Breast problems are a common complaint of reproductive aged women. Breast pain and a palpable lump are the usual symptoms. Others include nipple discharge or unusual skin changes. In addition, abnormal changes can be found on breast imaging. These findings produce a great deal of distress since most women immediately worry about cancer. However, the majority of breast problems are non-cancerous or benign.

In order to understand breast problems it is first important to understand breast anatomy. The breasts are paired mammary organs that are designed to produce milk and transport it to the suckling infant. They are composed of fibrous and fat tissue that surrounds 15-20 lobes of glands. The lobes form a circle around the nipple and communicate with the nipple via ducts that allow the passage of milk. The areola is the darker, thicker and more wrinkled skin that extends 1-2 centimeters out from the nipples onto the skin of the breast.

Both benign and cancerous changes occur in different tissues of the breast. The abnormalities can occur in the milk ducts, the glands and in the tissue surrounding the lobes and ducts such as the fat cells. There are many possible sources for breast problems and usually it isn’t cancer.

Early detection is the key to survival in breast cancer! This is the reason healthcare providers make such a big deal of self breast examinations, annual clinical breast examinations and mammograms starting at age 40. If you feel a breast lump or have breast pain, it is important to see your doctor; this maybe the first indication that something is wrong.

If you have a problem, the first step in the evaluation is a breast examination by your doctor. She will feel around the entire breast and in the arm pit looking for lumps or other abnormalities. The doctor may elect to order a mammogram or a breast ultrasound. Other test may include a ductogram or magnetic resonance imaging. If there is an abnormality further testing or surveillance maybe required. Sometimes they recommend imaging every 3-6 months to see if there are any changes. Other options may include biopsy which can either be done with a large needle (core biopsy) or through surgical excision. This provides a definitive diagnosis making the next steps in management clear.

Benign breast problems falls into 3 groups: non-proliferative, proliferative without atypia and atypical hyperplasia. The categorization is based on the future risk of malignancy. Imaging and biopsy are required to define the problem. Prompt evaluation is important so that the opportunity to diagnose and treat early stage breast cancer isn’t missed.

Future articles will describe the problems in each category and explain the associated risk of cancer as well as treatment.

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!