Throughout life there are a number of changes that occur in the breasts. First change occurs during puberty with the development and growth of breast tissue. During pregnancy and after pregnancy the milk is produced in the lobes, and produced milk is carried through the ducts to the hole on the nipples. During breastfeeding the breast are increased.

With aging and entering the menopause the ovaries produce less of the hormones and the number of lobes is reduced, the breast tissue is being replaced by fat tissue. Breasts shrink and change their shape.

Typical changes in the breast

From puberty to menopause, breasts go through more natural phases and changes. Typical changes in the breast include lumps, pain and secretion from the nipple. These changes are mostly benign. For example, are your breasts swollen and painfully sensitive before menstruation? If so, you probably have cyclical changes in the breasts, a condition that affects 50% of women.

These cyclical changes always happen with the menstrual cycle, the breasts are affected by those same hormones that regulate the menstrual cycle.

Heaviness, tenderness and creation of lumps may also be reaction of the breast tissue to hormonal changes during the menstrual cycle; these changes usually disappear with the cessation of menstrual periods. It is important to tell your doctor about the changes that remain after the cessation of menstrual period.

Other frequent changes in the breast

• Ovarian cysts are fluid filled spaces in the breast tissue. They most commonly occur in women over the age of 30. Cysts are almost always harmless.
• Fat necrosis is solid lumps composed of damaged fat tissue. They may develop as a result of bruising or blow to the chest.
• Fibroadenoma are round, rubbery, benign tumors. Fibroadenomas are the most common tumors in the late teens and early 20s. Although these are not malignant tumors, they can grow during pregnancy or during breast-feeding.
• Fibrocystic changes in the breast cause the creation of lumps that are painfully sensitive and particularly pronounced just before the period. These changes may become more pronounced with women approaching middle age.
• Secretion from the nipple may be significant sign if it occurs by itself or only from one nipple. Tell your doctor about the color and composition of the secretion.
• Cyclic breast pain represents the tenderness of the breast during the menstrual cycle. This type of pain is caused by your hormones and is always related to the menstrual cycle.
• Non-cyclical breast pain often occurs in only one part of the breast. This kind of pain is not related to the functioning of neither hormones nor menstrual cycle. If you have this kind of pain you need to contact your doctor.
• Pain that does not occur in the breast usually occurs in the chest or ribs and it is often not connected to the breast. It is mostly caused by another medical condition, which should be confirmed by your doctor.

Treatment of benign breast conditions

You should talk to your doctor about the treatment of benign breast conditions. The doctor may recommend surgical removal of fibroadenoma or fat necrosis, as well as removal of painful cysts that do not withdraw.

In order to minimize inconvenience cause by, for example, fibrocystic changes in the breast, the doctor may recommend wearing a bra that is more pressing breasts to the chest. In some women, reducing the consumption of caffeine can reduce this discomfort.

Warning signs

If you notice any change in your breast, do not ignore it! Please consult a doctor who specializes in breast diseases. It is possible that this is a harmless condition, but also a sign that warns of possible breast cancer. In any case, the diagnosis needs to be set by the specialists in breast disease. Contact your doctor if you notice any of the following changes:

• Lump, nodule or thickening
• Swelling, hot spots, redness or darkening of the skin
• Change in the size or shape
• Creation of a socket or wrinkling of the breast skin
• Itching, peeling epidermis or rash on the nipple
• Retraction of the nipples or other parts of the breast
• Secretion from the nipple that suddenly occurs
• Unpleasant persistent pain

What is breast cancer?

Breast cancer is the most common form of cancer in women. In this century one in ten women will develop this disease. Breast cancer is the leading cause of death in women. Breast cancer is not one disease, but a group of diseases. It occurs when breast cells lining the tubules become malignant. Unlike benign tumors, malignant tumors are made up of abnormal cells that grow without the normal control mechanisms and overcome normal breast tissue. Breast cancer cells can spread beyond the breast to the other organs, and develop life-threatening metastases.

What can I do?

Early detection and treatment offer the best chance for a cure of breast cancer. When the cancer is confined to the breast, the rate of 5-year survival is over 95%.

Plan of early detection in 3 phases:

• monthly breast self-examination starting at the age of 20
• clinical breast examination by a doctor at least every two years starting at the age of 20, and each year when over 40 years of age
• screening-mammography, the breast screening on a special X-ray machine, mammography, every two years in women over 50 years, as well as in high-risk women aged 40-50 years. Women younger than 40 with cases of breast cancer in the family or other risk factors, the need and frequency of mammography screening should determine with their doctor.

Breast self-exam (BSE)

For successful self-exam of the breast, you should know the normal state of your breasts. Breast self-examination should be carried out once a month immediately after the menstrual cycle.

By performing breast self-exam, you are doing yourselves a great favor in terms of health. It will allow you to become thoroughly familiar with your breasts and to notice the possible change that you have not had. Consultation with the breast disease specialist will clarify what it is.

Most of the changes in the breast are harmless, but caution is required.

To be able to identify the changes, you must know the normal state (form, texture and color) of your breasts

• In front of the mirror, standing, straighten up the shoulders and position you exam the size, shape and color of breast, symmetry of the breast shape, the absence of swelling and other abnormalities
• Raise your arms and look for the same changes. While you're in front of a mirror, with your thumb and forefinger, gently squeeze the nipple to eventually discovered secretion. The secretion can be whitish, yellowish or blood - stained.
• The next step is the examination of the breasts lying down. Feel your left breast with right hand and vice versa. Use the cheekbones of three fingers (index finger, middle and ring), with medium pressure and circular movements of the fingers.
• It is important to check the entire breasts, from the collarbone to the beginning of the stomach and the armpits.
• Examination of the breast can start from the nipple, moving in increasing concentric circles towards the outer parts of the breast.
• Finally, check your breast in a standing or sitting position. It is best to exam them after a shower, when the skin is damp and slippery.

Contact a doctor immediately if you notice:

• unusual differences in size and shape of breasts
• a small lump or nodule on any part of the breast
• dimples on the breast, wrinkling, swelling
• that there has been a change of position or retraction nipples
• redness, tenderness, rash, swelling of the breast or nipple
• unusual discharge from the nipple

Clinical breast exam (CBE)

Clinical breast examination is performed by your doctor during the regular examinations. During clinical examination a doctor examines the size, shape and color of the breasts and armpits. In case that he/she notices unusual changes, the doctor should refer you to a specialist for breast disease.

Mammography

Self-examination, clinical examination and mammography are now the best way for the early detection of breast cancer. Mammography can detect breast cancer at a stage when there are no clinical signs and symptoms.

Mammography takes a few minutes and uses minimal doses of radiation.

Starting from 50 years of age, mammography is recommended for all women once every two years regardless of their level of risk. Women at high risk are recommended mammograms earlier, at intervals of 1-2 years between 40 and 50 years of age.

Girls over 20 years and women without high-risk younger than 50 years are recommended self-examination, clinical examination at least once a year and ultrasound examination of the breast because the hormonally active breast tissue is very dense and not suitable for mammography.

Am I at the risk of breast cancer?

The simple facts that you are a woman and you get older you exhibit a certain level of risk. In addition, there are other risk factors. The presence of several risk factors does not mean you will get breast cancer, it means that the chance that you are likely to get it is something higher than in other women.

What causes breast cancer?

The causes are not fully understood. However, there are certain risk factors that you can control and others that you cannot influence.

Factors that you can affect

• having a first child after 30 years of age
• abortion before the first born child
• not breastfeeding
• taking the contraceptive pill for five or more years, as well as infertility treatment with hormones without controlling their levels in the blood
• obesity after climax
• suppression of symptoms of climax with hormone preparations
• exposure to large amounts of radiation

The factors that you cannot affect

• aging
• breast cancer in the past
• cases of breast cancer in the family
• inherited the mutant gene for breast cancer, BRCA1 or BRCA2
• first period before the age of 12
• menopause after 55 years
• altered breast cells determined by cytological analysis of the sample of tissue or secretions from the breast

The best way to protect yourself from breast cancer is:

• be familiar with your breasts
• talk to your doctor about risk assessment and health of the breast
• through consultation with a breast disease specialist assess your own risk of breast cancer
• affect the risk factors that you can change or avoid
• regularly have preventive examinations

Recommendations for women with a higher risk of breast cancer:

• more frequent clinical examinations with mammography once a year
• taking antiestrogen tamoxifen to reduce the risk
• prophylactic or preventive mastectomy or oophorectomy to reduce the risk
• participation in the studies of chemo-prevention

Diagnosis of breast cancer

What is the difference between screening and diagnosis of breast cancer?

• The screening test is performed regularly and when there have been not been any unusual symptoms.
• Diagnostic procedures are carried out after the appearance of suspicious signs and symptoms.

Diagnostic mammograms

Each mammogram is compared to previous recordings of the breast in order to determine any changes. If the mammogram shows the need, the other diagnostic procedures are also conducted.

Ultrasound

Ultrasound examination may differentiate between fluid-filled cysts from solid lumps in the breast. Testing is painless and safe and is done by dragging the ultrasound probe through breasts lubricated with special gel. Breast ultrasound is suitable for monitoring and control of benign changes and breast health.

Biopsy

A biopsy involves taking a sample of breast tissue. During the procedure the doctor takes a tissue sample with a needle or scalpel. The tissue is examined microscopically for the presence of cancer or precancerous cells. A biopsy is generally not painful, but you may feel discomfort.

A biopsy is the only way to determine whether the change is benign or malignant in nature. It is important that you know that 4 out of 5 lumps that are biopsied are benign in nature.

Questions you can ask your doctor

• What type of biopsy you recommend and why?
• How will you perform the biopsy?
• How long biopsy takes?
• What are the possible side effects?
• When will I find out the results?
• When will I be able to get back to normal life?

Type of Breast Cancer

There are several types of breast cancer; they are widely classified into two groups:

In situ and invasive breast carcinoma.

• In situ cancer means that the abnormal growth of cells is retained within the walls of the ducts or lobes of the breast. These cancers are often called precancerous conditions because they can develop into invasive cancer or increase the risk of this cancer. In situ carcinomas, when in this form, do not have the ability of abstraction of the normal breast tissue nor metastasis.
• Invasive cancer involves the spread of abnormal growth of cells in the surrounding tissues. Invasive breast cancers often metastasize, ie. malignant cells from the tissue spread to other organs. The most common sites of metastasis are the lymph nodes, lungs, liver, bones and brain.

Staging (determining the expansion) of breast cancer

Beside the type of breast cancer, for the fight against this malignant disease, growth characteristics, size and spread of tumors are also important.

Defining these characteristics is called the breast cancer staging.

The stage is determined by three elements:

• tumor size
• spread of cancer to the lymph nodes in the armpit
• signs of metastasis to other parts of the body

Best results are obtained in patients whose tumor is smaller than 2 cm and there was no abstraction of lymph nodes in the armpit.

Oncological treatment for breast cancer

Surgery is very important in the treatment of early breast cancer, which is operable and is not bigger than 5cm. The goal of the treatment is a surgical removal of tissue that contains cancer. Surgical treatment is often combined with chemotherapy, hormonal or air therapy.

Generally there are two types of surgical treatments: sparing therapy and mastectomy.

• Breast-sparing surgery involves removal of the tumor, or a certain part of the breast. Axillary (armpit) lymph nodes are also removed. Radiation therapy is then applied to destroy the possibly remaining cancer cells.
• Mastectomy involves removal of the entire diseased breast and axillary lymph nodes.