Breast Pain

Breast pain is a common complain among women of menstruating age.

Susan is no exception. Besides pain, she has lumps in both breasts. Her symptoms are cyclic – associated with menstruation.

Since October is Breast Month, Susan wants her breasts examined. She is worried about cancer.

Susan’s physical examination reveals diffuse lumpy areas in both breasts with one discreet lump (about 3 cm in size) in the right breast. A fine needle aspiration of the lump confirms the presence of clear fluid and the lump disappears.

Susan’s mammogram reveals no suspicious lesions to suggest cancer. She is aware that 15 percent of mammograms fail to detect cancer (false negative).

Therefore, the conclusion is that Susan has fibrocystic changes in her breasts. The old term “Fibrocystic Disease” has now been replaced with fibrocystic changes. It cannot be a disease if the condition is very common, responds to physiological hormonal changes, and disappears later in life.

Women with fibrocystic changes not only suffer from pain but also have significant anxiety about cancer. One can easily miss a malignant lump among the multitude of benign appearing lumps.

Physicians and patients have to be vigilant at all times. The principle of management should be that a breast lump is malignant until proven otherwise.

Dr. B, can you tell me more about the fibrocystic changes of the breasts?

Susan, this condition is known by many different names and encompasses many benign conditions of the breast.

One textbook says that it is virtually impossible to estimate the incidence of benign breast disorders. But it is believed that 50 percent of women experience symptoms of fibrocystic changes at some point in their lifetime.

Usually the symptoms occur in women of menstruating age, with a mean age of 39years and a range of 18 to 67 years.

Solid benign lumps (fibroadenomas) occur in younger women, but cysts occur few years before and after menopause (35 to 60 years).

This condition is associated with a history of premenstrual breast discomfort, irregular menses, and spontaneous abortions; a family history of both benign and malignant breast disease; lack of use of oral contraceptives; a low incidence of obesity; small breasts, and late natural menopause (Breast Diseases by Harris and others).

The cause is unknown. It is likely due to imbalance of the female sex hormones as the condition occurs after the onset of menstruation and rarely appears after menopause.

Dr. B, do fibrocystic changes cause cancer of the breast?

Susan, there is inadequate evidence to suggest that fibrocystic changes lead to cancer of the breasts. Usually the fear is that cancer may be missed in women who have “lumpy” breasts. These women do and get regular breast checkups.

The management of this condition is not easy. We will discuss this next week. In the meantime remember: A breast lump is malignant until proven otherwise.

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.

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