Breast Health- 01

Anatomy of the Breast

Why Do My Breasts Hurt?
Breast Problems Overview
Diagnosing and Treating Breast Problems
Healthy Breasts for a Lifetime
Fibrocystic Breast Changes
Breast Calcification's
Breast Infection
Breast and Nipple Discharge
How Babies Change Your Breasts

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Anatomy of the Breast

Visuals of the Breast Lymph Nodes and Hormones

Each breast contains blood vessels, as well as vessels that carry a fluid called lymph. Lymph travels throughout the body through a network called the lymphatic system, carrying cells that help the body fight infections. The lymph vessels lead to the lymph nodes (small, bean-shaped glands).

One group of lymph nodes is located in the armpits, above the collarbone and in the chest. If breast cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body via the lymphatic system. Lymph nodes are also found in many other parts of the body.

Breast development and function depend on the hormones estrogen and progesterone, which is produced in the ovaries. Estrogen elongates the ducts and causes them to create side branches. Progesterone increases the number and size of the lobules in order to prepare the breast for nourishing a baby.

After ovulation, progesterone makes the breast cells grow and blood vessels enlarge and fill with blood. At this time, the breasts often become engorged with fluid and may be tender and swollen.

Why Do My Breasts Hurt?

Why Do My Breasts Hurt?

Soreness, swelling, heaviness, shooting or burning pangs, tightness -- whatever the feeling, breast pain hurts. It can be troubling, too -- it’s very common to wonder if what you’re feeling might be a sign of breast cancer.

Doctors call breast pain “mastalgia.” It’s important to track the cause of it. But know that pain in either or both of your breasts in itself isn’t a sign of breast cancer. Breast tenderness and another discomfort can happen for lots of different reasons. This article examines the most common ones.

Cyclical Breast Pain

Your breast pain is likely cyclical -- meaning it’s linked to your reproductive cycle -- if you have some of these signs:

• The pain feels achy and heavy
• Your breasts swell or seem lumpy
• Both breasts are affected, mainly the upper and outer areas. Sometimes, the pain can radiate to your armpits
• Symptoms get worse during the 2 weeks before your period, then improve afterwards
• You’re in your childbearing years (around your 20s and 30s), or you’re approaching menopause

To help ease cyclical breast pain, your doctor might recommend you take oral contraceptives, or she may tweak the dosage you already take. She might also suggest you cut back on caffeine or try over-the-counter pain relievers like acetaminophen, ibuprofen, or naproxen sodium.

Hormone Levels

Most breast pain seems to relate to the levels of two hormones -- estrogen and progesterone -- in your body. Doctors aren’t sure what triggers breast pain. It can happen at different times in your reproductive life, such as during:

• Puberty
• Your monthly period or when you have premenstrual syndrome (PMS)
• Pregnancy, usually in the first trimester
• Breastfeeding. Sometimes a blocked milk duct can get infected, a painful condition called mastitis. It needs to be treated immediately, usually with antibiotics.
• Menopause

Fibrocystic Breast Changes

This is likely linked to hormones, as well. Fibrous tissue (breast tissue that’s scar-like or ropey) and cysts (fluid-filled sacs) form in your breasts. It can be painful, but it’s normal and usually harmless.

About half of women in their 20s to 50s get it. You don’t need treatment unless your symptoms are severe.

Fatty Acid Imbalance

These acids are found in vegetable and animals oils. If there’s an imbalance of them in your cells, your breasts can be more sensitive to hormones.

To reduce your symptoms, try cutting down the fat in your diet. Your doctor might also recommend a diet high in complex carbs.

Some doctors think taking evening primrose oil helps correct fatty acid imbalances, too.

Noncyclical Breast Pain

Breast pain also can be triggered by reasons other than hormones. Yours might be linked to another issue if:

• Your pain feels like soreness, burning, or tightness
• Discomfort is constant (or unpredictable)
• Pain seems to affect one breast in a particular area
• You’ve passed menopause

Extramammary Breast Pain

This pain feels like it’s coming from your breasts. But it’s actually radiating from somewhere else, often the chest wall.

Usually, the pain gets better with rest, nonsteroidal anti-inflammatory meds (NSAIDs), and sometimes cortisone injections.

If you strain your pectoralis major muscle (that’s located beneath and around your breasts) it also can feel like your breasts are the source of the pain. This can result from activities like lifting, raking, and shovelling.

Infection

Though mastitis usually occurs in women who are breastfeeding, it can happen at any age. If your clothes chafe against your nipples, that can irritate them, too. It can let in bacteria that may lead to infection.

Injury

Trauma to a particular area of your breast -- such as from having surgery or getting implants --

can cause breast pain. Sometimes an injury can cause a breast vein to swell and a blood clot to form. Though painful, it’s usually not serious.

Medications

Certain prescription meds, as well as hormone medications, can cause breast pain. These include some heart medications and psychiatric drugs.

Support Issues

Women with large, heavy breasts can suffer pain from stretched ligaments and breast tissue. It can hurt not only in your breasts, but in your back, neck, and shoulders, as well. Reduction surgery can help, but it, too, can cause pain if the tissue is damaged during the operation.

A supportive, sturdy bra can help keep your breasts in place. Wearing a sports bra to bed and when exercising can also help.

Breast Problems Overview

Understanding Breast Problems -- The Basics

The female breast is an organ that changes with puberty, with the monthly menstrual cycle, and with pregnancy. It also continues to change with age.

Most changes in your breasts are perfectly normal and no cause for concern. But some changes need medical attention. Chief among these are breast pain and lumps.

Breast Lumps

Breast lumps come in many forms, including cysts, adenomas, and papillomas. They differ in size, shape, and location, as well as in causes and treatment. About half of all women have lumpy breasts or fibrocystic change. They are more common during the premenstrual period and usually disappear after menopause. Most lumps are benign and do not signal cancer; however, any time you find a new or unusual lump, have your doctor check it to make sure it is not precancerous or cancerous.

Researchers are studying the incidence of breast lumps in women using hormone replacement therapy (HRT). In combination HRT, women take the hormones estrogen and progestin to ease the symptoms of menopause. In 2002, a study called the Women’s Health Initiative discovered that HRT resulted in more harm than good. Taking both hormones was shown to increase the risk of breast cancer and change the breast's structure, increasing breast density and making mammograms harder to read. This could make finding cancer more difficult. To put this into numbers, if 10,000 women took combined HRT for a year, this would add up to about 8 more cases of breast cancer per year than if they had not taken hormone therapy (HT).

Cysts, which can be large or small, are harmless, fluid-filled sacs that may be painful.

After menopause, many cysts shrink or disappear. You should immediately have your doctor check any lumps that form after menopause.

Fibroadenomas are the most common benign breast tumours in women under 25 and occasionally in adolescents. These tumours are usually round, several centimetres across, and mobile. They tend to regress after menopause. Your doctor may recommend removal if the lump persists, gets larger, or if you are anxious about it. Tests will be done to check for cancer when it is removed.

Nipple adenomas are tumours of the nipple area. They vary in appearance, sometimes come back after being removed, and are sometimes associated with cancer. An intraductal papilloma is an uncommon small growth in the lining of the milk ducts near the nipple. Usually seen in women over 40, papillomas produce a discharge, which may be bloody.

Breast Self-Exams and Mammograms

You should discuss breast self-exams with your doctor, and your doctor should go over how to perform them with you. Premenstrual changes can cause temporary thickening in breast tissue that disappears after your period, so your doctor may tell you to wait until a few days after your period to do them.

A breast self-exam is easiest in the shower, using soap to smooth your skin. Look for dimpling. Using light pressure, check for lumps near the surface. Use firm pressure to explore deeper tissues. Squeeze each nipple gently; if there is any discharge -- especially if it is bloody -- consult your doctor.

Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancer. Most lumps are harmless. The best test for distinguishing a cyst from a solid tumour is ultrasound; a needle biopsy may also be done.

Mammograms -- detailed X-ray pictures of the breasts -- can reveal tumours too tiny to be felt by hand. There is disagreement as to when a woman should start getting mammograms: Some doctors say between ages 35 and 40; others say not until age 50. The American College of Obstetricians and Gynecologists recommends yearly mammograms starting at age 40. The National Cancer Institute recommends a mammogram every 1 to 2 years, starting at 40. The American Cancer Society recommends them after age 45. The USPSTF recommends routine screening for women starting at 50. If you have a family history of breast cancer, especially in your mother or sister, your doctor may want you to start them earlier. Three-dimensional mammograms, to be used along with traditional digital mammograms, are also available in some screening centres.

Breast Pain

Breast pain can have many causes, including the normal swelling of breast tissue during the menstrual cycle. Other causes include infection or injury; growths, including cancer; and perhaps diet.

The general swelling of breast tissue with your period can be painful, but it is not dangerous, and no treatment is necessary if you can tolerate the discomfort. Each monthly cycle brings about changes in hormones, including more estrogen and progesterone, that bring more fluid into the breasts, expanding tissue, stretching nerve fibres, and causing pain. Some women have this painful swelling just before their periods, with symptoms easing near the end of the menstrual flow. Others have it as a side effect of birth control pills.

Trauma and infection in the breast have the same symptoms you would see elsewhere in your body. Infections tend to become walled off from surrounding tissue, producing small abscesses. This may give them the appearance of cysts. If you think you have an infection, see your doctor. Your doctor will usually prescribe antibiotics, although many times the infection will come back and may require the removal of the infected tissue.

Cysts may produce pain, but breast cancer rarely does -- although pain does not rule out the possibility of cancer.

Diagnosing and Treating Breast Problems

Understanding Breast Problems -- Diagnosis & Treatment

How Are Breast Problems Diagnosed?

First, your doctor will examine your breasts. You may have mammogram or ultrasound done to look for tiny lumps or other things that can’t be found in an exam.

For breast lumps, treatment and diagnosis are often related. For example, your doctor may insert a needle into a cyst and draw out fluid, both to examine the fluid and get rid of the cyst. If the fluid is clear and the cyst disappears, your doctor will probably diagnose it as a benign cyst, and no further treatment is needed. Many doctors take the added precaution of having the fluid checked in a lab test. If a lump does not disappear and is still present after your next menstrual period, your doctor will want to re-examine you.

If the fluid from a suspected cyst is bloody, or if little or no fluid can be drawn out, this is a cause for concern, and you may need a biopsy to check for cancer.

Fibroadenomas can be diagnosed only by biopsy. Surgical removal, usually in a same-day surgical procedure, is considered the only treatment if they are large or painful, but treatment is not always necessary.

Nipple adenomas are surgically removed because they are sometimes associated with breast cancer.

Intraductal papillomas are surgically removed before they grow large enough to block the milk ducts.

What Are the Treatments for Breast Problems?

Nutrition and Diet

A high-fat diet and alcohol can both increase the risk of breast cancer. And even though there is no proof that diet can cause tumours, studies have shown a relationship. For instance, avoiding caffeine may help shrink breast cysts. And limiting fat to less than 20% of your total daily calories may help shrink or eliminate lumps.

To prevent and treat monthly breast swelling, your doctor may tell you to maintain a healthy weight and eat a balanced diet. Because salt can make the breasts swell, eat less salt near your period. Avoiding caffeine and related substances, such as methylxanthines (found in chocolate and tea), can ease breast pain.

Some doctors suggest taking daily vitamin E supplements, in doses of up to 800 IU, to treat breast pain not caused by cancer. Evening primrose oil may provide some relief.

Medications

For breast pain or tenderness, your doctor may suggest aspirin, Tylenol, or ibuprofen. A mild water pill, also called a diuretic, can help remove fluid from swollen breasts.

If these treatments don't help, your doctor may prescribe a hormone such as danazol, which has been shown to ease breast pain. You might also be given progesterone because some studies suggest a lack of progesterone may contribute to breast pain. The cancer drug tamoxifen is also prescribed in rare cases. These drugs can have serious side effects. They are used rarely and only for severe symptoms. Do not use these drugs if you are trying to become pregnant.

Breast infections are treated with antibiotics. If you have an abscess, your doctor may also make a small incision to drain it. If this doesn't work, minor surgery is the next step.

Home Remedies

For pain relief, apply heat to the breast with a heating pad or hot water bottle for 20 to 30 minutes. If you are using a heating pad, be sure to follow manufacturer's instructions and do not fall asleep.

Your doctor may suggest wearing a bra or sports bra, even 24 hours a day, to reduce breast movement and lessen the discomfort until the tenderness passes.

Healthy Breasts for a Lifetime

How to Have Healthy Breasts for Life

No matter your age, to keep your breasts healthy it helps to learn what's normal and what's not. It will put you on the lookout for changes that could be signs of trouble.

Just like any part of your body, find out what to expect at different stages of life.

"Knowing what your breasts look and feel like can help you recognize when something is suddenly different," says Pamela Peeke, MD, author of Body for Life for Women. "The same way you pay attention to your skin and watch for new moles, you should pay attention to your breasts."

Your doctor may give you a breast exam at your annual visit and may teach you how to do a self-exam at home. Research doesn't show that breast exams save lives or detect cancers earlier, but many doctors still recommend them. And it's always a good idea to be aware of your body and let your doctor know if you notice any changes.

What's Normal, What's Not

You may sometimes worry that your breasts don't look "right."  But most of the things women are concerned about are not actually that unusual, Peeke says. For example, it's completely normal if:

• Your breasts are slightly different sizes.
• One breast hangs slightly lower than the other.
• You have hair around your nipples.
• Your breasts hurt or feel tender before and during your period.

Tell your doctor if you see any unusual changes, though. For example, make an appointment if you notice:

• A firm lump you've never felt before
• Swelling around your breast, collarbone, or armpit
• Dry, cracked, red, or thickened skin (like an orange peel) around your nipple
• Blood or fluid (besides milk) leaking from your nipples
• Warmth or itching in your breasts

These symptoms don't always mean something's wrong, but it's important to get checked out by a doctor. They may be harmless changes, or they may be caused by an irritation or infection that can be easily treated. Rarely, they can be signs of cancer.

You may need to see a doctor if your nipple looks like it's pulling back into the breast. But only if it's a change in your appearance, says Erin Hofstatter, MD, assistant professor of medical oncology at Yale School of Medicine. "Roughly 10% of women have naturally inverted nipples," she says. It's not a problem if it's something you've had all along.

Know Your Risk for Breast Cancer

Talk to your doctor about things that may put you at higher risk for the disease. For instance, your chances of getting it may go up if you smoke, drink alcohol, or have a family history of breast cancer.

Women who don't have children, or who have them after age 30, also have a higher risk. So do women who have their first period before age 12, go through menopause later than normal, or take certain hormone drugs during menopause for longer than 5 years. 

If you take birth control pills, it could slightly raise your breast cancer risk. Together with your doctor, you should consider all of the things that may raise your odds of getting the disease before you decide what kind of birth control to use.

Changes When You're Pregnant or Breastfeeding

When you get pregnant, it's normal for your breasts to get larger and more tender, for your nipples to darken and blood vessels to become more visible, and for your breast tissue to get lumpier.

Cysts (fluid-filled sacs) and other non-cancerous tumours can form or get larger during pregnancy. "The vast majority of lumps discovered by pregnant women are not cancer," Peeke says. "But you can't rule it out for sure, so you should still mention them to your doctor."

Your breasts will likely swell and fill with milk a few days after you give birth. This can make them feel hard and tender. Breastfeeding can ease this feeling. If you opt to bottle-feed instead, your breasts should stop making milk after a few days.

If you are breastfeeding, you may get sore, cracked nipples or plugged milk ducts. It can lead to a painful infection called mastitis, which needs get treated with antibiotics.

Breast Health in Your 40s and Up

You'll notice physical changes as you get older. During menopause or the run-up to it, the glands that make milk shrink. They're replaced with new fat tissue so your bra-cup size may go up. Your breasts may also begin to sag more.

Your risk for breast cancer goes up as you get older, so talk to your doctor about when you should start getting screening tests called mammograms. Major health groups recommend them every 1 to 2 years for women 50 to 74, but some suggest you start at age 40 or 45.

Healthy Habits at Any Age

No matter your age, you can lower your risk of breast cancer if you limit alcohol to one drink a day or less, quit smoking if you've got the habit, and stay at a healthy weight. It's also important to get at least 150 minutes of moderate exercise a week and eat plenty of fruits and veggies.

It's never too early to start thinking about how to have healthy breasts for life -- or too late to make changes for the better.