BREAST DISEASES

We can classify diseases of the breast in the following categories:

1)       Benign i.e. non-malignant. Luckily this comprises the majority of breast disease, and lumps. Some of these as follows;

A) Breast cysts. These are fluid filled cavities that can be multiple and painful. Can often cause a painful lump and is responsible for much anxiety when felt. Should always be investigated by at least doing sonar study. Should never be aspirated blindly before doing sonar. When a cyst is punctured with a needle, it could cause the cyst to change character and on a sonar or mammogram it could look like a solid lesion afterwards. This could cause a lot of unnecessary investigations and cost. First do sonar and aspirate with a thin needle under sonar guidance and the problem is solved easily and the lump is gone. I often inject a small volume of 95% alcohol in the cyst which scleroses the inside so that it does not fill up again.

Cysts are common on young women and is only seen in older, postmenopausal women when they are on HRT .Cysts usually resolve spontaneously after the menopause unless thy are kept filling up by estrogen stimulation.

b) Fibro-adenomas. These are common benign tumors in young women 20-40 yrs. causing a hard rubbery and mobile lump. They are often multiple. Tend to grow and enlarge to certain size and then stop growing. Usually enlarge when taking the contraceptive pill. Surgery is seldom needed unless they grow big causing a cosmetic problem. When these tumors grow fast I usually do a core biopsy to confirm that it is not a phylloides tumor.

c) Phylloides tumor; they look like fibro-adenomas but grow fast and become large. More seen in older women (38-45).They are better removed after core biopsy confirmation and should be widely excised as they tend to recur locally.

d) Lypomas are fatty, soft tumors. More oval than round and easily identified on sonar. Translucent on the mammogram. Surgery hardly ever needed. Can become large and when removed a defect in the breast contour could result.

E) Breast tissue (parenchymal) lumps. Consist of normal tissue formed in a hard lump. Often misnamed as fibro-adenosis which is a microscopic/histological diagnosis. Need not be removed after confirmation with core biopsy.

f) Cystic fibro-adenosis. Hardened dense breast tissue, often with multiple small cysts within. Need not be removed after confirmation with core biopsy.

g)Ductal ectasia. Mass caused by dilated milk ducts around nipple area.Often with milky, brown or brown-red nipple discharge. The discharge often improves temporarily on antibiotics. I often see these together with HRT use in older women and in young women with elevated prolactin secretion. This could be caused by a small tumor in the hypofises but is most commonly due to some antidepressant which cause prolactinaemia and nipple discharge (galactoreoa)

H) Developmental tumors like Hamartomas are benign, often large and soft. Seen in young girls and women.

I) Mastopathy. Hard plaque like masses. Distressing. I have seen 2 diabetics on Insulin developing these hard plaques under the skin. Needle biopsy always necessary.

j) Papilloma. Small wart-like tumor in one of the milk ducts causing a bloody discharge. Hardly ever become malignant but we remove the because of the continuous bloody nipple discharge and mess.

2) Premalignant tumors

They have the tendency to become cancers in years to come, sometimes as long as 20 yrs.

A) Intraductal neoplasia, e.g. LCIS and DCIS. Often seen as calcifications in ducts on mammograms. Because these are removed nowadays, it is partly responsible for the decline in breast cancer mortality. Not all of these develop into real cancers.

b) Papillomatoses. Most often a co-incidental finding in a core biopsy. A real problem to manage.

3) Malignant (cancerous) tumors. They will be discussed under BREAST CANCER.