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Home What is Breast Cancer Diagnosis When should I be concerned about changes in my breast?

When should I be concerned about changes in my breast?

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We all know that a woman’s breasts undergo many changes throughout puberty, pregnancy, and after menopause. However, sometimes breast changes occur when you’re not expecting them – changes such as breast pain, nipple changes, breast discharge, and breast lumps. Most of the time, these changes are not cancer – but it’s still important to get checked out by your doctor to be absolutely sure!

Below are some of the more common breast changes that women experience and some information about what they might mean:


Breast Pain

Breast pain can be either cyclic or non-cyclic.

Cyclic breast pain is associated with the menstrual cycle, and is present only in the days before or during your period. Pain of this nature is almost never related to cancer, but can be uncomfortable or even unmanageable for some women. There are things doctors can recommend to diminish breast pain, so go see your doctor if the pain becomes unbearable or starts to interfere with your normal activities.

Non-cyclic breast pain is pain that is not associated with the menstrual cycle. This may mean that it’s there all the time, or comes and goes at random times. Some common causes of this kind of breast pain are acute mastitis, periductal mastitis, and fat necrosis. Acute mastitis is an infection of the breast associated with breast-feeding. It usually occurs in the first month of breast-feeding and is caused by bacteria from the skin or the baby’s mouth getting into small cracks in the nipple and causing an infection. In acute mastitis, the breast is often swollen, red, hot, and often associated with a fever. It is safe to continue breast-feeding (although it may be painful), and it is important to go see your doctor as antibiotics are needed to treat the infection. Periductal mastitis is an infection of the breast that is usually just under the nipple or areola area. Sometimes if the infection progresses it can cause an abscess (a bacteria and fluid filled cyst), which feels like a mass under the areola. It is often red, and sometimes can cause the nipple to be pulled inward towards the breast. This infection also needs to be treated with antibiotics and if an abscess has formed, it may need to be drained, so a visit to the doctor is definitely indicated. Fat necrosis is an area of breast tissue that has been injured, usually due to trauma such as a seat-belt injury, running without a supportive bra, or from previous breast biopsy or surgery. Fat necrosis may be painful, but can also be non-painful. Many times it shows up as a hard mass in the breast and so can be very worrisome. It is more common in women with large breasts or dense breast tissue, such as in African American women. Although fat necrosis is not cancerous and does not lead to cancer, it is often difficult to tell the difference between the two, so it is always important to go to the doctor and have any lump evaluated. While 95% of painful breast lumps are not cancer, 10% of breast cancer is painful [1] – so always err on the side of safety!


Nipple Changes

Nipple changes can be caused by cancer, but can also be due to other breast disease that is not cancerous. Nipple changes include redness, thickening or pitting of the areola, changes in color, nipple deviation away from its normal position, inversion towards the breast, flattening, or sores on the nipple that don’t heal. Any and all nipple changes should be checked by a doctor to rule out cancer.


Breast Discharge

Nipple discharge is pretty common. The discharge can be either from one breast, or from both breasts.

Galactorrhea is milky white discharge from both breasts. It can be caused by constant nipple stimulation (from a poorly fitted bra, for instance). Also some medications (such as oral contraceptive pills, tricyclic antidepressants, methyldopa, and phenothiazines) can cause discharge [1]. Hormonal imbalances in the body can be the cause of galactorrhea. Galactorrhea outside of pregnancy should be evaluated by a doctor.

Breast discharge from one breast is more likely to be caused by an underlying breast change that may be either benign or malignant. Thus it is important to see your doctor for further investigation.


Breast Lumps

There are many causes for breast lumps, including abscesses and fat necrosis (discussed above), as well as both benign and malignant tumors. The majority of breast lumps in women under the age of 40 are benign. The risk of breast cancer increases with increasing age. All breast lumps need to be evaluated by a doctor! Some common causes of benign breast lumps not previously discussed include breast cysts and fibroadenomas. Breast cysts are a common cause of breast lumpiness, and are fluid-filled sacs lined by breast tissue. They are rarely cancerous, but still need to be evaluated by a doctor to rule out cancer. Fibroadenomas are small, firm, rubbery, mobile masses in the breast, usually in women between the ages of 20 and 40. They are relatively common and almost never lead to cancer. Phyllodes tumor is a larger, more aggressive version of a fibroadenoma which is more likely to be invasive and can become cancerous about 10% of the time [2].


Breast Changes in Men

While far less common than in women, men can also experience breast changes. The most common breast change in men is called gynecomastia, which is an enlargement of male breast tissue. Gynecomastia can be in one breast or both breasts. It is normal for a little bit of breast enlargement to occur around puberty and in older men due to hormonal changes. Gynecomastia can also be caused by certain drugs such as alcohol, marijuana, heroin, antiretroviral drugs, anabolic steroids, and psychoactive drugs. It is common in men with underlying cirrhosis of the liver due to an overproduction of estrogen. Gynecomastia is rarely due to cancer, but should still be assessed by a doctor to find and treat the underlying cause.

About 1% of all breast cancers occurs in men – so breast lumps in men also need to be promptly evaluated by a doctor.


Olga Kantor, Shikha Jain, MD


References

[1] Kumar et al, eds. “Chapter 23: The Breast”. Robbins and Cotran Pathologic Basis of Disease, 8th ed. 2010.

[2] D.M. Miltenburg, MD and V.O. Speights Jr DO. “Benign Breast Disease”. Obstetrics and Gynecology Clinics of North America. Vol 35: 285-300, 2008.