Breast lumps are very common and account for more than half the referrals seen at breast clinics.
They can occur in women of any age, and most are benign in nature.
The most common types of lump are fibro-adenomas, lumps due to fibrocystic change, breast cysts and breast cancer.
When assessing a breast lump, certain clinical features are important. These can help to determine which type of pathology is present.
The likelihood of certain conditions depends mainly upon age. Most breast disorders, whether benign or malignant, can occur in women of any age, but certain patterns are well known:
- 15 - 30: fibro adenomas (benign)
- 30 - 45: fibrocystic changes (benign)
- 45: menopause : breast cysts (benign)
- After menopause: cancer could be more likely
Lumps such as fibro-adenomas and cysts, are normally smooth.
Lumps due to fibrocystic change are often described as "lumpy", with an apparently irregular shape.
Breast cancers are more often irregular in shape.
The texture of a lump can suggest its nature.
Fibro-adenomas usually feel hard and rubbery, whilst breast cysts are "fluctuant" - i.e. when they are felt it is possible to change their shape slightly.
Fibrocystic lumps can assume different degrees of texture. They are often hard but not always, and when assessing consistency, it is important to consider the texture of the normal surrounding breast tissue.
Breast cancers are usually hard on palpation. This is not always the case however, and they can present in a similar way to the others listed above.
The mobility of a breast lump is an important clinical feature because breast cancers are often fixed as a result of their ability to invade surrounding tissues and therefore do not seem to move much when examined.
Fibro-adenomas are very mobile, and have been referred to as "breast mice" because of this feature.
Breast cysts are also mobile, whereas fibrocystic lumps (or areas of lumpiness) can be either mobile or not mobile.
Size is not quite so reliable as a clinical feature, especially with regard to cancer, because cancer can manifest as a lump of any size.
Most fibro-adenomas can grow to about 3 cm in size. Sometimes they can be larger than this, but this is less common.
Lumps due to fibrocystic change are often difficult to measure accurately because of their indistinct margins. Sometimes they can feel like an entire quadrant of the breast, even though they are entirely benign.
Breast cysts often appear quickly, unlike most other lumps that take longer to develop. Once again they can be of variable size.
The one type of pathology that is known to be associated with large size is the Phyllodes Tumour. These lesions, sometimes referred to as "giant fibro adenomas", can reach enormous proportions. However, these days most women will alert their doctor before such a size is reached. It should be noted however, these tumours are very rare.
Fibro-adenomas and cancers are usually single. Fibrocystic lumps (and lumpiness) as well as breast cysts are often multiple.
Lumps can be painful (mastalgia). As a general rule it is often said that benign lumps are more likely to be associated with pain than cancers. This is true, especially for fibrocystic lumps.
Fibro adenomas and cysts can also be painful.
It should also be noted that breast cancer can present as a painful lump and such lumps should never be presumed to be benign until proven otherwise.
Breast pain is extremely common and most women, at some stage or another, will experience breast pain as a symptom.
Breast pain can be due to a number of problems, but is best understood as cyclical or non-cyclical in terms of its relationship to normal menstruation.
There is a clear relationship with the menstrual cycle. Obviously therefore, it occurs in women before the menopause at an average age of about 35.
Most women experience some discomfort and lumpiness in the breasts in the week leading up to the start of a period. Cyclical breast pain that is "abnormal" is different from this in that it is usually much more severe, lasts longer and often causes a certain degree of impairment - e.g. in terms of marital relations, playing sports etc. Some women are affected so much by these symptoms that their quality of life is impaired.
When attending a clinic with breast pain, women are often asked to complete a breast pain chart which will show whether or not the pain is cyclical in nature.
A number of other conditions can give rise to non-cyclical pain in the breast. In these conditions, the pain is present most of the time at varying levels of intensity, but is not related to the menstrual cycle.
Such conditions include inflammation of the costochondral junctions (Tietze's syndrome), trauma, "trigger point" mastalgia, fat necrosis as well as fibro adenomas and breast cysts.
Inversion of the nipple (either on one or both sides) can be normal for some women, and in most cases it is not a problem. Occasionally difficulties can be experienced during breast feeding.
When a nipple that was previously normal becomes inverted, there is often an underlying condition. In most cases the cause will be benign such as diseases affecting the 20 or so large ducts immediately under the nipple. Breast cancer can also cause inversion or retraction of the nipple, but there are often other clinical features such as a lump, distortion of the skin, nipple eczema and bleeding.
Nipple discharge is also common. Once again in most cases it is benign. Discharge that is creamy or green in colour is usually benign. Blood-stained nipple discharge can be associated with duct papillomas (benign) but may also be due to breast cancer. For this reason, nipple discharge should be investigated, normally by taking a smear of the discharge for microscopic examination as well as investigation of any associated lumps.
The breast, or one part of it, can become inflamed showing typical signs of redness, heat, swelling and thickening of the tissues including the skin. This can be found in a number of conditions, most of which are benign. They include breast abscesses and periductal mastitis.
Breast cancer can occasionally present as an inflammatory mass. For this reason most patients are followed up to ensure that their condition is settling.
It is thought that breast cancer in Western countries may be genetic in origin in 10 % of all patients. A number of genes have been identified as being associated with breast cancer including the BRCA1 and BRCA2 genes on chromosomes 17 and 13 respectively. Another important gene in the development of breast cancer is the p53 gene.
All of these can be transmitted through either sex during the development of the foetus. It is by no means certain however that a carrier of these will go on to develop breast cancer.
The risk of breast cancer is higher in women with a first degree relative (daughter, mother or sister) who developed the disease when young (pre-menopausal, <50).
Women who develop breast cancer in older age (e.g. over 70's) do not confer a higher risk. In these patients it is presumed that the cancer arises spontaneously rather than from a genetic abnormality.
Conversely, if a woman is in a family that is affected by breast cancer, but has not developed breast cancer herself by the age of 65, it is unlikely that she has the gene.
Families in whom breast cancer is common, are also more likely to have other types of cancer such as ovarian cancer.
It is known that certain Chinese Herbs and tonics can help in the general wellbeing of the body, and also in the treatment of matters relating to breast health. It is most important that patients seek medical advice, specific to their ailments. However, the following have been shown to promote wellbeing, have anti-tumour properties and generally be beneficial to breast health.
Please consult an AcuMedic specialist if you are unsure of any particular remedy:
Traditional use: Blood tonic, promote blood circulation, relieve pain and special problems of women. Experiment discovery: Dual directionally regulate myometrium of uterus, promote blood production and circulation, anti tumor, anti bacterial, protect the liver, relieve pain and inflammation.
Traditional use: Tonify vital energy and defensive energy, induce dieresis and cure edema, relieve cough, dyspnea, rheumatic pain. Experiment discovery: Promote cell metabolism, reduce protein in urine due to nephritis, improve function of the kidney, induce dieresis, inhibit bacteria, analgesia.
Traditional use: Soften sclerosis, resolve lamp. Experiment discovery: Anti tumor, reduce blood sugar, total cholesterol and triglyceride, anti radiation.
Traditional use: Detoxify, eliminate phlegm, resolve lamp. Experiment discovery: Decrease blood pressure.
Traditional use: Relieve rheumatics, strengthen the bone and tender, arrest bleeding. Experiment discovery: Anti bacterial, depress sexual activity, promote function of immune system.
Traditional use: Tonify the kidney, strengthen "yang", eliminate "dampness". Experiment discovery: Promote secretion of the ejaculate fluid, eliminate phlegm, anti bacterial, anti inflammation, reduce blood sugar, total cholesterol and triglyceride.
Traditional use: Soothe the depressed liver, invigorate the spleen-yang, expel pathogenic factors from the exterior and reduce fever. Experiment discovery: Compose, anti inflammation, protect the liver cells and promote fat metabolism in the liver, inhibit flu virus, promote growth of adrenal grand, anti tumor, enhance immune system
Become Breast Self Aware. Early detection is the best defence against breast cancer. The steps involved in self exam are:
- Place yourself in front of a mirror with breasts exposed.
- Place your hands on your hips.
- Look for signs of swelling, dimpling, redness or soreness in all parts of your breasts in the mirror.
- Do the same with your arms raised above your head.
- While still standing, feel for lumps by applying gentle pressure to your breasts with your fingers. Use a larger area of your fingers rather than prodding. Feel the area just beneath the skin aswell as the tissue deeper within.
- Go over the entire breast while examining - a useful method is the 'circular method' - Using a circular motion, start from the nipple and move out around the breast being aware of lumps or other irregularities. Also examine the "axillary tail" of each breast that points towards the axilla (armpit).
- Repeat the process while lying down.
- Check the nipples and the area just beneath them. Gently squeeze each nipple to check for any discharge.
Ms. V.H - Breast Cancer (Chemotherapy)
During a holiday in China, Ms. V.H visited a Chinese doctor and was told, after initial consultation that her energy levels were very low and her heart muscle was weak. The doctor prescribed her herbs for the rest of her time in China. On her return she decided to continue the treatment and came to AcuMedic for a further prescription. She made an appointment to see Dr. Lily and was administered acupuncture. Ms. V.H noticed an improvement in her wellbeing almost immediately.
Three to four months later, Ms. V.H discovered a lump in her left breast, and was diagnosed with breast cancer shortly afterwards - receiving chemotherapy and radiotherapy. During her conventional treatment, Ms. V.H visited the AcuMedic centre, she was worried about her white blood cells being low, and was given specific herbal treatment and acupuncture to nourish the blood. When she was having her blood tested at the hospital that was administering the chemotherapy and radiotherapy, she was surprised to learn that her white blood cells had stabilised. She attributes this to the herbs and acupuncture she was prescribed.
Now almost a year since finishing her conventional treatment, Ms. V.H claims she is almost 100% better and intends to continue the herbal and acupuncture therapy.
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