Breast health is every woman’s concern. Every day we are bombarded with information about breast cancer. While women have reason to be anxious, far more women will die of heart disease, and not breast cancer. It does behoove us, however, to become knowledgeable about our breast health. We can become accustomed to what is normal, so that if there is a change, it can be evaluated by a specialist.
Women’s breast change over their life span. From puberty through menopause, hormonal changes prepare the breasts for pregnancy and nourishing a baby.
Breasts come in all shapes and sizes, coloring and skin texture. Areolas differ in size and shape and color. Nipples may be erect or inverted. One breast may be even 2 cup sizes larger than the opposite breast. All of these findings are generally normal, unless a prompt change occurs.
During the menstrual cycle, a premenopausal woman may experience swelling, tenderness, increased firmness or increased lumpiness. There is great variability in the way breasts feel. This is called fibrocystic change. During pregnancy, the mammary glandular tissue enlarges to produce milk. The areola may darken and enlarge. After pregnancy the breasts may become less firm. In the postmenopausal women who choses to avoid hormone replacement therapy, her breasts may feel less lumpy and firm, and may look larger. The supportive structures may weaken, and the breasts may sag.
Along with the above physiologic changes, sometimes lumps, nipple discharge or pain may occur. Most lumps are related to fibrocystic changes, and are hormonally influenced. However, any lump that persists beyond a second menstrual cycle should be further evaluated. Most will get smaller or disappear. In postmenopausal women who are not on hormones, any breast mass should be evaluated if it persists past a few weeks.
Breast pain is a common symptom and is also usually related to hormonal changes associated with fibrocystic changes. If it is severe or does not go away after a month or so, it, too, should be evaluated. Occasionally the pain is due to inflammation of the ribs beneath the breast along the rib cage. Pain associated with redness may be a breast infection (mastitis) and should be evaluated promptly and treated with antibiotics.
Nipple discharge can also be related to fibrocystic changes in the breast, pregnancy, or lactation. Clear or bloody nipple discharge should be promptly evaluated, but in itself, generally is related to a benign growth called a papilloma of the breast. Surgical removal of the growth will generally relieve the symptom. Some practitioners are now using ductal lavage and ductoscopy to evaluate nipple discharge in women with a strong family history of breast cancer.
It is important that women learn to determine what is a normal breast exam for themselves. The American Cancer Society recommends that women begin performing breast self-examination on a monthly basis beginning at age 18 and undergo a clinical breast examination every 3 years until age 40 at which time examinations by a health care provider should be increased to annually. The use of annual mammography is recommended beginning at age 40, earlier if there is a strong family history of breast cancer, or to evaluate symptoms.
Other tools used to evaluate breast symptoms include breast ultrasonography and MRI. Neither is considered a screening tool and should only be used as an adjunct to screening mammography outside of a clinical trial.
If a woman or her health care provider finds a change in her examination, radiologic imaging may be recommended- generally a mammogram. For young women (under the age of 30) ultrasound may be the tool used as dense breast tissue found in young women limits the sensitivity of mammography.
In some instances, a biopsy will be recommended. If findings are seen only on imaging tests, an image-guided or image-directed biopsy will be suggested. For women who present with a lump, a palpation-guided biopsy can be done by a breast specialist. This may involve doing a fine needle aspiration or core biopsy. Each of these tests enable the patient to receive results within one working day, thereby lessening the anxiety associated with waiting for results. In some situations, when there is high concern that a lump is cancer, removal of the lump (excisional biopsy) will be recommended even if the above diagnostic tests are normal. Some breast cancers do not image on mammography or ultrasound. Woman must advocate for themselves and request to see a specialist if a reason for her breast lump cannot be explained by routine tests.
Breast Care Specialists
NorthShore has a number of breast care specialists.
Evanston, Glenbrook & Skokie Hospitals
These physicians generally see patients in the Center for Breast Health located at Evanston, Glenbrook, Highland Park and Skokie Hospitals. Imaging services are offered at each of these sites among other NorthShore mammography locations throughout Chicagoland.
NorthShore is currently engaged in research in the early detection of breast cancer in high-risk women as well as other clinical trials related to breast cancer. NorthShore is designated as a National Cancer Institute Community Clinical Oncology Program (CCOP), meaning we can offer patients new and innovative treatment options. Please visit the Kellogg Cancer Center site to learn more about our breast cancer program.