Health Tips

Many Malaysian women feel shy talking about their breast health, although they shouldn’t be – women of all ages, from adolescents to older women, can face various breast problems. While it can be frightening to discover a new breast problem, most breast problems are not caused by breast cancer. With that being said, it is important for women to understand some of the common breast problems and make better decisions about their reproductive health.

What kinds of problems can women have with their breasts?

Breast lumpiness/ a “mass”

Breast lumpiness is discovered via breast examination. A “lump”, regardless of where it’s located, always spells bad news. The truth is: it is difficult to determine by examination alone if a lump is caused by breast cancer. Although most breast lumps in women age 20 to 50 are not of cancer origin, all new breast lumps should be evaluated by a healthcare provider to determine if further testing is needed. The choice of test will partly be determined by your age.

Breast pain or tenderness

Also known as mastalgia, breast pain can be caused by many factors. The most common reason being the hormonal changes that occur several days before the menstrual period begins. Hormonal changes during perimenopausal (transitioning into menopause) can also lead to breast pain. These kinds of breast pain are usually cyclical in nature and not serious.

However, some breast pain can have less common but more serious causes. They are known as non cyclical breast pain, as they aren’t related to menstruation and might occur in only one breast or one area of the breast. Non cyclical breast pain is usually caused by a problem outside the breast, such as muscle or connective tissue strain, skin injury, spinal conditions, or problems in another organ system (eg, heartburn, chest pain). Non cyclical breast pain is caused by breast cancer in only a very small percentage of women.

Nipple discharge 

Nipple discharge means that fluid leaks from the nipples, such as clear, white, yellow, green, or red fluid. This is especially common during the first year or two after giving birth. Nipple discharge from both breasts can also occur in women with medical conditions such as hypothyroidism (underactive thyroid gland), a growth in the pituitary gland (a part of the brain that controls productions of certain hormones) that causes an increase of a hormone called prolactin. Nipple discharge can also happen as a result of side effects of certain medications. Here are some examples of medications that may cause nipple discharge:

• Clomipramine, a medication that is used to treat depression

• Risperidone, a medication that is used to treat mental illness such as bipolar disorder

• Metoclopramide, a medication that stops vomiting

• Domperidone, also a medication that stops vomiting and stomach ache

Nipple inversion 

Image credit: BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons

Many women are born with nipples that naturally invert (pull in) at times and evert (poke out) at other times (sometimes called "bifid," "cleft," or "slit-like" nipples). Other women find that this happens after breastfeeding. Nipple inversion of this type is not cause for concern.

If your nipples have always been everted (not inverted), and begin to invert for no obvious reason, this should be evaluated by your healthcare provider. Most causes of nipple inversion are not a cause for concern, but occasionally this is the first sign of a breast cancer. Your healthcare provider may recommend further testing to evaluate if it’s really breast cancer.

Sore, cracked and itchy nipples

Sore, cracked or itchy nipples are usually caused by breastfeeding. The skin around the nipple can split and become painful. You may see a doctor or pharmacist for treatments that might help relieve such discomfort. If these changes develop when you are not breastfeeding or pregnant, see your doctor.

Breast and nipple infections

Infections can happen in the breast too, especially with breastfeeding mothers. If you develop any inflammation or infection in your nipples, see your doctor. It could be a sign of eczema (a common skin problem in which the skin is itchy and dry) or an infection known as mastitis. 

Changes in the skin of the breast

Skin problems can develop on or near the breast, some of which cause itching, scaling or crusting, dimpling, swelling, redness, or changes in skin color. While most of these changes are not caused by a serious breast problem, it is important to be evaluated if a skin problem on your breast does not resolve within a few days. 

Some of the less common forms of breast cancers, such as Paget disease or inflammatory breast cancer, do lead to skin changes of the breast. Women may also find rashes, moles, cysts, or skin infections on the breast skin. Do get a breast examination from your healthcare provider if you’re unsure what to make of the changes in the skin of your breast.

Further testing for breast problems.

After a breast examination, your healthcare provider may further evaluate your breast problems through the following options:

Breast ultrasound 

Image credit: https://www.radiologyinfo.org/en/info.cfm?pg=breastus

This is an imaging test that uses sound waves to create pictures of the inside of your breast. Among other things, it can show if a lump is solid or filled with fluid.

Breast biopsy 

Image credit: http://www.myhealth.gov.my/en/breast-self-examination-breast-cancer/

During a biopsy, a doctor takes one or more tiny samples of suspicious breast tissue using a needle. The samples then go to the lab to be checked for cancer or other problems.

Mammogram 

Image credit: http://www.myhealth.gov.my/en/breast-self-examination-breast-cancer/

Mammograms are special X-rays of the breast. They can help doctors find breast cancer. Your healthcare provider will decide which tests you need based on your individual situation.

Cultivating breast self-awareness

We don’t mean that your breast becomes “self-aware”–  breast self-awareness means being aware of how your breasts normally look and feel. This is important because knowing what is normal for you will help you detect any changes that may signal a problem. You can do so by carrying out a breast self-examination (BSE).

Breast self-examination (BSE)

1. Look for any changes in the breast while standing in front of a mirror
   

2. Feel for changes while lying down

3. Look for bleeding or discharge from nipples 

4. Feel for any lumps under the armpit

5. Repeat the same steps for the other breast

Source: http://www.myhealth.gov.my/en/breast-self-examination-breast-cancer/

For those who are still menstruating, BSE should be carried out once a month. The best time is a week after the start of each period (day 7 – 10). For those who no longer have periods; remember a date and do it monthly (e.g. day 1 or last day of the month). If you notice any abnormalities in your breast, see your healthcare provider as soon as possible. Further testing, follow-up over time, or referral to a breast specialist may be recommended.

A word from Doc2Us

If you have any questions related to breast health, you can consult our professional doctors and healthcare professionals on Doc2Us. Doc2Us is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

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Disclaimer: As a service to our users and general public, Doc2Us provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. UpToDate - Patient education: Common breastfeeding problems (The Basics)

2. UpToDate - Patient education: Common breast problems (The Basics)

3. UpToDate - Patient education: Common breast problems (Beyond the Basics)

4. UpToDate - Patient education: Locally advanced and inflammatory breast cancer (Beyond the Basics)

5. American Family Physician - Common Breast Problems

6. ACOG - Benign Breast Conditions

7. Cancer Council Victoria - Common breast problems

Cover image credit: Charles Deluvio on Unsplash

Written By

Ms Joyce Toh

Reviewed By

Doc2us Medical Board