Description
The breasts are intricate structures made up of tissue, fat, and glands. Developing a breast lump, cyst, or tumor is a rather typical occurrence. We call this benign breast illness. Even though none of these breast disorders are deadly or malignant, they could raise your chance of getting breast cancer in the future. Even while the majority of breast diseases don't result in cancer, the idea is to get familiar with the feel and appearance of breasts to recognize changes even if the majority of breast diseases are not malignant.
Summary Listen
- Breast diseases are relevant to a large population, with breast cancer being the most common cancer in women worldwide, including India, where approximately two lakh new cases are diagnosed annually.
- Distinguishing benign breast conditions from cancerous ones is crucial, as clinical presentations can be confusing, particularly in young, breastfeeding women or those undergoing menopause. Some cancers in these groups can mimic benign conditions like breast cysts.
- A significant percentage (4%) of breast cancers present with palpable masses that are not detected on imaging, emphasizing the importance of clinical examination, thorough history taking, and a detailed breast examination.
- No age is exempt from breast cancer, and early diagnosis is critical for improving patient outcomes, as survival rates decrease from 95% in early stages to 70% in advanced stages.
- Common breast symptoms include breast pain, breast lumps, skin or nipple changes, nipple discharge, and lumps in the armpit.
- Fibrocystic breast disease is a common benign condition, typically presenting with breast nodularity, cysts, and painful, lumpy breasts in women aged 20 to 50. Fibroadenomas, another common benign condition, usually present as mobile lumps that gradually increase in size.
- Phylloid tumors, although less common, can be locally aggressive and require careful differentiation from fibroadenomas, as they fall on a spectrum of fibroepithelial lesions.
- Other benign breast conditions include fat necrosis, mastitis (acute and chronic), and nipple discharge caused by papillomas or duct ectasia. Bloody or clear nipple discharge from a single duct warrants further investigation.
- A triple assessment, including clinical examination, breast imaging (ultrasound and mammography), and pathological assessment, is essential for accurate diagnosis.
- Breast MRI is used for specific indications, such as in cases of high risk or indeterminate findings.
- The age of the patient, along with presenting features, onset, duration, and progression of the condition, helps in differentiating various breast diseases.
- Fibrocystic disease presents with lumpy, nodular breasts and tenderness, while fibroadenomas are hard, mobile lumps. Phyllodes tumors are large, less mobile, and may have prominent veins.
- Ultrasound is generally the initial imaging modality, while diagnostic mammography is usually considered for patients over 30. Screening mammography typically starts at age 40.
- Triple assessment aims to rule out breast cancer while reaching a diagnosis of a specific breast pathology. The management pathway is dependent upon the resulting pathology.
- Core needle biopsy is the gold standard for pathological assessment. Fine needle aspiration is an accepted preliminary investigation.
- Important aspects of history taking include age, gender, onset, duration, other symptoms, reproductive history, and a risk assessment. There are various models for risk assessment and genetic evaluation can be warranted if one has a significant family history of cancer.
- Lifestyle, environment, and hormone exposure are modifiable risk factors for breast cancer.
- Physical examination should note any lumps, skin thickening, dimpling, or skin changes.
- Ultrasound and mammography are complementary imaging modalities. Ultrasound is preferred to image the breast in younger populations with greater breast density. Mammography can better visualize calcifications.
- Byrads is the scale used to classify imaging features of the breast. Byrads 1 and 2 are usually benign, Byrads 3 is probably benign and necessitates follow-up imaging, Byrads 4 has a moderate risk of malignancy, Byrads 5 has a high risk of malignancy, and Byrads 6 has a diagnosis of cancer based on tissue sampling.
- Management of benign breast conditions, such as fibroadenomas, involves observation, surgical excision, or vacuum assisted excision, depending on the patient's age, size of the lesion, and symptoms.
- Surgical intervention is reserved for patients with mass growth, uncertain diagnosis, symptomatic breast pain, and/or emotional distress.
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About the Speakers
Dr. Anushree Vartak
Senior Consultant Breast Surgical Oncology, Yashoda Superspeciality and Cancer Institutes, Ghaziabad
Financial Disclosure
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