The breast is an important part of the
female reproductive system. And, like internal reproductive organs, it is dependent to an extent on the level of hormone activity. This is exemplified by
changes in size and consistency of breast tissue during the menstrual cycle and
during pregnancy as hormonal levels change. The breast is made up of glandulartissue arranged in a complicated pattern of lobes. The milk ducts lead into
the nipple at the approximate center of the lobes. The breast is subject to a
number of disorders that are difficult to differentiate by physical examination
alone, since they most commonly take the form of a lump or mass.
Since primary prevention for any of these conditions is
limited, early detection of a lump and identification of its nature are an
important preventive measure. Self-examination of' the breasts at least once a
month, at the end of the menstrual cycle (after the monthly flow) when the
breasts are normally soft, is an excellent means of early detection. Women who
feel that they cannot adequately perform self-examination can make arrangements
with their doctor for a brief monthly examination. The technique of self-examination
is described. Of course, examination of the breast is an important
part of a regular physical examination. In many cases, when a mass is found,
the physician can determine if it is benign through history and examination.
Among other things, he will consider the age of the patient;
breast cancer is rare below age 20 and quite uncommon until the 40'S. Any painand fluctuation in size of the lump usually indicate that the cause is benign
cystic change of glandular tissue. Some women are prone to recurrent breast
cysts, a condition referred to as chronic cystic mastitis or benign cystic
disease (see below). Nipple discharge, with or without a lump, is almost always
indicative of a benign growth.
The physician also will consider the consistency
of the mass, whether it is well demarcated, and whether there are skin changes
over the area. In most cases, when there is any doubt as to the nature of the
suspicious mass, the physician will remove it for microscopic examination. This
will resolve doubts and fears of both doctor and patient. The surgery is minor
even though it is usually done under general anesthesia.
