fluid, the usual treatment for this condition. Further treatment is usually not required if the cyst collapses and disappears after draining and the drained fluid is greenish or clear. In cases where the fluid may contain blood, your doctor may order further tests to check for the presence of cancer or other conditions.

Nipple Discharge: There are many possible causes of nipple discharge, including fibroadenoma of the mammary ducts and breast cancer. Nipple discharge often occurs in women taking hormonal or other medications and may be accompanied by changes in hormone levels. In cases where the discharge occurs spontaneously (i.e. not during pregnancy or breast feeding), see your doctor immediately.

Mastitis: Breast mastitis usually affects women who are breast feeding. It results from the blockage of the breast’s milk ducts and excess milk and can produce inflammation and infection. Signs of mastitis include diffuse swelling, redness, heat, pain and inflammation of the breasts, which can feel tender and warm. Infective mastitis is usually treated with antibiotics. In some cases, your doctor may use aspiration or drainage by incision to treat the condition.

Mammary duct ectasia: Mammary duct ectasia usually affects women approaching menopause. It results from breast inflammation caused by blockage or clogging of a milk duct beneath the nipple. Some women may have tenderness along with a dirty, viscous gray or greenish nipple discharge. A warm compress applied to the nipple area and gentle squeezing of the nipple help drain the discharge and reduce pain and swelling. If symptoms persist, you should consult your doctor as you may require antibiotics or surgical removal of the affected milk duct.

Breast Cancer: Breast cancer is a malignant mass or tumor that, if left untreated, can prove life-threatening. Early stage tumors usually don’t produce symptoms and can be difficult to detect through self-examination. Advanced diagnostic tests such as X-rays, mammograms and ultrasound allow doctors to detect breast cancer much earlier than before. The size of a breast cancer lump usually doesn’t correspond with menstrual periods. In some cases it may be indicated by a nipple discharge or an unusual change in the texture of the breast skin.

As with all cancers, the earlier breast cancer is detected, the more likely that treatment will be successful and less traumatic. When breast cancer is diagnosed at a later stage, it’s much more difficult to treat and may have already spread to other parts of the body.

“Breast health requires knowledge and attention on a regular basis,” Dr. Pongnares explains. “It’s critical that women not minimize the importance of periodic breast self-exams. This helps women become more familiar with their healthy breasts’ look and feel, which makes it easier to spot anything abnormal. It’s equally important for women to see their doctor regularly for check-ups and further examination of any changes in breast condition.”