Breast self-examination :
breast self-examination is a useful and important screening tool
especially when used in combination with regular physical exams by a doctor, mammography, and in some cases ultrasound and/or MRI.
Breast self-exam is a convenient, no-cost tool that you can use on a regular basis and at any age.
recommend that all women routinely perform breast self-exams as part of their overall breast cancer screening strategy
procedure;
- Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Here’s what you should look for: Breasts that are their usual size, shape, and color Breasts that are evenly shaped without visible distortion or swelling
- Now, raise your arms and look for the same changes.
- While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).
- Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast.
Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together.
Use a circular motion, about the size of a quarter.
Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast.
You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast.
You can also move your fingers up and down vertically or in rows
Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back.
When you’ve reached the deep tissue, you should be able to feel down to your ribcage.
5.Finally, feel your breasts while you are standing or sitting.
Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower.
Cover your entire breast, using the same hand movements described in step 4.
If you see any of the following changes, please visit your doctor:
- Dimpling, puckering, or bulging of the skin
- A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
- Redness, soreness, rash, or swelling
Breast lesions:
- breast cysts
- fibroadenoma
- fibrocystic adenoma
- lipoma
- breast cancer
- mastitis
Breast fibroadenoma
Overview:
Breast fibroadenomas are the most common type of noncancerous (benign) breast tumor.
They usually occur in premenopausal women, and may grow during pregnancy, breastfeeding, or estrogen therapy.
Fibroadenomas can be felt during your monthly breast self-exam and will show up on mammograms and ultrasounds. Fibroadenomas are often described as round, painless breast lumps, which feel smooth and rubbery.
Although fibroadenomas have a typical feel on physical examination and appearance on breast ultrasound, the only way to be sure that a breast lump is a fibroadenoma is through a biopsy. Proven fibroadenomas may not need treatment unless they are large, fast growing, or cause bothersome symptoms.
Symptoms:
Typically, the only symptom of a fibroadenoma is a small lump in the breast that you may discover during a self-exam.
These lumps feel firm, round, smooth, rubbery, and are movable.
Fibroadenomas are so mobile that women sometimes refer to them as “breast mice,” as they tend to run away from your fingers.
The masses may feel tender or painful, especially right before your period, when they may swell due to hormonal changes.
Most fibroadenomas are between 1 and 5 centimeters in diameter.
Causes:
The exact cause of fibroadenomas is unknown.
They seem to be influenced by estrogen because they appear most often in premenopausal or pregnant women, or in women who are taking estrogen therapy.
Conversely, they may shrink or disappear after menopause.
Most fibroadenomas change in size during your menstrual cycle, when your hormone levels are changing.
Thus, during this period, the same fibroadenoma can become more noticeable or it may shrink to the point where it is not easily detected.
Risk Factors:
- women who are between 15 and 30 years old
- during pregnancy
- Once you hit menopause, your risk goes down unless you’re using estrogen therapy
Diagnosis:
A fibroadenoma may first be discovered on physical examination or during a routine screening mammogram.
On a mammogram, fibroadenomas appear as round or oval smooth-edged masses.
The outline will be clearly defined, not blurry, and will not be invading the adjacent spaces.
Sometimes they are accompanied by coarse calcifications (calcium deposits).
Fibroadenomas can look like cysts or a well-contained tumor.
If you notice a lump during an exam or if an abnormality is seen on mammography, a breast ultrasound is usually the next step.
This is especially true if you have dense breast tissue, which can make a lump more difficult to view.
On ultrasound, a fibroadenoma will be easier to distinguish from other tissue because of the way it responds to sound waves.
It will appear as a dark area with a definite outline.
It will look homogeneous (looks the same throughout), round or oval, and may have smooth-edged bumps.
Biopsy: while imaging tests may suggest a fibroadenoma, the conclusive diagnostic test is usually a breast biopsy, a procedure to remove a sample of tissue for examination in a lab.
Different types of biopsy procedures include fine-needle aspiration or core-needle biopsy, both of which use needles to extract tissue, and open biopsy, a surgical procedure in which a cut is made in the skin to extract sample tissue.
Treatment:
It’s important to distinguish between the two types of fibroadenomas when choosing the best treatment options because of the difference in associated breast cancer risk.
Fibroadenomas are classified as either:
- Simple:
Most fibroadenomas are the simple type; they are more common in younger people.
There’s usually just one mass in your breast, with a definite border and very uniform cells.
A simple fibroadenoma does not raise your risk for breast cancer.
- Complex ( hyperplasia and phyllodes tumor)
Complex fibroadenomas are less common but become more common as people age.
While they may have a definite border, it’s what is inside this kind of fibroadenoma that makes it different.
Under a microscope, a complex fibroadenoma will not look organized and uniform like a simple one.
Having a complex fibroadenoma can raise your risk of developing breast cancer.
Aside from fibroadenoma type, other factors may influence treatment choice, such as:
- Symptoms, especially discomfort and pain
- Emotional state, such as undue worry about it being cancer
In considering all of this, your healthcare provider will recommend one of the following fibroadenoma treatment options.
Close observation:
Since fibroadenomas are not always troublesome and sometimes shrink on their own, just keeping an eye on their progress is the least invasive way to handle them.
Ablation (laser – vacuum – radio frequency):
an ultrasound-guided device is used to destroy the fibroadenoma, leaving behind only a tiny scar, no sutures, and no change in breast shape.
You don’t need general anesthesia, and it’s usually an outpatient procedure, which means no hospital stay
Lumpectomy:
Surgical removal can be done if you’re worried about a fibroadenoma.
Depending on the relative size of the lump and your breast, a lumpectomy may cause a change in your breast’s size or shape.
New fibroadenomas may grow in the area of the first lump, so you should know that surgery is not a guarantee that you’ll never have another fibroadenoma.
On the other hand, your fibroadenoma can be carefully examined by a pathologist to make sure your diagnosis is correct.
Summary:
Breast fibroadenomas are the most common type of noncancerous (benign) breast tumor.
They usually occur in premenopausal women.
They may be felt during your monthly breast self-exam, and they can be detected on imaging with mammography or ultrasound.
The only way to be sure that a breast lump is a fibroadenoma is through a biopsy.
Most fibroadenomas are considered simple and are not associated with an increased risk of breast cancer.
Some fibroadenomas are considered complex, because their cells look unusual under a microscope.
Women with complex fibroadenomas have an increased risk of developing breast cancer, and they may require careful monitoring for signs of developing cancer.
Proven fibroadenomas may not need treatment unless they are large, fast growing, or cause bothersome symptoms.
Breast cysts
Overview:
Breast cysts are fluid-filled sacs that are among the most common breast lumps a woman may have.
They may also be a cause of other breast symptoms from pain to, nipple discharge.
Many women develop noncancerous changes in their breast tissue.
It’s one of the conditions known as fibrocystic breast disease, which includes fluid-filled cysts.
A cyst may show up in one or both breasts at the same time and in different parts of the breast.
Some cysts are so small that patients don’t feel a lump.
For many patients, breast cysts don’t have symptoms: Only about 7%of women have a breast cyst that may be felt with the hand.
Simple fluid-filled cysts form from fluid buildup in the breast glands. Microcysts are tiny and may only be spotted under a microscope.
Then there are complex cysts, which are either solid or filled with fluid and solids. These cysts may require a biopsy and drainage to check the cells, a procedure designed to determine whether the cyst is cancerous.
On rare occasions, complex cysts are cancerous or increase the risk of developing cancer later.
Symptoms:
Women with cysts may notice their breasts feel more painful before menstruation.
In addition to tenderness and, possibly, one or more lumps, they may also experience nipple discharge that is clear or slightly cloudy.
Oftentimes, a cyst is detected on a mammogram, and it’s usually not a cause for concern.
Risk factors:
Breast cysts are most common for women who are premenopausal, which typically describes those who are about age 30 to 50.
Although less common, menopausal women may still develop one.
This may be especially true if they’re taking menopausal hormone therapy, which is meant to reduce the symptoms of menopause and long-term biological changes, including bone loss.
Diagnosis:
Diagnosis is typically done through:
Doctor evaluation:
- Detailed information about what they’re experiencing, including a description of the pain and whether it’s affected by the menstrual cycle
- Recent injuries to that area
- Skin or nipple changes, such as nipple discharge
- Full history of past medical and surgical issues
- Age that menstruation and menopause, if applicable, started
- Family or personal history of breast cancer
- The doctor will examine the patient’s breasts, neck and chest, as well as the area under the arms.
Imaging:
including ultrasound or mammogram
- Ultrasound: The ultrasound reveals whether a mass is solid or filled with fluid.
This procedure is used in younger women who may have more dense breast tissue.
- Mammogram: This imaging test is a type of X-ray that takes images while the breast is pressed between plastic plates.
In some cases, women with dense breasts may undergo a mammogram and an ultrasound.
- Magnetic resonance imaging (MRI): It may be used as an adjunct to other imaging tests in patients at higher risk for breast cancer when results are unclear.
Biopsy:
Fine-needle aspiration or core needle biopsy
These procedures may help to confirm the diagnosis by collecting fluid and/or tissue.
- Fine-needle aspiration uses a needle to drain fluid from the cyst.
- core needle biopsy removes small pieces of breast tissue.
Treatment:
Once confirmed, a simple cyst doesn’t usually require treatment. Doctors may recommend monitoring the cyst over time.
If the patient is experiencing pressure and pain, doctors may rain the cyst, removing fluid and cells through the fine needle aspiration process.
A cyst also may be drained if its size is likely to interfere with a clinical breast exam.
It’s possible the cyst will fill back up with fluid later or go away over time.
A cyst may be surgically removed if:
- Drain failed
- Drain bloody fluid
- Suspicious cyst component
Gynecomastia
Overview:
Gynecomastia is a condition that makes breast tissue swell in boys and men.
It can happen when the balance of two hormones in your body is thrown off.
If you have enlarged breasts because of fat deposits, you have a different condition called “pseudogynecomastia.”
Although breasts don’t develop in men the way they do in women, all boys are born with a small amount of breast tissue.
males’ bodies mostly make a hormone called testosterone, which guides their sexual growth during puberty.
But males also make some estrogen , the hormone that steers sexual growth in girls.
When a boy is going through puberty, or when an older man’s body makes less testosterone, the balance of the two hormones changes.
Sometimes when that happens, a higher percentage of estrogen causes male breast tissue to swell.
About half of adolescent boys and as many as two-thirds of men older than 50 will have this to some degree.
Symptoms:
Your first sign of gynecomastia may be a lump of fatty tissue under the nipple.
Sometimes this lump is tender or sore.
This might make you worry that you have breast cancer, which does occur in a small number of men.
Gynecomastia is not necessarily a sign of cancer, but your doctor may run some tests to rule it out.
Swelling of the breasts may happen unevenly, with one becoming larger than the other. You may also have breast tenderness.
See your doctor if you notice that your breasts have swelling, are painful or tender, or there is a discharge from the nipple of one or both breasts.
Causes:
A lot of things can trigger the hormone imbalance that causes male breast growth, and many times the exact cause isn’t known.
In addition to body changes such as puberty and aging, some things that can cause gynecomastia are:
- Injury or diseases that affect the testicles, which make testosterone
- Thyroid problems, since hormones from that gland control growth and sexual development
- Some cancers, including tumors of the lungs, pituitary gland, or adrenal glands
- Obesity, which can result in more estrogen
- Illegal drugs, including anabolic steroids, marijuana, and heroin
- Kidney failure(when they can no longer clean and filter your blood)
- Liverdisease
Some infant boys may get gynecomastia briefly while hormones from their mother are still in their bodies.
Some types of medicines can lead to gynecomastia, such as:
- Anti-androgens. These are drugs that treat an enlarged prostate or prostate cancer.
- Anabolic steroids and androgens.
- Athletes sometimes use these drugs illicitly in an effort to improve their athletic performance.
- HIV drugs: gynecomastia can sometimes be a side effect of an HIV treatmentcalled “highly active antiretroviral therapy.”
- Anti-anxiety drugs: medicines such as diazepam(Valium) can sometimes cause gynecomastia.
- Heart medications: drugs such as digoxin (Lanoxin) and calcium channel blockers can lead to gynecomastia sometimes.
- Medicines used to empty your stomach as metoclopramide(Reglan) can have gynecomastia as a side effect.
- Ulcer drugs: some medicines that you buy over the counter for ulcers can lead to gynecomastia, such as cimetidine(Tagamet HB).
- Some antibioticscan also cause gynecomastia.
- So can tricyclic antidepressants and some cancer treatments.
Diagnosis:
Medical history in details with physical examination
Oher investigations could include:
- Blood tests or urine samples
- Mammogram
- Biopsy
- CT scans
- MRI scans
- Testicular ultrasounds
Treatment:
Most cases slowly get better on their own without treatment.
When you have gynecomastia, your doctor might refer you to an endocrinologist, who treats problems related to hormones and how they affect your body.
How your condition is treated may depend on your age, your health, how long your condition may last, and how well you respond to certain drugs.
If gynecomastia happens during puberty, it usually goes away on its own.
This might take anywhere from 6 months to 3 years.
If it turns out your hormones are out of balance because of another health problem, you’ll want to treat that underlying condition.
You might be given medication to address the hormone imbalance that’s causing breast growth.
In some cases, you might need surgery. may recommend techniques such as:
- Liposuction (removal of extra breast fat)
- Mastectomy (removal of breast gland tissue)
- Both technique at same time
