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Lumps in the breastsDefinition There are many causes for lumps in the breast. These range from normal changes in your body to abnormal breast disease. Breast lumps are either benign (noncancerous) or malignant (cancerous). See also:
Causes, incidence, and risk factors Some lumps are age-dependent. Newborn boys and girls both have lumps of enlarged breast tissue beneath the nipple, which have been stimulated by maternal hormones. These disappear within a few months of birth. Beginning as early as age 8, girls may develop tender lumps beneath one or both nipples (frequently only one). These lumps are breast buds and are one of the earlier signs of the beginning of puberty. Boys at mid-puberty (usually around age 14 or 15) may develop tender lumps beneath one or both nipples, also in response to the hormonal changes of puberty. These tend to disappear over a period of 6 months to 1 year. It is also important to remember that hormonal changes just prior to menstruation may give a lumpy or granular feeling to the breast tissue. The discovery of a lump in the breast usually brings the thought of cancer immediately to mind. However, it is important to remember that 80-85% of all breast lumps are benign, especially in women less than age 40. Benign causes of breast lumps include fibrocystic breast changes, fibroadenoma, fat necrosis (damage to some of the fat tissue within the breast), and breast abscess. FIBROCYSTIC BREAST DISEASE Many providers perfer the term "condition" to "disease" because fibrocystic breast disease is so common. The cause is not completely understood but is believed to be associated with ovarian hormones, since the condition usually subsides with menopause and varies with the menstrual cycle. This condition may occur in over 60% of all women. It is common in women aged 30 to 50 and is rare after menopause. The condition is less common in women taking birth control pills. Risk factors may include heredity and diet (excessive dietary fat, caffeine intake). FIBROADENOMA While the cause is not known, some research suggests that increased fat consumption may play a role. The highest incidence is in women from their teen years into their 20s. Fibroadenomas rarely develop after age 30. Single or multiple fibroadenomas may develop in one or both breasts. FAT NECROSIS Trauma is presumed to be the cause. Bruising is occasionally noted near the lump and the area may or may not be tender. The mass may be associated with skin or nipple retraction as time progresses. A fat necrosis mass cannot be distinguished from breast cancer without biopsy. BREAST ABSCESS In breast-feeding women, a local breast infection introduced through the nipple may wall off into an abscess. Young to middle-aged women who are not breast-feeding rarely develop subareolar abscesses (located beneath the areola, which is the darker area around the nipple). Abscesses in breast tissue other than the subareolar area are excessively rare in women who are not breast-feeding, and such abscesses should be surgically removed and biopsied. BREAST CANCER Breast cancer may occur in men and women, but it is much more common in women. While the cause is unknown, a number of predisposing factors have been identified. Recent statistics say that 1 in 8 or 9 American women will develop breast cancer at some point in her life. Risk increases exponentially after age 30. The average age of women diagnosed with breast cancer is 60. In general, the rate of breast cancer is lower in underdeveloped countries and higher in more affluent countries (with the exception of Japan, where the rate is quite low). In the United States, whites (especially those of northern European descent) have a higher incidence compared with other racial groups. However, the incidence in blacks is increasing, particularly in women less than 60. Other risk factors include: family history of breast cancer, particularly in mother or siblings; past medical history of breast, ovarian, uterine, or colon cancer; menstrual history consistent with early menarche (first period before age 12) or late menopause (after age 50); no pregnancies or first pregnancy after age 40; and radiation exposure. Postmenopausal estrogen therapy and oral contraceptive use are considered possible risk factors, but the majority of recent studies do not indicate such risk. Although the majority of breast cancers occur in postmenopausal women, it can also occur in women who are in their 30s or 40s. This is rare. In these cases, the cancers may have a strong genetic link. Symptoms A potentially malignant (cancerous) breast lump may include some of these features:
Benign fibrocystic changes may range from mild to severe during the menstrual cycle. Symptoms typically peak just before each period and improve immediately after the period. The breast tissue has a dense, "cobblestone" consistency, usually more obvious along the outer edges of the breast. An intermittent (on and off) or persistent sense of breast "fullness" with dull, heavy pain and tenderness is experienced. Signs and tests Your health care provider will perform a breast exam by feeling the breasts for lumps. Benign fibrocystic changes in both breasts are common. Benign lumps are usually rounded with smooth borders, either rubbery or slightly movable, and not anchored. Nipple discharge occurs only after the nipple is manipulated, is milky looking, and may be expressed from both breasts. For a potentially cancerous breast lump, there may be spontaneous nipple discharge on one side from a single duct. Lymph nodes in the armpit may be enlarged or tender. The following tests may be performed:
A biopsy can confirm or rule out suspected cancer in solid lumps:
Treatment If a woman has been diagnosed with fibrocystic breast disease, she should examine her breasts monthly to watch for changes. A well-fitting bra should be worn to provide good breast support. The effectiveness of vitamin E, vitamin B-6, and herbal preparations (such as evening primrose oil) are controversial and should be discussed with your health care provider. Consider restricting dietary fat to approximately 25% of the total daily calorie intake and eliminating caffeine and cigarette smoking to see if symptoms subside. Birth control pills may be prescribed because they often reduce symptoms. The choice of initial treatment for biopsy-confirmed breast cancer is based on the extent and aggressiveness of the disease. Currently, breast cancer is viewed as a systemic (involving the entire body) disease that requires both local and systemic treatment. Local treatment may include lumpectomy, mastectomy (removal of part or all of the breast, and sometimes involving the armpit lymph nodes), and radiation therapy -- all directed at the breast and surrounding tissue. Systemic treatment includes chemotherapy and hormone therapy, which circulate throughout the entire body in an attempt to eliminate cancer cells that may be present in distant parts of the body. Most women receive a combination therapy including surgery, radiation, chemotherapy, and hormonal therapy. Therapy will depend on the extent of the local disease, if there is cancer in local lymph nodes or in other parts of the body, as well as the genetic findings after analyzing the cancer cells. Expectations (prognosis) The long-term outlook depends on the type of problem. See the specific condition for detailed information. Complications Because fibrocystic changes may make breast examination and mammography more difficult to interpret, early cancers may occasionally be overlooked. Even with aggressive and appropriate treatment, breast cancer often spreads to the lungs, liver, and bones. Cancer returns to the breasts in about 5% of cases after total mastectomy and removal of the armpit lymph nodes, if the nodes themselves were found to be cancer-free. Breast cancer returns in about 25% of cases in those with similar treatment where the nodes were found to have cancer. Calling your health care provider Call your health care provider if new, unusual, changing, or "dominant" lumps are noted in breast tissue during your breast self-examination. Also call for an appointment if you are a woman:
Prevention To avoid fibrocystic changes in your breast tissue, avoid excessive fat and caffeine in your diet. Most cases of breast cancer cannot be prevented. However, early detection and prompt treatment is important. Therefore, check your breasts regularly, get routine breast exams from your doctor, and get routine screening mammograms. Research is underway to determine if the drug tamoxifen can reduce the risk of breast cancer in women with a family history of breast cancer (mother, maternal aunts, sisters). Preliminary results showed that tamoxifen significantly reduced the chance of breast cancer in women at high risk for the disease. In some women, the risk of breast cancer can be reduced almost 50% when drugs, such as tamoxifen, are taken regularly. However, tamoxifen is also associated with developing blood clots in the legs and with uterine cancer. See your health care provider to find out if you should take tamoxifen to prevent breast cancer. Illustrations
Page Content: Fibroadenoma; Breast mass; Abnormal breast mass ; breast mass; mass in breast; excision of breast mass; palpable mass breast; breast cancer mass palpable; fibroadenoma; fibroadenoma treatment; breast fibroadenoma; fibroadenoma removal; benign fibroadenoma; fibroadenoma surgery; fibroadenoma mamario; fibroadenoma and ultrasound; que es un fibroadenoma; picture of fibroadenoma |
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