women s health issues
Overview of Breast Disorders
Evaluation of Breast Disorders
Doctors ask the woman about the symptoms she is having and other information related to possible causes, including What the symptoms are How long the woman has had the symptoms Whether the symptoms occur at certain times of the month (related to the menstrual cycle) Whether she has a discharge from the nipple, and if so, what it looks like Whether she is pregnant What drugs she is taking Whether she or a family member has had breast cancer When she had her last mammogram and what the results were A breast examination is done. With the woman sitting or lying down, the doctor inspects the breasts for irregularities in shape, a nipple that turns inward (inverted nipple), and lumps. The doctor also checks for dimpling, thickening, redness, or tightening of the skin over the breast. The doctor applies pressure around the nipples to check for a discharge. The discharge is examined to determine whether it contains blood. The armpits are checked for enlarged lymph nodes. The doctor may examine the breast and armpits with the woman in different positions. For example, while sitting, she may be asked to press her palms together in front of the forehead. This position makes the chest muscles contract and makes subtle changes in the breast more noticeable. Imaging tests are used to Check for breast abnormalities before they are noticed (called Symptoms ) Evaluate abnormalities that have been identified, such as a breast lump found during the doctor's examination Mammographyinvolves taking x-rays of both breasts to check for abnormalities. A low dose of radiation is used. Only about 10 to 15% of abnormalities detected by mammography result from cancer. Experts agree that all women should be screened for breast cancer. However, experts disagree about When it should start How often it should be done When (or if) it should be stopped Screening may include Mammography A breast examination by a health care practitioner Magnetic resonance imaging (MRI) for high-risk patients Mammography is usually started between the ages of 40 and 50 (see sidebar The types of tissue in the breast affect how well a mammogram can detect an abnormality. The breast contains fibroglandular tissue (composed of fibrous tissue and glands) and fatty tissue. As women age, the amount of fatty tissue in the breasts increases and the amount of fibroglandular tissue decreases. Abnormalities next to fatty tissue are easier to detect with a mammogram. That is why a mammogram becomes more accurate after age 50. Some women have dense breasts. Having dense breasts means that women have more fibroglandular tissue and less fatty tissue. Abnormalities in dense breasts are harder to detect on a mammogram . Also, women with dense breasts have an increased risk of breast cancer. Thus, these women may require additional tests, such as breast ultrasonography, 3-dimensional mammography ( Breast examination by a health care professional ), or magnetic resonance imaging (MRI). Mammographycan be used to do the following: Provide images of any abnormalities (such as a tumor or an abscess) and the tissues around the abnormality Provide images of lymph nodes to check for abnormalities Help doctors place a biopsy needle into abnormal tissue After surgery, help doctors determine whether all the cancer was removed Mammography may also be done if a woman or doctor finds a lump while examining the breasts or if a woman has breast pain or a discharge from the nipple. Ultrasonographycan be used to do the following: Provide the first image of abnormalities that were detected during a breast examination in women under 30 Provide more information about abnormalities detected by magnetic resonance imaging or mammography—for example, ultrasonography can show whether lumps are solid or filled with fluid (fluid-filled lumps—called cysts—are rarely cancerous) Help doctors place a biopsy needle into abnormal tissue Identify abnormal lymph nodes that may require biopsy Staging None Magnetic resonance imaging (MRI)can be used to do the following: To diagnose abnormalities in the breast, especially in women with dense breast tissue or a Breast cancer gene mutation (a After breast cancer is diagnosed, to determine the size and number of the tumors, especially in women with dense breast tissue To identify abnormal lymph nodes and thus help stage breast cancer This information can help doctors plan surgery or other treatments for breast cancer. MRI is done at the same time as mammography to screen women if they have an increased risk of developing breast cancer—for example, if they have a mutation in the gene for breast cancer. 