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Fibrocystic breast changes ncbi9/25/2023 ![]() ![]() Cancerous breast masses rarely present with pain, although the presence of pain should not exclude neoplastic lesions from the differential. More important is to establish whether the mass had developed in association with trauma or other symptoms and how rapidly the mass appears to be growing or changing, if at all.Īn acutely tender breast lump is more likely to be an abscess or hematoma secondary to trauma. Indeed, a proportion of breast lumps are identified through routine screening, so this is not necessarily an accurate way of determining the acuity of such a mass. Patients who do not regularly carry out breast self-examination may take longer to notice a breast lump. It is not always possible to establish the duration for which the mass has been present. Particular emphasis should be placed on the chronological development of the lump and the symptoms associated with it. Ī thorough and accurate history is the cornerstone of approaching any new breast mass. Other risk factors, such as excess alcohol intake and obesity, are thought to increase endogenous estrogens. Male patients should be asked about previous hormonal treatments for prostate cancer, the use of finasteride or testosterone, episodes of orchitis/epididymitis, or previously diagnosed Klinefelter syndrome. Early age of menarche, late age of first pregnancy, nulliparity, oral contraceptive or hormone replacement therapy, and late menopause increase estrogen exposure, while breastfeeding is a protective factor. Therefore, it is essential to interrogate lifetime estrogen exposure in all patients presenting a new breast mass. The primary risk factor for developing breast cancer is excess exposure to estrogens. Breast tissues, and indeed the majority of breast pathologies, are responsive to changes in hormone levels. Breast tissues involute significantly following menopause, the glandular tissue atrophies due to the reduction of circulating estrogen levels and is largely replaced by fatty tissue. īreast tissue is present in children and males but is more developed in females of reproductive age due to hormonal surges that arise at puberty. Lymphatic drainage is primarily through the axillary lymph nodes and involves the pectoral, subscapular, and internal mammary nodes. ![]() The lobes are supported by fibrous stroma and fatty stroma. Each breast has 15 to 20 lobes, which are drained by lactiferous ducts that converge beneath the nipple in the subareolar region. ![]() The breast, or mammary gland, is a modified sweat gland containing various fibrous tissue, glandular tissue, and adipose tissue. Such an approach will be described in this article, with examples throughout of the common breast pathologies encountered. In general, the approach should follow the triple-assessment pathway of clinical examination, radiological imaging, and pathology analysis. īreast cancer is the most common type of cancer in women worldwide, with an incidence of approximately 12%, and therefore although the vast majority of breast lumps are benign, a thorough and structured approach is required in all cases. Indeed, male breast cancer is a well-documented condition and requires a considered index of suspicion for its timely diagnosis and intervention. Although the majority of breast masses present in adult women, children and men can also be affected. Breast masses have a wide range of causes, from physiological adenosis to highly aggressive malignancy. ![]() Over 25% of women are affected by breast disease in their lifetime, and the vast majority of these cases will present initially as a new breast mass in the primary care setting. Breast lumps or masses are very common, particularly among women of reproductive age. ![]()
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