Breast pain, lumps or changes in the appearance of the breast can be an indication of a problem. This tends to cause a great deal of distress and many women are uncertain what should be done. Some problems should prompt you to see your doctor immediately while others can be monitored for a short time to see if they resolve.

Breast problems generally present in a handful of ways. Breast pain is the most common symptom and can either be cyclic occurring just before the period or constant. Cyclic pain typically occurs 1 week before the period and usually resolves with the onset of the period. This is due to stimulation of the breast tissue by the increased estrogen that occur just before menstruation. The drop in estrogen levels that trigger the period leads to resolution of the breast pain. Even though this is uncomfortable it is essentially normal. Constant breast pain however is more concerning and maybe an indication of a greater problem.

A breast mass or lump is another common presentation. The mass maybe found on self-breast exam or during a clinical exam performed by the doctor. The lump maybe associated with pain or without pain. Sometimes the lump maybe associated with pain and occurs 1-2 weeks before the period and then resolves. This is most likely a breast cyst, which occurred as a result of the estrogen stimulation. If it resolves then there isn’t any concern for a more serious problem, however it is important to continue regular self-examination. There are multiple causes of lumps so further imaging tests are usually recommended when the lump persists.

Another symptom is nipple discharge. The discharge can be clear, milky, green or dark colored. The discharge can also come from one or both breast. If the discharge is from one side then it may indicate a local problem with that breast. If the discharge is milky in appearance and/or comes from both breasts it is usually a reflection of a hormonal problem such as an elevated prolactin. This is most likely the case in women who are pregnant, recently delivered or recently stopped nursing.

No matter what the presenting problem, the goal from a physician’s perspective is to relieve the symptoms, make sure it isn’t cancer and determine what this says about future cancer risks. Certain breast lesions indicate a greater risk of breast cancer. In addition there are other factors that places one at higher or lower risk.

Women who are at higher than average risk of breast cancer have the below listed factors.
• A family history of breast cancer, especially in 1st degree relatives such as a parent or sibling.
• Postmenopausal women
• Hormone replacement therapy, especially if > 5years
• Never pregnant
• Early onset of menstruation
• Late age of first pregnancy
• Late menopause

Women who are at lower risk of breast cancer fit into the categories listed below.
• Breast fed >3months
• Has had multiple pregnancies & deliveries
• Premature menopause
• Other factors that may have interrupted menstrual cycles

It is important to know your status. Are you at higher or lower risk of developing breast cancer? The answer to this question should dictate how vigilant you should be with recommended screening or how urgently you should see a physician if you develop a breast problem.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!