Common Breast Problems

The Breast Care Center physicians and staff are skilled in assessing and treating breast diseases and problems, many of which are common and not related to breast cancer.

Breast Pain

This is the most common breast concern that brings a woman into our Center. It is most often seen in young/premenopausal women with dense breast tissue. Typically, it occurs cyclically, waxing and waning with a woman's menstrual cycle. It is not unusual for only one breast to be painful. The pain can be constant or just an occasional "jolt" or "stab" that often starts at the nipple area and radiates outward or upward. Pain in a single area, in only one breast, can suggest the presence of a cyst or cysts, especially when the pain starts suddenly in a young (premenopausal) woman. Breast pain, in addition to being uncomfortable, causes anxiety in many sufferers, as they think it may be a signal of a very serious problem, such as a cancer. However, breast pain is rarely a sign of breast cancer, as most breast cancers are painless. Treatment of breast pain begins with examination by a health care provider and often a breast ultrasound or mammogram may be ordered. However, these breast imaging studies often do not give us an explanation for the pain. The mainstay of treatment is caffeine reduction and an herbal product, Evening Primrose Oil, which is available in capsule form and taken by mouth. Non steroidal anti-inflammatory medications such as Naproxen or Ibuprofen are also quite effective in treating breast pain. However, these drugs have side effects and are generally only recommended for short periods of time (up to two weeks).

Nipple Discharge

This is any fluid that leaks or seeps out of the nipple in a woman who is not pregnant or breast-feeding. Nipple discharge may be clear, white, yellow, green, rusty or bloody. Although nipple discharge is not necessarily abnormal, it should be evaluated by a health care provider. Nipple discharge is rarely a sign of breast cancer. Least worrisome is milky or colored (but not bloody) discharge that occurs when the nipple is squeezed, such as during self breast examination. Most worrisome is bloody discharge that occurs on its own (spontaneous). Your provider may test the discharge for blood and cytology (abnormal cells), and may order an ultrasound and mammogram. There are many benign (not cancer) causes of nipple discharge, such as medications, breast infection, pregnancy, imbalance of the hormone -prolactin, and excessive breast stimulation. Take care to avoid nipple stimulation, including frequent checks for discharge, because stimulation actually makes the discharge persist.

Breast Lumps

A lump is a prominent area in the breast that can be easily identified from amongst the surrounding tissue. Any such finding should be further evaluated by your health care provider. There are two types of breast lumps, fluid-filled (cysts) and solid.

  • Cysts are fluid-filled pockets in the breast that vary in size. Some can be very painful, but most cause no symptoms. Cysts are particularly common in pre-menopausal women, and can come and go in response to the hormonal fluctuation of your menstrual cycle. Cysts are easily identified on ultrasound and typically do not require any treatment. When a cyst is causing significant pain, it can be aspirated (fluid removed with a fine needle). If the fluid in the cyst is bloody, it can be sent for cytology.
  • Solid lumps. Many times, a lump noted by a woman is actually normal glandular breast tissue that is engorged or swollen in response to hormonal stimulation. This type of finding can be determined through clinical breast examination, mammogram and ultrasound. If a distinct lump is confirmed, then in most cases, a biopsy is necessary to determine what the abnormality represents. There are many kinds of benign breast lumps, the most common of which is a fibroadenoma. This is a fibrous mass, very often found in younger women. It has smooth, rounded edges, is mobile (can be pushed about with the fingers) usually non-tender. When a biopsy confirms this, then no further action is necessary. In a small number of cases, a fibroadenoma can grow rapidly over a short period of time, and is then surgically removed.

Paget's Disease

Is a rare form of breast cancer that involves the nipple and the dark circle around it (areola) on one side. It is NOT related to Paget's disease of the bone. Paget's disease of the breast typically occurs in women over 50, and starts as a crusting or scaling rash with thickening of the skin. It may include redness, itching or oozing and there may eventually be a mass or lump underneath the nipple. This disease may first be mistaken for dermatitis (irritation of the skin) such as eczema and may even respond initially to skin treatments with steroid containing creams or lotions. However, in Paget's disease, the symptoms will return, persist and increase- and the nipple may flatten or invert (turn inward). To confirm or rule out a breast cancer, a surgical biopsy of the affected skin and underlying tissue is performed. There may not be obvious abnormalities on a mammogram, particularly in the early stages.

Inflammatory Breast Cancer

This is another rare form of breast cancer that causes the skin of the breast to become red and thickened. The breast may feel swollen, and sometimes is tender. There may be ridges or bumps in the skin that make it look like the peel of an orange. The breast discoloration may include shades of pink and purple, such as seen with bruising. There is rarely a lump associated with inflammatory breast cancer. The redness and swelling is caused when cancer cells invade and block the lymph channels and vessels. This type of breast cancer is often mistaken for a breast infection.

Male Breast Cancer

Although rare, men can develop breast cancer, with symptoms and treatment very similar to that in women. A painless lump, skin thickening or puckering of the skin over the breast or nipple inversion (drawing inward), discharge or crusting, should be reported promptly to a health care provider. A mammogram and or ultrasound and a breast biopsy may be performed. Most breast cancers in men occur at an older age and are diagnosed at later stages, as men tend to ignore or delay reporting breast symptoms.