There’s nothing quite like the quiet dread a woman feels when she discovers something unusual going on with her breasts – maybe a small lump or a sore spot.
Breast disorders occupy a special place in women’s fears. That’s because practically any breast disorder can be a sign of something really serious: breast cancer.
Even though breast cancer is one of the types of cancer with a higher survival rate, it’s also among the most common types of cancer. Consider these statistics from breastcancer.org:
- Every year, nearly two million women get diagnosed with breast cancer
- Breast cancer makes up a quarter of ALL cancers in women
- In the US, about one in eight women develop breast cancer at some point in their lives
Breast disorders can definitely be serious … but don’t panic. Lumps or sore spots in the breast don’t always point to cancer. There are are many other possible explanations.
Always get an examination when you’re concerned about a breast problem
Breast examinations are important. Getting an examination when something feels wrong is a crucial step in the early detection of breast cancer. The sooner you know what’s going on, the sooner you can get proper treatment from a breast cancer specialist.
AUTHOR’S NOTE: My grandmother died from a cancer of the breast that could’ve been successfully treated, had she only sought medical attention sooner. That’s why I wrote this article and asked Dr. Higgins if I could post it here. I know what it’s like to lose a loved one to breast cancer unnecessarily. I also know what it’s like to wake up in the middle of the night aware of a sore spot in my breast, then to obsess about it until I could get in to see my doctor for a diagnoses.
This article is all about disorders of the breast – what gets affected and what the signs and symptoms are. My aim is to help alleviate your fears and get you motivated to schedule an examination without delay, should something feel wrong.
Breast Anatomy – The Short Course
The breast is largely composed of adipose tissue, a clump of fat cells which give the breast its particular shape and feel. Interspersed among the tissue are 12-20 lobes and lobules; the gland that produces milk in lactating women. These then connect to milk ducts which bring milk to the nipple. An abnormality in these structures is often the origin of breast cancer.
The breast is also comprised of ligaments and fibrous connective tissue to keep the structure together, nerves to stimulate and potentiate feeling, lymph vessels and nodes to fight disease, and blood vessels to provide oxygen and nutrition to the overall breast tissue.
Breast Disorders and Symptoms
Common symptoms of breast abnormalities include pain in the breast, lumps or masses, fluid discharge from the nipple, and skin changes like redness and swelling. These symptoms are common and are the reason for more than 15 million visits to the doctor each year.
These though, are not always the cause of concern. Breast pain for example, may be because of menstrual periods, pregnancy, or certain drugs. Always see your doctor to be sure. Don’t mess around with breast concerns.
Here are some of the most common benign breast disorders. Some increase the risk of cancer, but are not typically cancerous themselves.
- Also known as adenosis, aggregate adenosis, tumoral adenosis, and adenosis tumor.
- Signs and symptoms: Adenosis is a painless mass in breast.
- Overview: Adenosis is a breast tumor common in young women. It affects the lobes of the breast tissue. These lobes are enlarged or increased.
- Breast cancer risk: The risk is low, but is slightly increased if the mass hardens (sclerosing adenosis).
- Diagnosis: Adenosis is normally diagnosed with a biopsy.
- Treatment: May be removed by surgery, but adenosis does not normally need any special treatment.
Mammary duct ectasia
- Also known as duct ectasia or periductal mastitis.
- Signs and symptoms:
- Sticky and thick green or black nipple discharge
- Nipple and breast tissue tender and red
- Lump or mass in the breast
- Overview: Duct ectasia is a widening and thickening of the milk duct, causing a buildup of fluid behind the block.
- Breast cancer risk: Duct ectasia is not believed to increase the risk of breast cancer.
- Diagnosis: Depending on the symptoms you present, testing by ultrasound or mammography may be indicated.
- Treatment: Duct ectasia can get better without treatment. Warm compresses and antibiotics may be advisable. Breast surgery may be necessary to remove an abnormal duct.
Ductal and lobular hyperplasia
- Also known as epithelial hyperplasia or proliferative breast disease.
- May be termed either ductal hyperplasia or lobular hyperplasia, depending on the structure of the cells involved.
- Overview: ductal and lobular hyperplasia describe an overgrowth of cells lining the ducts or lobules in the breast.
- Signs and symptoms: There are normally no lumps, but the disorder can be diagnosed by changes in a mammogram.
- Breast cancer risk: There is a link, but it is mild to moderate. Most women who exhibit ductal or lobular hyperplasia do not go on to develop breast cancer.
- Treatment: If hyperplasia is atypical (atypical ductal hyperplasia or atypical lobular hyperplasia), tissue may be removed to ensure there is no cancer.
- Overview: Fat necrosis is a condition of the breast that occurs when the adipose tissue is damaged, possibly from injury to the breast, breast surgery, or radiation treatment. Oil cysts may also occur instead of scarring, if fat cells die and release their contents.
- Signs and symptoms:
- Mass in the breast
- Thicker skin around mass
- Skin may be red or bruised
- Breast cancer risk: Fat necrosis does not increase the risk of breast cancer.
- Diagnosis: Mammogram, ultrasound and biopsy.
- Treatment: Does not need to be treated and may go away on its own. Oil cysts may be removed by needle aspiration.
- Overview: Fibroadenomas are tumors made up of both glandular and connective tissue. The disorder is common in women in their 20s and 30s. The tumors may shrink as one goes through menopause.
- Signs and symptoms: Fibroadenomas present as painless lumps in the breast.
- Breast cancer risk: Risk is increased about 1.5 times as compared to women who experience no breast changes.
- Diagnosis: Doctor’s or self examination, mammogram, ultrasound, or biopsy.
- Treatment: Surgery is required to remove fibroadenomas, though your doctor may recommend no treatment at all. The tumors often shrink on their own.
Fibrosis and simple cysts
- Overview: Cysts and fibrosis are common in women of childbearing age. The growths are commonly constructed of connective tissue or fluid. If fluid-filled, they are known as cysts. If made up of connective tissue, the condition is known as fibrosis.
- Signs and symptoms:
- Painless lumps in the breast
- Menstrual periods may cause cysts to become bigger and possibly painful
- Possible swelling
- Possible clear or slightly cloudy nipple discharge
- Breast cancer risk: Simple cysts or fibrosis does not increase your breast cancer risk.
- Diagnosis: Diagnosed based on symptoms — lumps, pain, swelling. Often confirmed by ultrasound. Biopsy may be indicated.
- Treatment: Simple cysts and fibrosis do not usually need to be removed. They may go away over time.
Granular cell tumors
- Also known as Abrikossoff’s tumor, breast granular cell myoblastoma, granular cell nerve sheath tumor, and granular cell schwannoma
- Overview: A rare form of tumor found in the breast that is often felt as a firm lump that can be moved. It is thought to start in early forms of nerve cells
- Signs and Symptoms:
- Presents as a breast mass that may be attached to the skin or wall of the chest
- Breast cancer risk: Does not increase breast cancer risk
- Diagnosis: Breast examination, mammogram, ultrasound, and biopsy
- Treatment: Breast granular cell tumors are normally removed by surgery, along with a rim of normal breast tissue
- Overview: These are wart-like tumors that may be solitary or multiple. They often grow in milk ducts near the nipple.
- Signs and symptoms:
- Clear or bloodly nipple discharge
- Small lump behind or next to the nipple
- May cause pain
- Breast cancer risk: A solitary papilloma does not increase risk of breast cancer, unless it is found with other breast changes. Multiple papillomas may increase the risk of cancer slightly.
- Diagnosis: Ductograms (x-rays of breast ducts), ultrasounds, and mammograms. Biopsy may also be advised, if the lump is large enough.
- Treatment: Surgery to remove the papilloma and the affected part of the duct.
Lobular carcinoma in situ (LCIS)
- Also known as lobular neoplasia and LCIS.
- Overview: Presents as suspicious cells growing in the lobules of the breast, but that do not grow through the wall of the lobules. Though technically called a carcinoma, carcinomas in situ are not invasive.
- Signs and symptoms: you may feel a soreness or slight lump.
- Breast cancer risk: women found with a lobular carcinoma in situ are at a 7-12 times higher risk of developing invasive cancer.
- Diagnosis: ultrasound, mammography, biopsy.
- Treatment: May be removed by excisional biopsy, depending on the size. This disorder should always be taken seriously and watched closely.
Ductal carcinoma in situ (DCIS)
- Overview: Considered an early form of breast cancer, ductal carcinoma in situ consists of abnormal cells inside a milk duct.
- Signs and symptoms: Normally discovered during a routine breast exam, but may become painful and be palpated earlier
- Breast cancer risk: DCIS is sometimes known as “pre-cancer.” There is disagreement in the medical community over how aggressively it should be treated. Find a breast cancer specialist who will take time to listen to your concerns. Don’t ignore DCIS.
- Diagnoses: Mammography, ultrasound, biopsy.
- Treatment: DCIS is always closely watched. Depending on the size of the affected area and the rate of change, breast cancer specialists often advise breast surgery to remove the DCIS and surrounding tissue.
AUTHOR’S NOTE: This is how my grandmother’s cancer began. She said it “wasn’t serious.” Before long, though, the DCIS spread to become invasive. It was in her lymphatic system by the time she agreed to surgery. Had she listened to the warnings from her doctor, she might still be alive today. Breast cancer surgery can save your life when done in time to halt the spread of the disease.
- Also known as lactation or puerperal mastitis.
- Overview: Mastitis is an inflammation or swelling of the breast caused by an infection. It often affects women who are breastfeeding, and is due to clogged milk ducts, milk not fully draining from the breast, or breaks in the skin.
- Signs and Symptoms:
- Flu-like symptoms
- Swollen, painful, red, and warm breast
- Breast cancer risk: Mastitis does not increase the risk of breast cancer.
- Diagnosis: Breast exam.
- Treatment: Antibiotics. If an abscess forms this may be drained by surgery or by needle aspiration.
- Overview: These are rare breast tumors that start in the connective tissue of the breast, common in women in their 40s. While most are not cancerous, about one in four tumors are malignant.
- Signs and Symptoms:
- Often painless lumps, but may hurt
- Grow quickly and stretch the skin
- Breast cancer risk: Does not increase the risk of breast cancer.
- Diagnosis: Excisional biopsy.
- Treatment: Breast-conserving surgery (lumpectomy) or mastectomy.
Along with these, other lumps in the breast may be:
- Lipoma: A tumor made up of fat cells
- Hamartoma: An overgrowth of mature breast cells
- Hemangioma: A tumor made of blood vessels
- Hematoma: A blood filled cyst
- Adenomyoepithelioma: A very rare tumor made up of certain cells of the milk duct walls
- Neurofibroma: A tumor made up of an overgrowth of nerve cells
Common Malignancies of the Breast (Breast Cancer)
General symptoms of breast cancer:
- Breast pain
- Abnormal nipple discharge
- Lump in underarm area
- Nipple pain or nipple turning inward
- Swelling of the breast
- Skin irritation
- Redness, scaliness, or thickening of the nipple or breast
As you can see, these same symptoms often occur with non-malignant (benign) breast abnormalities. That’s why it is so very important that you seek medical attention when something unusual occurs in your breast.
By the way, men can get breast cancer too — though the situation is rare. Less than one percent of breast cancers are male-centered.
Common Types of Breast Cancer
In situ breast cancers ( do not spread)
- Ductal carcinoma in situ (DCIS – already mentioned above)
- Lobular carcinoma in situ (LCIS – already mentioned above)
Invasive (infiltrating) breast cancer – Invasive ductal carcinoma (IDC)
About eighty percent of invasive breast cancers are infiltrating ductal carcinomas (IDC’s). This cancer starts in the lining of the milk duct and breaks through its wall, spreading to nearby tissues. IDC can also spread to other parts of the body through the lymph nodes and the blood stream.
Invasive lobular carcinoma (ILC)
About ten percent of invasive breast cancers are invasive lobular carcinomas. This cancer starts in the lobules of the breast. Similar to IDC, it can spread to other parts of the body through the lymphatic system and bloodstream. It is harder to detect than IDC.
Inflammatory breast cancer (IBC)
IBC is a type of cancer with symptoms similar to mastitis: swelling or redness. In the case of IBC, though, the symptoms aren’t caused by infection or injury. Rather the irritation is caused by cancer cells blocking lymph vessels in the skin.
- Symptoms of IBC:
- Purple or red color of skin
- Pitting or thickening of skin of breast (looks and feel like an orange peel)
- Retracted or inverted nipple
- May be tender, painful, or itchy
Paget disease of the nipple
This is a cancer that starts in ducts and spreads to the nipple and to the areola. This may be diagnosed with other tumors through diagnostic mammograms, breast ultrasounds, or an MRI. But only a biopsy can ascertain that it’s cancer.
- Symptoms related to Paget disease of the nipple:
- Crusted, scaly, and red nipple and areola
- May have blood or yellow fluid nipple discharge
- Nipple may be flat or inverted
- May burn or itch
Treatments for breast cancer
Your breast cancer surgeon’s primary desire will be to rid your body of cancer and prevent it from coming back. Each treatment is tailored, by your breast cancer specialist, to you, the type of breast cancer you have, the size of the tumor, the stage of the disease, and other factors.
The first job is to remove the disease from the breast. Those breast cancer treatments include surgical procedures (mastectomies and lumpectomies) and radiation therapy. A mastectomy is a surgery wherein the whole breast is removed. A lumpectomy is when only the tumor and associated tissure are removed (also known as breast-conserving surgery).
Other possible treatments include chemotherapy, hormone therapy, and targeted therapy (therapy which orders the immune system to destroy the cancer). If the cancer has spread, the battle will necessarily be waged on several fronts.
AUTHOR’S NOTE: My grandmother’s DCIS broke through to become an invasive ductal carcinoma. Once again, had she agreed to aggressive treatment while it was still in situ, she might still be with us today. I think of her often and wonder why she had to be so resistant to modern medical care. Dr. Higgin’s patients often say he is one of those rare doctors who will listen carefully to your every concern. My grandma said her doctor was demanding and wouldn’t listen to her. I believe that is part of why she wouldn’t cooperate.
As you can see, are plenty of disorders associated with the breast, and a good number of them AREN’T cancerous. These descriptions aren’t meant to replace a visit to your doctor. My aim has been to honor my grandmother by telling the story … and hopefully to encourage you to find a doctor you trust, then listen to that professional as if your life depended on it … for it may. You can always get additional opinions from doctors of varying medical philosophies, but don’t play roulette with your health. Breast cancer can often be stopped when caught in time.
Please Note: The articles on Dr. Andy Higgins’ website are obtained from a variety of sources. While they pertain to the treatment of breast cancer, colon cancer, and other maladies, their presence here is not to help diagnose or treat any disease, but to stimulate conversation about health-related issues. All articles are cleared by an editor, but not necessarily by Doctor Higgins himself.