Women often wonder if their breasts are “normal.” Breasts come in all shapes and sizes (and may be very asymmetrical!) and will also change as they adjust to hormonal shifts associated with puberty, with the monthly menstrual cycle, with contraception, and with pregnancy. Breasts may also change in response to weight changes and aging. For most young women, breast concerns such as lumps or masses, pain, or \ even nipple discharge are not dangerous. However, a woman experiencing any of these issues should be evaluated by a health care clinician.
BREAST LUMPS
Cancer in premenopausal women is uncommon. Most breast lumps are benign (harmless) and are caused by normal glandular changes associated with the menstrual cycle. Over 50% of women experience these fibrocystic changes that cause noticeable pain, swelling, or thickening. Women tend to notice symptoms most in the week or so leading up to their period because hormonal stimulation causes the breast’s milk glands and ducts to enlarge. As a result the breasts retain water. Breast swelling and lumpiness usually improves after menstruation. Hard masses that do not change in size during a woman’s menstrual cycle are most likely benign cysts or solid tumors such as fibroadenomas or papillomas. Once diagnosed, most of these lesions are left alone or monitored unless they are causing significant discomfort. RARELY solid masses can be cancer. If a woman notices that a particular lump feels much firmer than the other areas of her breast, or if it does not seem to get smaller after her period, she should be evaluated by a clinician for a breast exam and to discuss whether imaging studies (such as an ultrasound or mammogram) or needle biopsy are warranted.
BREAST PAIN
Breast pain is rarely a sign of breast cancer. Pain in the breasts is usually caused by hormone fluctuations (natural or related to birth control pill use) or premenstrual fluid retention. Trauma or infection can also cause breast pain. Comfort measures that may help with fibrocystic breast pain and lumpiness include wearing more supportive bras (even to bed), avoiding caffeine, applying heat to the breasts, reducing salt intake, and taking over-the-counter analgesics (pain killers) such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Some women find that evening primrose helps in treating breast pain.
NIPPLE DISCHARGE
Nipple discharge (fluid coming from the nipple) can be caused by trauma (from nipple stimulation in foreplay or from rubbing from poorly fitting bras), medications (including birth control pills and antidepressants), hormone imbalances, or endocrine problems such as hypothyroidism. Benign pituitary tumors called prolactinomas cause breast discharge that is often accompanied by a change in periods. Discharge can also be caused by intraductal papillomas (growths inside the milk ducts)and, rarely, cancer. Nipple discharge may be more concerning if it appears spontaneously (without squeezing the nipple), bloody or watery (rather than milky), or on only one side (unilateral). Nipple discharge should always be evaluated by a health care clinician.
In the past it was recommended that women perform monthly self breast exam (SBE) to become familiar with their breasts and to help identify changes for early detection of breast cancer. However, multiple large randomized, controlled studies have found that SBE may actually cause more harm than good by encouraging women to find more benign breast lesions. This tends to cause extreme anxiety and cost because of needless testing. For even those women who found an early cancerous lump through SBE, this detection did not tend to improve rates of mortality (death). Because of this, self breast exam is no longer recommended. Please see the topic labeled “Breast cancer” for further discussion of breast cancer risks and screening.
If you have a breast concern, please call Student Health at 766-2130 and make an appointment to visit with a clinician.
