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BREAST HEALTH

A discussion of breast health and breast cancer screening are often routine parts of a visit to your gynecologist. Breast cancer is one of the most common female cancers in the United States. Although it is the second most common cause of cancer death in women, early diagnosis and treatment often cures it and reduces the chance of dying from breast cancer. Breast cancer occurs when normal cells in the breast become abnormal and grow out of control. Sometimes breast cancer is discovered when women find a lump in one of their breasts.

WHAT IS BREAST CANCER SCREENING?

Cancer screening is designed to help make a diagnosis of cancer early in its course, before signs or symptoms arise, and when it is most treatable. Breast cancer screening breast screening reduces the chance that a woman will die of breast cancer.

WHY SHOULD I GET SCREENED?

Screening helps find cancer while it is still in early stages, before it grows, spreads and causes other problems. Screening makes it easier to treat and decreases the chance of dying from breast cancer.

WHEN SHOULD I START GETTING SCREENED?

It is recommended that most women start getting screened at age 40. Women at high risk of breast cancer should begin screening at a younger age (i.e. women carrying certain genes such as “BRCA” or who have close relatives who got breast cancer).

WHAT ARE SOME COMMON BREAST HEALTH PROBLEMS?

Women of all ages can have different changes in their breast tissue. Most changes in breast tissue are not caused by breast cancer, but it is important to become educated and see a doctor if you notice changes. The most common breast problems or changes are:

  • Breast lumpiness
  • Single breast lump
  • Breast pain or tenderness
  • Nipple discharge
  • Nipple inversion
  • Changes in skin of breast (i.e. change in skin color, itching, crusting, redness)

See the information below for more detail about each of these conditions.

BREAST LUMPS

  • Women under 30 may find breast lumps before their menstrual period.  In this age group breast lumps are associated with hormonal changes and may resolve after the menstrual period is over. Your doctor may recommend a follow up evaluation after your period.
  • Women over 30 may require further testing with a mammogram, breast ultrasound or biopsy.

BREAST PAIN OR TENDERNESS

This can occur for many reasons. Sometimes it can be due to hormones and occur before your period and then resolve.  See your doctor if you have pain that does not resolve.

NIPPLE DISCHARGE

Some types of nipple discharge can be normal, while other may be more concerning. Some causes include:

  • Giving birth: milky colored discharge from the nipples is normal in the first year after giving birth
  • Hormones- underactive thyroid or increase in prolactin hormone can cause nipple discharge
  • Physiologic discharge- small amount of yellow, green or brown discharge can be squeezed out. This is usually not cancer.
  • Side effect of certain medications
  • Cancer or other breast problem- spontaneous discharge, clear or bloody discharge

If you have nipple discharge, see your doctor for further evaluation.

INVERTED NIPPLES

If your nipples begin to invert (pull in) for no obvious reason and if this is a new change, you should see your doctor for further evaluation. Sometimes this can be the first sign of breast cancer.

SKIN CHANGES

Skin problems such as itching, scaling, crusting, dimpling, swelling or redness can occur near and around the breast. This can occur due to rashes, moles, cysts or skin infections. Certain types of breast cancers may also present as skin changes. See your doctor if you notice new skin changes.

WHEN SHOULD I SEEK HELP?

If you discover a new breast change or problem, make an appointment with your primary care or gynecologic doctor. The doctor will probably do a clinical breast exam and determine if further evaluation is needed. This may include a mammogram, ultrasound or referral to a breast surgeon.

WHAT IS INVOLVED IN BREAST CANCER SCREENING?

  • CLINICAL BREAST EXAM

Your doctor should examine your breasts during regular and routine check ups. During the exam the doctor will look at your breasts and feel for changes such as lumps, nipple changes or changes in skin or tissue.  Women 29-39 years old should get a clinical breast exam ever 1-3 years.  Women over 40 years should have 1 every year.

  • MAMMOGRAM

A mammogram is a special x-ray used for two main reasons:

  • As screening to regularly check for breast cancer in women with no signs or symptoms of the disease
  • And used as a diagnostic test to further assess lumps or other changes.

How is a mammogram performed?

Before the mammogram, you will have to undress from waist up and put a gown on. Then each breast is X-rayed one at a time. The breast being examined is placed between to plastic or glass plates. The plates will apply pressure on your breast. This is then repeated on the other breast to get an x-ray of it. Don’t schedule a mammogram just before or during your period since breasts are extra sensitive then. Don’t use underarm deodorant, lotions or powder the day of the appointment. These substances can make the x-ray hard to read.

  • BREAST ULTRASOUND (SONOGRAM)

A breast ultrasound (or sonogram) is an imaging test that can show if a breast lump is solid or fluid filled.  Solid lumps may need a biopsy. If a fluid filled cyst is found, it may resolve on its own or be drained but it is usually not cancer.

WHAT ARE THE RISKS OF A MAMMOGRAM?

Mammography uses a low level of radiation similar to a regular x-ray. Risk of harm is low and annual mammograms are not known to increase the chance of cancer.

ABNORMAL MAMMOGRAM RESULTS

  • Nine out of 10 women with abnormal mammogram results do NOT have breast cancer.
  • If mammogram results show a lump another abnormal change, further evaluation is needed either with another more detailed mammogram or breast ultrasound.
  • If findings are suspicious for cancer, a biopsy is needed to confirm whether it is malignant (cancer) or benign (not cancer).

WHAT IS A BREAST BIOPSY?

A doctor uses a needle to take small sample of breast tissue, usually with local anesthesia to numb the skin. The sample of cells is looked at under a microscope for changes that look like cancer or other problems.

BREAST CANCER MANAGEMENT

There are several options for treating and managing breast cancer. These options include hormone therapy, targeted drug therapy, chemotherapy, radiation and surgery. The best option for you depends on many factors. A breast surgeon and specialist will talk you about the best options for you depending on the type of cancer, its staging (how far the cancer has spread or not spread), treatment side effects and other factors.

|    © 2014-2018 copyright Taraneh Shirazian, MD

wwc   ny

Joan H. Tisch Center for Women's Health

207 E 84th Street

New York, NY 10028

Phone: 646-754-3300

 

Email: info@wwcofny.com