PROBLEM AND PROSPECT OF BREAST LUMP ON UNDERGRADUATE STUDENTS

PROBLEM AND PROSPECT OF BREAST LUMP ON UNDERGRADUATE STUDENTS

CHAPTER ONE

INTRODUCTION

1.1      Background of the study

Any noticeable change, thickening, or localized swelling in your breast that wasn’t there before may be a lump. Most breast lumps are not cancerous and most women will experience a benign lump sometime in their lives. The following are common breast problems that appear as lumps. These are the most common cause of breast lumps in women age 35 to 50, and are responsible for at least half of all breast operations performed. This condition, formerly called fibrocystic breast disease, is not an actual disease, but probably an overreaction by the mammary glands, ducts, and fibrous tissue to normal hormonal changes. As a result, multiple pockets of fluid (called sacs or cysts) develop, and an increase in fibrous tissue may form. In some instances, a lump may consist only of fibrous rubbery tissue (a condition called mammary dysplasia). Tenderness and lump size commonly increase during the week before menstruation and decrease the week after. Many women experience decreased tenderness with the elimination of caffeine from their diet. Vitamin E supplements have been recommended in dosages of 200-400 I.U./day (consult your doctor). Some home remedies such as wearing a supportive bra, reducing salt intake to minimize fluid retention, and using ice packs to ease discomfort—may alleviate swelling and pain. Fibrocystic changes usually disappear after menopause. Breast lumps are a common finding in women of all ages, but are particularly common during the reproductive years (from first menstruation until menopause). One study examined 40 to 69 year old women presenting with breast complaints – 40% of these were for breast lumps or lumpiness. In those complaining of a lump, breast cancer was found in 11% of patients. Breast cancer is the most common among women (excluding skin cancers) and constitutes 27.7% of all cancer diagnoses in women. In Nigeria, 35 women are diagnosed with breast cancer every day. Rates of breast cancer are highest in the age group 60–64, but can affect women of all ages. Two out of three breast cancers are diagnosed in women aged 40–69.

Having a breast lump does not automatically mean a patient has breast cancer, as only 11% of people presenting with breast lumps turn out to have breast cancer. Additionally, many breast cancers are localised and can be treated effectively if diagnosed early. Most breast lumps are benign breast disease, a range of conditions that can cause breast lumps but are not cancerous. However, some benign breast diseases are associated with a slightly increased risk of cancer in the future, depending on that patient’s medical history, family history and risk factors. See your doctor for further advice and appropriate investigations for a breast lump.

The following conditions are common, benign causes of breast lumps and do not increase your risk of breast cancer in the future.

• Breast cyst – blocked ducts in the breast create a small, fluid-filled sac – these are common around the time of menopause. They can sometimes be painful, and are easily managed by drainage with a needle;
• Mastitis – usually due to an infection, the breast develops an area of inflammation that can be hard, red or tender. They are common during breastfeeding and can range from simple infections to complicated abscesses that require aggressive treatment. Mastitis that does not respond to treatment should be investigated further with biopsy to ensure correct diagnosis;
• Lipoma – a benign tumour of fat cells that can occur anywhere in the body. They are common and generally soft and painless.

Some benign breast diseases are not themselves cancerous but can carry a slight increase in the risk of breast cancer in the future. The level of this risk depends on the patient’s medical and family history. These include:

• Fibroadenomas – areas of overgrowth of normal breast tissue due to hormonal stimulation that are common in younger women. They are generally painless, soft and mobile. They are removed if larger than 2 cm, growing rapidly, or causing distress to the patient;
• Intraductal papilloma – benign tumours of the tissue lining milk ducts in the breast. They can be single or multiple and can cause a discharge of fluid from the nipple. They are not usually associated with cancer and are most commonly seen in women aged 30 to 50;
• Tubular adenomas – benign tumours of cells of breast glands, they are rare but most common in younger women;
• Phyllodes tumour – rare tumours of breast tissue that can be difficult to diagnose. They appear similar to fibroadenomas but have a greater tendency to recur. Rarely, a Phyllodes tumour can be cancerous and spread to distant tissues and are therefore surgically removed if diagnosed.

Many other rare conditions can present as a breast lump. 
Malignant causes of breast lumps Breast cancer is the most common cancer in women (excluding skin cancers) and second most common cause of cancer deaths in women. The main risk factors for the development of breast cancer include age, age at first menstruation, age at first childbirth, hormonal factors, family history and a history of abnormal breast biopsies.

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