Breast Cancer Symptoms & Diagnosis

Breast lumps are very common and most women will experience one or more at some time in their lives. However the vast majority (at least 9 out of 10) are benign, i.e. not cancerous.

Benign lumps can be caused by cysts (sacks of fluid which build up in the breast tissue) or fibroadenomas (solid growths made up of fibrous and glandular tissue).

What to look out for:

A change or size in shape of your breasts
Dimpling or puckering of the skin (skin may look similar to orange peel)
Lumpiness or thickening
Newly inverted (turned-in) nipples
Bloodstained discharge from the nipple
A rash, often eczema-like, on the nipple or surrounding area
Swelling or a lump in the armpit

Treatment for Breast Lumps

Benign breast lumps do not normally need treatment, although they may be removed as part of the diagnostic process (if the lump is removed for biopsy for example).

What is a Breast Cyst?

A cyst is a liquid filled lump in the breast. They are commonly found between the ages of 30 and 50. Breast Cysts form from the milk duct. The milk ducts are tiny tubes, for draining the milk from the breast tissue to the nipple. There are often dozens of tiny cysts throughout the breasts, giving a honeycomb appearance. Cysts often appear suddenly, even quite large ones. Cysts can sometimes be uncomfortable.

What causes Breast Cysts?

We do not know exactly why cysts form; they are not a disease as such, but simply a sign of the changing hormone levels that occur naturally throughout life. As the menopause approaches, a women's hormone levels fall and most the milk producing part of the breast is replaced by fatty tissue. During this phase there is a tendency for cysts to form, often in several parts of the breast. Cysts have nothing to do with cancer. Cysts do not turn into cancer. However, a cancer may feel similar to a cyst, as it too is usually noticed as a painless lump.

This is why any lump should be reported to your doctor so that a full examination can be carried out. If a lump is proven to be a cyst, then you need not worry.

What can be done?

Although a simple cyst is not serious, the diagnosis needs to be confirmed by a mammogram and/or ultrasound scan. Cysts often settle without treatment, but sometimes your doctor will insert a needle into the cyst to draw off the fluid. Once the fluid has been removed the cyst should disappear. There may be some bruising of the skin for a day or two and sometimes this can cause some thickening where the cyst was.

There is a chance of 1 in 5 cysts returning in the future. If this happens, then you should report back to the breast clinic (if this happens within 12 months) or to your doctor so that checks can be made to ensure that it is another cyst and not anything else.

How to recognise a Breast Infection?

Breast infection causes a lot of pain in the breast, usually just behind the nipple. This is usually associated with a lump and reddening of the skin. The glands under the arm may also become tender.

What causes Breast Infections?

Breast infection commonly occur whilst breast feeding, however they can also occur at other times. Breast infections may occur due to a process called periductal mastitis. If the infection set up in the milk duct breaks out into the tissue of the breast, then an infection may develop. Smoking is a significant cause of this type of inflammation.

What is periductal mastitis?

Periductal mastisis is inflammation around a breast duct. With ageing, the breast ducts can become dilated (duct ectasia), the milky substance filling the duct can then be infected by one of the bacteria which normally lives on the skin where they usually do no harm.

Treatment

A prompt course of antibiotics from your doctor may resolve the problem before an abscess forms, but sometimes surgery is required to drain the abscess. If the antibiotics only partly treat the problem, then it may be possible to remove the fluid with a needle.

Cyclical Breast Pain

Cyclical breast pain is common and can occur at any stage after periods start, but commonly occurs in ages between 30 and 50. It does not occur in women past the menopause when the periods have stopped.

What are the symptoms?

Cyclical pain can be severe and begin 1-2 weeks prior to your period. The severity can vary from month to month. Typically the pain affects both breasts and is usually worst in the upper and outer part of the breast, but may travel down the arms. If you have cyclical breast pain your breasts may also become larger, tender, and slightly lumpy in the week or so before a period.

What causes cyclical breast pain?

It is thought that breast tissue is more sensitive than usual due to the hormonal changes that occur each month. It is not due to any hormone diseases, or to any problem in the breast itself.

Treatment Options for Cyclical Pain

Supporting the breasts: Wear a well supportive bra when you have pain, and a sports bra when you are exercising. It is best to avoid underwired bras.

Painkillers: I.e. paracetamol or ibuprofen. Take regularly on the days when the breasts are painful.

Topical Anti-Inflammatory Creams: I.e. Topical diclofenac or topical ibuprofen

Considering Medication: The contraceptive pill or hormone replacement therapy (HRT) may make cyclical breast pain worse. If appropriate, it may be worth discussing with your doctor stopping or changing the preparation to see if this helps.

Diet: Fatty acids may have a role in causing breast pain, so adjusting your diet by reducing animal fats (butter, cream, fatty meat) and increasing your intake of fresh fruit and veg can be helpful.

Drugs to block hormones: Medication such as danazol or tamoxifen can ease pain in most cases. These medicines work by reducing the level, or blocking the effect of female hormones such as oestrogen. You need to take them regularly (not just when the pain occurs). Significant side effects are common with these drugs so they are not usually recommended until breast pain does not ease with other treatments.

Non-Cyclical Breast Pain (pain not related to periods)

This type of breast pain is not related to periods and is most common in women over 40. The pain may be in just one breast, and may be localised to one area in a breast. Sometimes pain is felt all over both breasts.

There can be many causes for non-cyclical pain:

Pain coming from the breast tissue itself in the absence of any lumps, tumors, or other abnormality being detected. The reason why this type of pain occurs is unknown.
Pain coming or radiating from the chest wall under the breast rather than the breast itself. Muscular or bony problems of the chest account for some of these cases.
Infection.
Breast pain is rarely a symptom of Breast Cancer.

Treatment for Non-Cyclical Breast Pain

In many cases the pain goes after a few months without any treatment. Anti-inflammatory painkillers such as ibuprofen may ease the pain. Topical anti-inflammatory cream may also work. Other treatments may be appropriate, depending on whether a cause is found.

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