Health – Breast check

Not all breast prob­lems in­di­cate the pres­ence of can­cer. Here are four com­mon ones to look out for.

True Love - - Contents - By AYANDA NKONYANA

Women have two big mis­con­cep­tions about breasts: first, that the only breast ill­ness that ex­ists is can­cer, and sec­ond, that all lumps are can­cer­ous. But it’s not so. Breast prob­lems are com­mon. Although fright­en­ing when dis­cov­ered, most of these prob­lems will not give rise to panic, ac­cord­ing to the World Health Or­gan­i­sa­tion, be­cause more than 70% of all pa­tients with breast prob­lems don’t have can­cer.

How­ever, these prob­lems can cause symp­toms akin to those of breast can­cer. Joburg­based breast spe­cial­ist Dr Sarah Rayne says: “The most com­mon symp­toms that women no­tice are lumps, pain, a nip­ple dis­charge and changes in the skin of the breast.”

We speak to ex­perts about these four symp­toms and how to han­dle them.

SUS­PI­CIOUS LUMPS

Most breast lumps are be­nign, mean­ing they aren’t can­cer­ous. The lumps usu­ally have smooth edges, can move slightly when you push against them and are of­ten found in both breasts. Re­filoe, 25, a stu­dent, de­vel­oped a lump in her left breast two years ago. “I was fit­ting a new bra when I no­ticed a lump in my left breast,” she says. “It was pain­less – that’s what made me con­cerned that it

might be breast can­cer. I saw a doc­tor, who did a breast ex­am­i­na­tion and, thank­fully, found it was a be­nign tu­mour.” Dr Rayne says: “The most im­por­tant thing to know when you feel a lump in your breast, is that most of these are not breast can­cer. They’re present in 25% of all women, usu­ally from ages 15 to 35. They can be in one breast or both, sin­gle or mul­ti­ple. It’s nor­mal breast tis­sue that has be­come en­larged by hor­mones.”

Still, she ad­vises go­ing for a breast ex­am­i­na­tion if you no­tice a lump. “The best way to check out ev­ery new prob­lem is by a phys­i­cal ex­am­i­na­tion, along with non­threat­en­ing, pain­less in­ves­ti­ga­tions like ul­tra­sound, a mam­mo­gram and biopsy.”

PAINFUL TOUCH

Pain in the breasts is a fre­quent com­plaint, and al­most all women ex­pe­ri­ence it at some stage. Ac­cord­ing to the Net­care Breast Care Cen­tre, can­cer only presents with pain in 10% of cases – and this is a con­stant pain, lo­calised to tis­sue around a lump.

When so­cial worker Zanele, 29, ex­pe­ri­enced pain in her breasts, she pan­icked. “I started feel­ing a burn­ing pain in my breasts, es­pe­cially the nip­ples,” she says. “They felt heavy, like I needed to breast­feed a baby. I was cer­tain it was can­cer – only to find it was pain caused by stress!”

Dr Rayne adds: “It’s rare for pain alone to be the first sign of breast can­cer, but it is al­ways wise to get any changes in your breasts checked out.”

The pain can be dif­fi­cult to treat be­cause there are sev­eral rea­sons pain can oc­cur. “Cycli­cal breast pain is most com­mon in women in their 20s and 30s,” Dr Rayne ex­plains, “and it may get bet­ter dur­ing preg­nancy or menopause. It’s re­lated to the monthly hor­monal bal­ance in the body through­out your ovu­la­tion cy­cle, and it’s also associated with in­creased lev­els of anx­i­ety and de­pres­sion. It presents as heavy, aching or un­com­fort­able breasts. “The sec­ond type of pain is non-cycli­cal mastal­gia. There are many rea­sons this type oc­curs. It may have a hor­monal cause like cycli­cal pain, if the breasts have be­come sen­si­tised to the lev­els of hor­mones cir­cu­lat­ing, or it can be associated with hor­mone re­place­ment ther­apy (HRT). It may have an anatom­i­cal ori­gin, such as cysts, or it could be caused by what’s med­i­cally termed ‘di­lata­tion’ of the breast ducts – stretch­ing be­yond their nor­mal lim­its.

“The re­sul­tant com­plaint is called duct ec­ta­sia – typ­i­cally, a burn­ing, shoot­ing pain around the nip­ples.”

NIP­PLE DIS­CHARGE

Katlego, 30, an ac­coun­tant, had a wa­tery and milky dis­charge when she pressed on her nip­ple. “I was sur­prised as I wasn’t breast­feed­ing,” she says.

Nip­ple dis­charges are clas­si­fied ac­cord­ing to colour and the num­ber of ducts in­volved. Like other ducts in the body, breast ducts make and carry a va­ri­ety of se­cre­tions. Many women can squeeze out a small amount of milky yel­low­ish, green­ish or brown­ish dis­charge, without it nec­es­sar­ily be­ing an in­di­ca­tion of a prob­lem.

Sur­geon and au­thor Dr Va­lerie L Staradub writes in her book, Pa­tient Ed­u­ca­tion: Com­mon Breast Prob­lems: “This is of­ten called ‘phys­i­o­logic’ dis­charge and is not a cause for con­cern if it is not bloody.” The treat­ment en­tails cut­ting out the in­volved duct with mi­cro­surgery. Some of the tis­sue must then be sent for his­tol­ogy (the study of the mi­cro­scopic struc­ture of tis­sues) to con­firm that it is be­nign, or to prompt fur­ther treat­ment if it is can­cer­ous.

SKIN CHANGES

Skin prob­lems that can de­velop on or near the breasts in­clude itch­ing, crust­ing, dim­pling, swelling, red­ness or changes in skin colour. For some peo­ple, breasts be­come darker and the skin rougher – but af­ter a few days, this dis­ap­pears. While most of these changes are not caused by a se­ri­ous prob­lem, the USA’s Na­tional Can­cer In­sti­tute ad­vises that you get a skin con­di­tion on your breasts eval­u­ated if it does not clear up within a few days.

Most women ex­pe­ri­ence breast changes in their life­time. Many of these changes are caused by hor­mones or the nor­mal age­ing process, and most are not can­cer. But early de­tec­tion re­mains key to fight­ing the dis­ease, so any time you no­tice any change in your breasts, don’t wait un­til your next mam­mo­gram – make an ap­point­ment as soon as pos­si­ble and get it checked.

“THE MOST IM­POR­TANT THING TO KNOW WHEN YOU FEEL A LUMP IN YOUR BREAST IS THAT MOST LUMPS ARE NOT BREAST CAN­CER.”

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