Breast Diseases
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Breast anatomy
The mammary gland tissue in women consists of mammary glands, mammary ducts, muscle tissue and bed located between them, fat, nerves, blood vessels, and lymph nodes.
The mammary glands are gathered into groups which are called lobes. Every mammary gland has 15-20 lobes. Every lobe is divided into smaller areas called lobules (small mammary clusters). These lobules contain small vesicles which produce milk. In terms of its shape, every lobule can be compared to a cluster of grapes. Lobes, lobules, and vesicles are connected with thin mammary ducts. These ducts join together near the nipple and are opened exactly in the middle of the nipple in the dark-colored area called the areola.
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What kind of changes take place in the mammary gland during menstrual cycle?
In the first phase of the menstrual cycle, mammary ducts in the breast are extended under the influence of the estrogenic hormone the secretion of which is increased. Meanwhile, under the influence of the increased estrogenic hormone, an ovulation process takes place during the middle phase of the menstrual cycle. After that, there begins an increase of progesterone hormone level which also provides the development of mammary glands. During this period water retention in the breast is increased, the breast is swollen and becomes more sensible. The reason for the sensation of pain and increased sensibility before the beginning of the menstrual cycle is such changes in the breast. This sensation of pain is in no way connected to the breast cancer. Shortly before the beginning of the menstrual cycle there is also an external structure of the breast changed which can be felt by touching it and in terms of an increased mammary glands it is possible to feel different lumps. Therefore, it makes sense to conduct self-examination after the menstrual cycle.
These changes observed in the breast are the preliminary preparation for the nourishing of a baby that will be born in case of pregnancy. If no pregnancy occurs, the menstrual cycle comes to an end. The increased cells are destroyed by other cells. The amount of water retained in the breast returns to a normal level. As a result, the sensation of pain in the breast disappears or is decreased.
Changes in mammary glands during pregnancy and lactation period
Changes in mammary glands are one of the earliest signs of pregnancy. The complete formation of a mammary gland happens only after childbirth. In addition to the changes in areolas, mammary glands begin to increase in size. As a result of such process of development of mammary ducts and mammary glands, such complaints as pain in the breast, pain in the nipple area, and burning sensation can occur. During the early period of pregnancy mammary ducts and glands are developed, while during the further periods, the cells in mammary glands completely turn into such cells, which can produce milk.
Starting from the 5th or 6th month of pregnancy mammary glands can produce milk. In addition, vessels begin to show through, the color of areolas becomes darker, and the breast increases in size. The only reason for all these changes in the breast is the preparation for the nourishing of a newborn baby.
Changes during menopause
In terms of menopause coming closer, the level of estrogen and progesterone hormones in the blood is significantly decreased. Under the influence of the estrogen hormone, a regression begins in all tissues including the breast which is one of them. Regression occurs as well in mammary glands, the amount of water in connective tissues and the bed is decreased (dehydration), and the breast becomes less elastic and hangs down.
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Breast self-examination
The purpose of mammary gland self-examination is to independently determine the normal breast tissue starting from an early age and the ability to distinguish any unusual changes at an early stage and, accordingly, consult a doctor in this regard. However, if the examination is not carried out correctly, this may be the reason that you get the impression of having a problem in your breast and will experience unnecessary stress. For this reason, it is recommended to try self-examination only after reading the explanations carefully and making sure that you have correctly learned the procedure for the examination.
How is breast self-examination done?
Self-examination is performed in the standing position in front of the mirror, lying down, or in the shower.
Visual examination:
While standing upright in front of the mirror, stretch your arms along the sides and look if you have any irregularities in your chest, skin depressions, deflection of the nipple to the side or pulling inwards, or color changes. Carry out a similar procedure while straining your hands by pressure on your thighs, thereby constricting your breast muscles, and then – while lifting your arms up.
Armpit examination:
The armpit area – the cavity just behind the pectoral muscle. With the help of your fingers of another hand check both areas of your armpits both in the standing and lying down position. Check, whether there are any lumps or sensitive areas.
Manual examination:
You can carry it out while standing, lying down, or in the shower. Apply body lotion or soap onto your fingers, thereby increasing the glide to make the examination easier. To examine your right breast, place your right arm behind your head, with the 2nd and 3rd fingers of your left hand examine your breast starting from the nipple in circular motions, by gently moving your fingers. During the examination try to feel the tissue of your breast thoroughly with the help of small finger movements, and try to distinguish different tissues of your breast. Pay attention, to whether there are any lumps, swelling, skin calcification, nipple calcification, hypersensitivity, or discharge from the nipples. Repeat the same procedure on your left breast.
When is it done?
During the first week after the end of the menstrual cycle for each woman over 20 years of age.
On a certain day of the month for women who do not have menstrual cycles (for example, every 1st or 3rd day of the month)
Lactating mothers – after milk runs out as a result of nourishing
Women who use contraception against pregnancy – on the day preceding the start of the use of a new package of the drug.
When is it recommended to consult a doctor?
The likelihood that the lump in the breast will be malignant is small. However, every such lump must be carefully examined by a doctor. If you consider during the examination that you have any problems, if a liquid is discharged from a nipple as a result of the slight squeezing and/or you feel with your hands any lumps, you should immediately consult a doctor.
Do not forget! 80% of lumps in the breast are determined as a result of your monthly self-examinations.
What shall you pay your attention to?
- Are there any lumps
- Is there any compression on the skin of the breast or nipple
- Is there any changes of color of the breast skin
- Is there any unmotivated discharge from the nipple
- Are there any lumps in the armpit area.
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Breast Cancer
Along with the fact that breast cancer is one of the most significant problems that threatens women’s health, it occasionally occurs in men. It ranks second after lung cancer in terms of the causes of death associated with cancer. One in eight women in the United States and Western Europe – one in 10 women has breast cancer. In our country, there are approximately 30,000 cases of breast cancer diagnosed every year. Nowadays, the increase in the possibilities of early diagnosis and numerous studies and works carried out in this area reduce the percentage of deaths from breast cancer.
The fact that diagnosing breast cancer in the early stages before the beginning of complaints increases the likelihood of full recovery. The first important step in fighting breast cancer is women’s awareness of this disease and the awareness of how they can gain the healthy condition of their breasts.
The breast is an important organ that undergoes several structural and functional changes during the childhood, adolescence, and menopause periods. Every woman should carry out periodic monitoring of the functioning and health of her breasts, carry out self-examination at certain intervals, and be very careful in this matter.
The causes of breast cancer development are unknown. However, knowing the risk factors and protection factors against breast cancer can provide benefits in the form of awareness of this type of cancer. At the same time, due to early diagnosis, most of the problems breast cancer can lead to are successfully solved and the period and quality of life after treatment can be substantially extended.
Signs of Breast Cancer
- Lumps in the breast or armpit area (calcification, nodosity)
- Discharge from the nipple (from one duct, with blood or transparent fluid)
- Depression of a nipple, impaired shape
- Changes in the nipple skin (paleness, peeling)
- Appearance of wounds, redness, swelling, calcifications, and depressions on the breast skin (looking like the skin of an orange)
- Breast augmentation, form disorder, asymmetry or changes in color
Risk Factors
- The most important risk factor for breast cancer is being a woman.
- Early beginning of menstrual cycles and early menopause increase the risk of breast cancer.
- It is more common in women who did not give birth, or whose first birth was after 35 years.
- The risk is increased if close relatives especially at an early age have breast cancer.
- Also among the factors of risk are weight gain after menopause, permanent alcohol consumption, modern lifestyle, and big breasts.
What and at what age should be done?
20 years old: This is the age when every woman shall begin to examine herself.
30 years old: This is the age when every woman shall begin to undergo a medical examination once a year.
40 years old: This is the age when women belonging to the high-risk group begin to undergo a mammogram once a year.
50 years old and older: This is the age at which a mammogram should be done once a year.
Breast Cancer and its Diagnosing
- Early diagnosing of breast cancer reduces the risk of death.
- A self-examination is important for early diagnosis.
- Scanning programs play an important role in early diagnosis.
- At an age in which breast cancer can most often occur, it is necessary to see a doctor and undergo scanning at certain intervals.
This disease can also occur in young women.
Early diagnosing of breast cancer is facilitated by the patient’s attention to the matter and the continuity of patient-doctor communication. Typically, the first sign of breast cancer is lumps in the breast or armpit area. The fact, that such lumps can be detected by a patient, is directly related to the women’s need to periodically examine themselves. However, unfortunately, due to insufficient awareness of patients on this issue, women do not examine themselves or are afraid of it. The easiest method to overcome this problem is to develop a habit among women to ask themselves some questions throughout their lives.
Even if you did not find anything during self-examination, there is always a risk of breast cancer. It is possible that in early stages breast cancer does not form any lumps and it can only be determined using scanning methods. The goal is to be able to diagnose breast cancer at such an early period, apply the necessary treatment and provide a full recovery from this disease. The scanning methods used in diagnosing breast cancer are chosen based on the patient’s age and clinical picture. Mammograms and ultrasounds are used most often. Magnetic resonance imaging is used to confirm the patient’s analysis.
Formation and types of breast cancer
Breast cancer is an uncontrolled cell growth in the mammary glands and mammary ducts, which spread and continue to develop in other parts of the body. Breast cancer is divided into several types. One of the most often diagnosed is “duct cancer”, occurring in mammary ducts. Cancer that occurs in lobules is called “lobular breast cancer.” Lobular breast cancer is less common in comparison with duct cancer, but the risk of multiple lumps in one breast or both breasts is higher. When cancer cells go beyond the breast tissues, it is usually the lymph nodes in the armpit. Because lymph ducts of the breast transfer lymph from breast tissues to the armpit glands. If cancer cells reach lymph ducts, this can cause the spreading of the disease to other parts of the body. For this reason, the first place in terms of treatment and monitoring of the disease is the clusters in the lymph nodes.
The process of breast cancer spreading to other body organs beyond breasts and lymph nodes is called metastatic breast cancer. Breast cancer is most often spread to the lungs, liver, and bones. In this case, even if the cancer in the breast is successfully treated, cancer cells spread to other organs can grow again and lead to the formation of metastatic lesions.
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Breast Ultrasound Scanning
Ultrasound scanning is a harmless and simple method, during which the information is obtained due to sound waves. It helps to obtain information about fluid-filled structures (cysts) or lumps (solid areas) in breast tissues. Moreover, It is very important for diagnosing and evaluating lesions in young patients, whose sensitivity to mammograms is low. For patients with breast density, whose sensitivity to mammograms is low, it is necessary to undergo this method of visualization along with the mammogram.
Mammogram
The principles of mammogram – the breast structure visualization with the help of x-rays. It is used in breast cancer for diagnosing and scanning. Mammographic scanning increases the percentage of early diagnosing of breast cancer, thereby reducing the risk of death by 25-30%. Compared to other methods of diagnosing breast cancer, this is a method of visualization, which is recommended as a “gold standard”. Because FFDM (Full Field Digital Mammogram), which has been used in recent years, has a high resolution and high image clarity, it provides an easier visualization of calcification sites and small nodes being the early symptoms of breast cancer.
Breast Cancer Treatment
What are the options for monitoring and treating breast cancer?
In terms of the treatment of breast cancer, the most important and determining factor is the early diagnosis of this disease. Operational methods used years ago have now given way to techniques with less damage to the patient. Nowadays, the preference is given to surgeries, which are more aimed at protecting the breast, in other words, such methods of removing the tumor or the site in which the tumor is located. Early diagnosing significantly reduces the risk of complete breast removal in women with this disease (mastectomy). For this reason, the goal is to diagnose the disease as early as possible.
In terms of the treatment of breast cancer there not one but several methods of treatment are used together. In addition to surgical treatment, there is radiotherapy, hormone therapy, and chemotherapy used, depending on the stage of the disease, the age of the patient, and the characteristics of the tumor.
- Breast cancer is a type of cancer that occurs most often in women.
- In case of early diagnosis, the chance of a full recovery from breast cancer is very high.
- Due to early diagnosis, it is very unlikely that breast removal will be necessary.
- Every woman at the age of 20-25 must carry out the so-called self-examination on a monthly basis.
- Every woman ast the age of 30-35 must undergo a breast examination, even if there are no complaints. Ultrasound scanning is to be done.
- Women at the age of 40 or older must undergo a doctor’s examination and a mammogram every year.
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Fibrocystic Breast Disease
It is also called a fibrocystic breast condition, however, as these changes occur only in 60-70% of women, these days it is not considered a disease. Women’s breast tissue becomes very dense and the breast has an irregular shape. This disease makes it difficult to find real diseases in the breast tissue, so women should be more attentive and undergo a medical examination more often.
Fibroadenoma
It is a breast tumor that originates in the secretory tissue of the breast. It is assumed that it is formed as a result of hypersensitivity of breast tissue to the estrogen hormone. Fibroadenomas have a very regular surface and can be floating. Very often, they occur in several more than one. They are most often found in young people but they can also occur at any other age. They can disappear by themselves. They do not grow in size mostly. If they grow, then it happens most often during the period of puberty, pregnancy, and nourishing. This should not be an issue to worry about. It is usually possible to distinguish the floating lumps. Ultrasound scanning is used for diagnosis, and the final diagnosis is made after a biopsy with the help of a needle. If fibroadenomas show a propensity for growth, they are removed surgically, besides this, they form no risks.
Breast cyst
Inside the breast cysts, there are sacs full of liquid formed together with the expansion of breast ducts. The frequency of their occurrence increases with age. They are most often observed after 35 years of age but can be found at any age. Manually can be determined as lumps. Cysts can also be seen on a mammogram but the most correct diagnosis is made by breast ultrasound scanning. There is no harm caused by cysts and they do not require any treatment. However, sometimes their size can be very large, which leads to excessive sensitivity. In this case, the content is removed through a needle and the cyst does not tend to form repeatedly. If the cyst is often formed repeatedly even though its content is removed, it is necessary to remove the cyst itself. When removing the content of the cyst, the fluid should be sent for cytological examination. Such examination is especially required if the liquid contains blood.
Nipple Discharge
Nipple discharges are most often observed in case of fibrocystic breast changes, the expansion of mammary ducts. The discharge itself can only be a warning. The color of the discharge can be light and transparent but it can also be dark green or dark brown. Sometimes a white fluid continues to discharge from a nipple for many years after breastfeeding. What matters is if the nipple discharge contains blood. If the discharge is of red or pink color, it is required to examine its source. A discharge containing blood may be caused by breast cancer or lumps in the mammary ducts (for example, in the case of intraductal papilloma). The discharge of milk from the nipple for many years may occur in case of the presence of abnormalities in the pituitary gland. In such a case it is necessary to determine the level of prolactin hormone and carry out a brain MRI which allows to find any abnormalities, if any.
Inflammation and Apostem of the Breast:
Breast inflammation occurs most commonly during the period of breastfeeding. The breast milk is a very suitable medium for bacterial growth. Small cracks occurring on the nipple as a result of nourishing enable different bacteria to get into the organism. It is very important during this period to look after your hygiene and not to let the breast be full of milk. Before nourishing it is recommended to wash your hands thoroughly, as well as pay specific attention to the mother and baby hygiene.
Chronic breast inflammation:
It is formed most often and repeated in the areola area (the area of brown color). It is believed that there are sebaceous glands of the skin are inflamed and, as a result, the subcutaneous abscess occurs. It is necessary to remove the abscess and carry out an antibiotic treatment. It is thought that the reason for the frequent repeated occurrences of such abscesses is the fact that sebaceous glands are easily clogged which leads to inflammation.
Breast pain (Mastalgia):
Breast pain is a symptom that can occur in women at any age. It is necessary to dissociate the breast pain caused by the beginning of the menstrual cycle and the one not connected thereto. It is possible to treat both of them. Both types of pain can occur only in one breast, both breasts, and one part of a breast. The breast pain itself can barely be a symptom of cancer, however, it is still recommended to consult a doctor and find out about the reason for the occurrence of such pain.
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