Chapter 52: Breast Disorders
Screening guidelines for early detection of breast cancer are yearly mammograms starting
at age 40, and clinical breast examinations every 3 years for women between ages 20 and
30 and every year for women beginning at age 40.
Women should report any breast changes promptly to their health care provider.
Breast self-examination is an option for women.
Women at increased breast cancer risk (family history, genetic tendency, past breast
cancer) should talk with their health care provider about benefits and limitations of
starting mammography screening earlier, having additional tests (breast ultrasound), or
having more frequent examinations.
Mammography is used to visualize internal structures of the breast using x-rays. This
procedure can detect tumors and cysts not felt by palpation.
Ultrasound is another procedure used to differentiate a benign tumor from a malignant
tumor. It is useful for women with fibrocystic changes whose breasts are very dense.
Definitive diagnosis of breast cancer is made by histologic examination of biopsied
tissue. Biopsy techniques include fine-needle aspiration (FNA) biopsy, stereotactic or
handheld core biopsy, and open surgical biopsy.
Mastalgia (breast pain):
o Mastalgia is the most common breast-related benign complaint in women.
o It is described as diffuse breast tenderness or heaviness.
o Breast pain may last 2 to 3 days or most of month.
o Symptoms often decrease with menopause.
o Some relief may occur with caffeine and dietary fat reduction; hormonal therapy,
taking vitamins, and gamma-linolenic acid (evening primrose oil); and wearing of
o Mastitis is a breast inflammatory condition that occurs most frequently in
o Lactational mastitis manifests as a localized area that is erythematous, painful,
and tender to palpation.
o Fever is usually present. Infection develops when organisms, usually
staphylococci, gain access to breast through cracked nipple.
o In its early stages, mastitis can be cured with antibiotics.
Fibrocystic changes in breast:
o Fibrocystic changes is a common benign condition characterized by changes in
breast tissue including development of excess fibrous tissue, hyperplasia of epithelial lining of mammary ducts, proliferation of mammary ducts, and cyst
o These changes produce pain by nerve irritation from edema in connective tissue
and by fibrosis from nerve pinching.
o Types of treatment that might help fibrocystic breast disease include use of good
support bra, dietary therapy (low-salt diet, restriction of methylxanthines such as
coffee and chocolate), vitamin E therapy, analgesics, danazol, diuretics, hormone
therapy, and antiestrogen therapy.
o Fibroadenoma is a common cause of benign breast lumps in young women. A
possible cause may be increased estrogen sensitivity in localized area of breast.
Treatment includes surgical excision or cryoablation.
o Gynecomastia is a transient, noninflammatory enlargement of one or both breasts
and is the most common benign breast problem in men.
Breast cancer is the most common malignancy in American women except for skin
Although the etiology of breast cancer is not completely understood, a number of factors
are thought to relate to breast cancer including a family history, environmental factors,
genetics, early menarche and late menopause, and age 60 or over. However, most women
who develop breast cancer have no identifiable risk factors.
Noninvasive breast cancers include ductal carcinoma in situ (DCIS) and lobular
carcinoma in situ (LCIS).
o DCIS tends to be unilateral and most likely would progress to invasive breast
cancer if left untreated.
o LCIS is a risk factor for developing breast cancer, but it is not known to be a
premalignant lesion. No treatment is necessary for LCIS. Tamoxifen may be