Disease of the Breast

The Investigations required in the Diseases of the Breast

• MAMMOGRAPHY done by placing breast in direct contact with an ultrasenstive film and giving exposure with low voltage , high amperage Xrays dose of radiation 0 to 1 cGy , therefore mammography is a very safe investigation . sensitivity increases with age of the patient as breasts become less dense with age .
• ULTRASOUND OF THE BREAST done in young women with less dense breasts , when mammograms are difficult to interpret and in distinguishing cystic from solid lesions , can be easily called the most useful diagnostic tool .
• MRI OF THE BREAST useful in post surgical patients to distinguish scar of surgery from recurrence of breast cancer , helps in detection of malignancy in the axilla
• NEEDLE BIOPSY done under local anesthesia using a trucut needle or or core cut biopsy device

A triple assessment is done to diagnose a breast disease

• clinical examination
• radiological examination
• cytological examination

Benign Breast Disease

• Diseases of the nipple:

  Some of which include absence of nipple , supernumary nipples retraction ,papiloma , retention cyst , chancre ,eczema some symptoms are a skin lesion , discharge from the nipple , which could be a clear serous discharge , blood stained or black or greenish discharge from a patient with duct ectasia.

• Congenital diseases: Absence of breast or multiple breasts
• Inflammation: Mastitis of lactation or puberty
• Injuries: Haematoma, traumatic fat necrosis of the breast diagnosed on FNAC or by biopsy.
• Acute and subacute inflammation of breast: Associated with lactation , caused by bacteria of the staphylococcal group , an infected haematoma or periductal mastitis.
• Chronic inflammation of the breast: Occurs due to inadequate drainage or injudicious use of antibiotics.
• Tuberculosis of the breast: A very rare condition, occurs in parous women (women who have borne children).
• Actinomycosis of the breast: Syphilis.
• Mondor disease of the breast: Thrombophlebitis of the superficial veins of the breast, has to be differentiated from carcinoma of the breast.
• Aberrations of normal development and involution(ANDI) are a group of diseases of the breast with a benign pathology known as ANDI. Cause: Breast undergoes various physiological changes during the course of a women’s reproductive cycle . The pathogenesis of ANDI involves disturbance in the breast physiology .

Cause: Breast undergoes various physiological changes during the course of a women’s reproductive cycle . The pathogenesis of ANDI involves disturbance in the breast physiology.

Clinical Findings in ANDI

• lump in breast
• Lumpiness accompanied with pain
• Only pain (mastalgia) more in the premenstrual phase

Patient with above symptoms should

• Chart the pattern of her symptoms with respect to menstrual cycle
• Avoid caffeine
• Have a proper breast support
• Should reduce her weight if her BMI is more than 23
• Have fresh fruits and a fiber rich diet
• And consult a health care practioner.

BREAST CYSTS: occur in last decade of reproductive life are often multiple and may mimic malignancy. Diagnosed by FNAC or ultrasound

GACTOCOEL: occurs commonly during lactation, is a solitary, subareolar cyst.

FIBROADENOMA: A swelling which is firm to hard in consistency occurs in the age group of 15 to 25 years is diagnosed by FNAC and mammography or ultrasound

PHYLLODES TUMOUR: is a non malignant tumour occurs in women aged more than 40 years

BREAST CANCER: most common cause of death on females. Some facts:

• more in the west
• Rare below age of 20 years
• Incidence increases with age
• <0.5% occur in males
• More common in women with family history of breast cancer
• Occurs due to mutation of genes in some patients
• Diets low in antioxidants and phytoestogens
• Smoking and alchohol intake
• Common in multiparous women
• Breast feeding is protective
• Having first child at an early age is protective
• Higher incidence in patients with early menarche and late menopause
• More in obese postmenopausal women
• HRT (hormone replacement therapy ) increases the risk for ca breast

TYPES

• DUCTAL CA
• INFILTRATIVE CARCINOMA
• IN SITU CARCINOMA

• SPREAD LOCAL increases in size , spreads to surrounding skin or to underlying muscles and chest wall
• LYMPHTIC to axillary and mammary lymph nodes
• BLOOD STREAM to spine , ribs skull , liver , brain and ovaries

SYMPTOMS: lump in the breat , which is slowly growing and is very hard in consistency, skin may show dimpling or ulceration.

INVESTIGATIONS: cbc, lft . kft . Xray chest . usg abd . bone scan and a Pet scan STAGING a TNM classification is required treatement.

• surgery ... modified or radical mastectomy
• With hormone therapy LHRH agonists , tamoxifen or anastrazole
• Radiotherapy .. given in extensive local disease
• Chemotherapy a six monthly cylcle of CMF (cyclophosphamide , methotrexate , and 5 flourouracil)
• A breast reconstruction may be done at a later stage

THE MALE BREAST GYNAECOMASTIA: is enlargement of the male breast .it may be on one side or both the sides.It occurs during puberty and the cause is unknown.At times it occurs in patients of prostrate cancer who are put on stilbosterol therapy.

Gynaecomastia occurs in some patients of leprosy or in patients with cancer prostrate, due to ectopic production of estrogen hormone.

In patients of liver failure the female hormone is not metabolized fully and theremay be an enlargement of the breast in a male patient. Klenefelter syndrome XXY chromosomal anamoly may also be a cause. Treatment is reassurance of the patient , surgery is done only when the breast is too enlarged.

(Dr. Anila Khosla)
Medical Officer
IIT Hospital