Benign (Non-Cancerous) Breast Changes
Most women experience breast changes or breast problems at various stages of their lives. And at different times during the menstrual cycle, fluctuating hormones can result in short-term changes in the look, feel and tenderness of breast tissue. Any breast change that is long-lasting, significantly different than normal, or causes concern should be evaluated your doctor. However, most of these conditions are normal and not cancerous. Here are some examples.
Breast pain is very common-two out of three women suffer from breast pain at some time in their lives. Like any other breast problem, it can be worrying, but most breast pain can be treated and it is not ordinarily a symptom of cancer. However, a woman with persistent breast pain or pain associated with a breast lump should see a medical professional for an evaluation.
There are two types of breast pain: pain related to the menstrual cycle (cyclical breast pain) or pain unrelated to your cycle (non-cyclical breast pain). Most frequently, breast pain is associated with normal changes in hormone levels during the menstrual cycle and/or the presence of a breast cyst. Often it disappears as mysteriously as it came. Medical treatment for breast pain is dependent upon the cause.
This term applies to a generalized lumpiness of the breast. Women sometimes describe the lumpiness as "ropy" or "granular." Cysts (fluid-filled sacs) may also be present. Frequently cysts enlarge and become tender or painful just before the menstrual period.
Having lumpy breasts can be perfectly normal for some women. The most common lump is called diffuse nodularity or benign breast change, where the breasts feel generally knobby but without any single outstanding lump. This is part of normal breast development and can occur at any time in life, though it happens less after menopause. Often it varies with your menstrual cycle, being worse before a period, and it may be painful.
Some cysts cannot be felt while others are large in size. Cysts are usually treated by observation or fine-needle aspiration (a slender needle is used to remove fluid from the cyst).
This is a common benign breast lump made up of both fibrous and glandular tissue. Usually fibroadenomas are round, moveable and feel rubbery. They USUALLY occur in women under age 30 and are more common in African American women.
Fibroadenomas have a benign appearance on mammography. Fine needle aspiration or ultrasound may be used to further evaluate these lumps. Most surgeons prefer to surgically remove fibroadenomas to verify that the lump is benign.
Most nipple discharge is caused by benign (non-cancerous) conditions. Women taking birth control pills or other medications such as sedatives or tranquilizers may have a nipple discharge. Furthermore, many women who have children continue to have a very slight milky discharge from both nipples, which may continue for months after breast feeding stops.
Others with fibrocystic changes may experience a sticky discharge that is brown or green. A small wartlike growth in the ducts near the nipple (intraductal papilloma) can also cause a discharge.
Nipple discharge can also be caused by an infection and may require antibiotics. Remember any change in your normal breasts, including a new discharge or a change in the amount or color of an existing discharge, should be reported to your medical professional.
Women who develop a bloody nipple discharge should be seen by a doctor as soon as possible for evaluation of the cause. In some cases, this can be a sign of cancer, but not always.
Some breast cancers are actually considered pre-cancerous conditions or very early cancers. They are sometimes called "carcinoma in situ." There are two types of breast cancer in situ: lobular carcinoma in situ (LCIS), and ductal carcinoma in situ (DCIS), also known as intraductal carcinoma.
Each breast has 15 to 20 overlapping sections called lobes. Within each lobe are many smaller lobules, which end in dozens of tiny bulbs that can produce milk. Lobular carcinoma arises in these lobules.
The lobes, lobules, and bulbs within the breast are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Ductal carcinoma begins in the lining of these ducts.
LCIS and DCIS have not yet broken through these lobules and ducts to invade the surrounding tissue of the breast and become a true invasive breast cancer.
Lobular carcinoma in situ (LCIS) is usually discovered by a biopsy done for another breast lump and is rarely seen on a woman's mammogram. LCIS is not cancer. It is a precancerous condition. A woman with LCIS is generally believed to have a 25% chance of developing breast cancer in either breast in the next 25 years.
Lobular carcinoma in situ is less common than DCIS, accounting for 13% of "in situ" breast cancers diagnosed in recent years. Between 1982 and 1988, increases in LCIS incidence rates were smaller than increases for DCIS, and since 1988, incidence rates of LCIS have remained level.
The treatment options for LCIS extend from mild to aggressive, and this broad range is a source of controversy. The options range from close monitoring with regular physical exams and annual mammograms (which are generally recommended), to total mastectomy-removal of both breasts. The use of tamoxifen, a hormone therapy that blocks the growth of some breast cancer cells, is a new option being explored for treating LCIS.
Ductal carcinoma in-situ or DCIS, is a pre-cancerous condition in which abnormal cells are confined to the duct in the breast. These tumors have no evidence of microscopic invasion to the surrounding breast tissues. DCIS is usually indicated by tiny specks of calcium on a mammogram. Since DCIS is a pre-cancerous condition, it can become an invasive cancer if left untreated.
Most cases of DCIS are detectable only by mammography, and the large increases in DCIS incidence rates since 1982 are a direct result of better mammography screening practices. Although invasive breast cancer incidence rates have remained level since 1988, DCIS incidence rates have continued to increase. This, however, reflects a shift in the stage of the disease at diagnosis toward earlier, more curable cancers rather than a true increase in occurrence.
It is sometimes difficult to distinguish between DCIS and atypical hyperplasia, a benign breast condition consisting of more breast cells than is normal, some with atypical features. A second-opinion of the biopsy may therefore be appropriate. Accurate diagnosis is important because of the significant differences in treatment options.
Treatment for DCIS may be:
There is disagreement among breast cancer experts about whether mastectomy is an appropriate treatment for DCIS that is localized to one area of the breast and that could be removed by a lumpectomy. Some feel breast removal is not justified for a diagnosis that may never lead to breast cancer. One study (National Surgical Breast and Bowel Project study B-17) showed that lumpectomy plus radiation was an acceptable alternative to mastectomy.
An ongoing national study being conducted by the National Cancer Institute is seeking to learn whether lumpectomy followed by radiation therapy and tamoxifen is more effective than lumpectomy followed only by radiation. Results are not yet available.
SOURCES:
The National Cancer Institute (www.nci.nih.gov)
The American Cancer Society (www.cancer.org)
The Susan G. Komen Breast Cancer Foundation (www.komen.org)
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