What kinds of problems can women have with their breasts?

There can be different types of breast related problems. However, not all of them are caused by breast cancer. If you are having any breast related problems, always consult a doctor as soon as possible to have it checked before coming to conclusions yourself.

Common breast related problems include:

• Lumpiness of breasts
• Lump (or mass) in one breast
• Breast pain
• Breast tenderness
• Abnormal discharge from the nipples (leaky fluid, could be clear, white, yellow, green or red in colour)
• Nipple inversion (new and especially if only occurring in one breast)
• Breast skin changes (redness, puckering)

These problems related to breast cancer can occur in any age and should always be discussed in detail with a doctor. Problems related to breasts are not an acute emergency, however, they should be checked as soon as possible to see if there is something serious underlying. Your doctor should give advice based on your medical history and examination, or may refer for further investigations with a specialist.

Breast Pain or Tenderness

The most common type of breast pain is caused by the hormones that control the menstrual period. These hormonal changes can cause pain in both breasts several days before the menstrual period begins. Because the pain can come and go with the menstrual cycle, it is called ‘cyclical’ breast pain. Cyclical breast pain is not usually caused by breast cancer or other serious breast problems.

Less commonly, a woman can have breast pain that does not come and go with the menstrual cycle (also called noncyclical breast pain). This type of pain is not related to the menstrual cycle and might occur in only one breast or one area of the breast. Noncyclical 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, heart burn, chest pain). Noncyclical breast pain is caused by breast cancer in only a very small percentage of women.

If testing shows no signs of a serious problem, you can try one or more of the following treatments:

• Pain relief medicines, such as or ibuprofen or Panadol. Women with very severe breast pain are sometimes treated with a prescription medicine.
• Decrease the dose or stop taking medicines that contain estrogen (after a discussion with your GP)
• Wear a well-fitted support or sports bra.
• Consider making changes to your diet. Elimination of caffeine and a low fat, high complex carbohydrate diet is helpful for some women. Dietary supplements such as vitamin E and evening primrose oil have also been suggested for breast pain

Nipple Discharge

Having a milky-colored discharge (also called galactorrhea) from both nipples is common, especially during the first year or two after giving birth. Nipple discharge from both breasts can also occur in women with an underactive thyroid (hypothyroidism), as a side effect of certain medications, or because of a growth in the pituitary (a part of the brain), causing an increase in a hormone called prolactin.

As with other ducts in the body, breast ducts make and carry secretions. Many women can express (squeeze out) a small amount of yellowish, greenish, or brownish discharge. This is often called "physiologic" discharge and is not a cause for concern. Physiologic discharge is not bloody.

Spontaneous nipple discharge (discharge that occurs without squeezing) or nipple discharge that is clear or bloody may be caused by an abnormal growth within the breast or, less commonly, by breast cancer.

Any woman with nipple discharge should be evaluated by a healthcare provider. A mammogram, breast ultrasound, and/or exam of the breast ducts may be recommended in some cases.

Inverted Nipples

Many women are born with nipples that naturally invert (pull in) at times and evert (poke out) at other times. Other women find that this happens after breast feeding.

Nipple inversion of this type is not cause for concern. If your nipples have always been everted, however, and begin to invert for no obvious reason, this should be evaluated. Most causes of nipple inversion are not a cause for concern, but occasionally this is the first sign of a breast cancer. New nipple inversion is usually evaluated with a breast examination and mammogram as a first step.

Breast Skin Changes

Skin problems can develop on or near the breast, some of which cause itching, scaling or crusting, dimpling, swelling, redness, or changes in skin colour. 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.

More serious causes of skin changes on the breast can include less common forms of breast cancer, such as Paget disease or inflammatory breast cancer. Other, more common skin problems, such as rashes, moles, cysts, or skin infections, can occur on the skin of the breast, as well.

The evaluation of breast skin changes usually includes a breast examination and may include a mammogram. A skin biopsy may be needed to confirm the diagnosis.

Which tests might I need?

Tests needed depend upon the individual case. Common investigations for breast problems include:

• Breast ultrasound: sound waves are used to get an image of inside of your breasts. It can show solid and fluid filled lumps in breasts.
• Mammogram: specialised X-rays of the breast, helpful to find problems like breast cancer.
• Breast biopsy: using a needle to get one or more tiny tissue samples of concerning breast tissue and getting it examined under a microscope by a pathologist to check for cancer or any other issue.

What could be causing the problem?

The breast related symptoms listed above could be caused by many non-cancerous problems like normal changes in hormones during the monthly menstrual cycle causing breast pain or lumps. However, any new breast related symptoms should be taken seriously as it can be a sign of a tumour. Therefore it’s important to consult with your doctor as soon as you notice them.