Table of Contents
By Dr. Erika
Breast health is an incredibly important part of women’s (and men’s) health and wellness. Both women and men can develop breast disease, and men can even be diagnosed with breast cancer. Though this article will focus mostly on women’s breast health, anyone with concerns about their breasts should contact their doctor for a thorough evaluation. A healthy breast encompasses various factors, including size, shape, and color. More importantly, regular screenings, such as mammograms, play an essential role in the early detection and prevention of breast cancer, a disease that affects millions of women every year.
What Should Healthy Breasts Look Like?
Breast size can vary significantly from person to person, and what is considered healthy varies as well. There is no one-size-fits-all definition of a healthy breast size. However, it’s essential to understand that breast size alone is not an indicator of breast health. What’s crucial is that breasts should be proportionate to a person’s body, and any sudden changes in size should be evaluated by a healthcare professional. Additionally, larger breasts may be more prone to certain discomforts like back pain, so addressing these issues is essential for overall well-being.
Breast shape also varies quite a bit. Healthy breasts come in various shapes, including round, teardrop, or asymmetrical. It’s essential to understand that breast asymmetry is common and rarely a cause for concern. What’s vital is that any changes in breast shape, such as dimpling, puckering, or unusual lumps, should be promptly examined by a healthcare provider. The color of healthy breasts can vary from person to person, depending on factors such as skin tone and ethnicity. The key here is to be aware of any changes in the color of the breast or nipple. Healthy breasts typically have a consistent color throughout. Discoloration or thickening of the skin should be reported to a healthcare professional for evaluation.
Nipple discharge can be normal or medically concerning, so it is always a good idea to mention it to your doctor. Clear or light white discharge usually does not indicate anything concerning, and often can be from healthy things like normal lactation. However, women who are not breastfeeding can lactate (express milk from their nipples), and this can be a sign of a problem with their endocrine system, requiring medical evaluation. Yellow to green discharge can indicate infection and bloody discharge can be from injury or even cancer, so if you notice any drainage from your nipple, be sure to contact your doctor to make an appointment for an evaluation.
Types of Breast Disease
There are several types of breast diseases, including benign (non-cancerous) and malignant (cancerous) conditions. Some common types are:
Fibroadenoma: A benign breast tumor made up of glandular and fibrous tissue. It’s usually painless and feels like a smooth, firm lump.
Cysts: These are fluid-filled sacs that can develop in the breast tissue. They are often benign and can cause breast pain and tenderness, and they can even become more pronounced or more painful around the time of your menstrual cycle.
Fibrocystic Change: Non-cancerous changes in breast tissue that can cause breast pain, lumpiness, and discomfort.
Mastitis: Inflammation of the breast tissue, often caused by infection or breastfeeding-related issues. Usually, this will require warm compresses, and often antibiotics are prescribed.
It’s important to note that while some breast diseases are benign, others can be malignant and potentially life-threatening. Regular breast self-exams, clinical breast exams, mammograms, and other imaging techniques like MRI and ultrasound are essential for early detection and appropriate management. If you have concerns about your breast health, consult a healthcare professional for evaluation and guidance.
Aside from skin cancer, breast cancer is the most common type of cancer found in women in the United States. The average risk of a US woman developing breast cancer in her lifetime is about 13%. The American Cancer Society estimates that in 2023, almost 300,000 new cases of breast cancer will be diagnosed in the US. Breast cancer can present with several different signs and symptoms. Regular self-breast exams (such as knowing your “normal” breast and seeking medical attention with any changes), as well as screenings such as mammograms, are very important to catch cancer at early stages when it is easier to treat and before it spreads to other areas of the body. Some of the more common signs/symptoms to look for include:
- New lump in breast or armpit (usually painless, hard and/or irregular in shape and not symmetrical).
- Change in size or shape of breast (enlargement of breast, or a noticeably new change in one breast growing compared to the other breast).
- Breast pain or tenderness (often, breast cancer is painless, but any new discomfort in your breast should be evaluated by a doctor to rule out an atypical presentation of breast cancer).
- Skin changes (dimpling, thickening, change in color).
- Nipple changes (inversion when previously turning outward, redness/scaling, discharge, itchiness).
Despite its high incidence, advances in early detection and treatment have led to a decline in breast cancer mortality rates. Therefore, it is very important for women to understand the importance of breast screening and follow recommended guidelines to increase the chances of early detection and successful treatment. By staying informed, proactive, and vigilant about breast health, women can take meaningful steps towards hopefully reducing the impact of breast cancer on their lives and communities.
The Importance of Breast Evaluations
In addition to self-breast exams or in-office breast exams by your doctor, there are other methods available to evaluate for breast disease, which include a variety of imaging tests.
A mammogram is a special type of x-ray used specifically on breast tissue for early detection of breast cancer. It is a diagnostic tool that can detect breast cancer at an early stage when treatment is most effective. Mammograms are typically performed by a radiologic technologist and interpreted by a radiologist. During a mammogram, your breast will be gently compressed between two flat plates, creating a clear image of the breast tissue. This compression may cause temporary discomfort but is necessary for obtaining a high-quality image. The X-ray images are then analyzed for any abnormalities, such as tumors or calcifications.
There are two types of mammograms: screening mammograms and diagnostic mammograms. Screening mammograms are routinely performed for women with no symptoms and are crucial for early detection. Diagnostic mammograms are performed when there are symptoms or when further evaluation is needed based on the results of a screening mammogram. Often, additional imaging, such as a breast ultrasound or breast MRI, will be ordered to follow up on an abnormal finding noticed on the mammogram.
Breast MRI (also known as magnetic resonance imaging) is a medical imaging technique that uses magnets and radio waves to create detailed images of the breast tissue. It often involves the use of a contrast dye injected into a vein. This contrast enhances the visibility of blood vessels and areas with increased blood flow, which is particularly useful for detecting tumors. Breast MRI can help detect breast cancers that may not be visible on mammograms or ultrasounds. It is often used in high-risk patients or when other imaging methods have inconclusive results.
Breast ultrasound, also called breast sonography, uses high-frequency sound waves to create images of the breast tissue. It is a non-invasive and radiation-free imaging method for imaging breasts. It can help distinguish between fluid-filled cysts and solid masses, which may require additional imaging techniques to further evaluate the area in question. If a woman has particularly dense breasts, often both mammogram and ultrasound are used for better views of the breast tissue. Ultrasound can also be used if a breast needle biopsy is conducted because the imaging can help with accurate needle placement.
Breast thermography is a technique that uses infrared technology to visualize variations in temperature and blood flow in breast tissue. It is based on the principle that cancerous cells and other abnormal tissue may have increased blood flow and more metabolic activity, which can cause a small elevation in temperature compared to nearby healthy tissue. It has limited sensitivity and specificity, meaning it can lead to false results and is, therefore, not a first-line or solely-recommended imaging technique due to its poor reliability.
The recommended frequency of breast imaging varies depending on several factors. Risk factors for breast cancer can include age over 50, family history of breast cancer, having certain gene mutations such as BRCA1 and BRCA2, dense breasts, early onset of menses or late menopause, alcohol use, obesity, radiation exposure and high hormone levels such as seen in PCOS.
In general, women should start getting regular mammograms at age 40 and continue annually. However, women with a higher risk of breast cancer may need to start screening earlier or undergo more frequent breast imaging. Sometimes, alternating between mammograms and breast MRIs is even advised. Since breast screening varies based on your personal and family history, developing a plan with your doctor matters so much in ensuring you have adequate screening and maintain your optimal health.