Retrospective analysis of breast diseases encountered at Shija Breast and Thyroid Clinics

Dr Ajit Lukram *

Early signs of breast cancer :: Pix - Wikipedia / National Institutes of Health, USA

This descriptive analysis was carried out between July 2013 to August 2014 at Shija Breast and Thyroid Clinics and reflects the importance of benign breast diseases in our region. Benign breast disease (BBD) as such has become a neglected entity although it forms the majority of breast complaints. Breast cancer has taken precedence over benign breast diseases as it is more fearsome despite the fact that females with benign breast disease are substantial.

The mammary gland – breast – is a very dynamic organ which undergoes cyclical changes throughout a woman’s reproductive life. Hormones and growth factors acting on the epithelial and stromal elements right from the onset of puberty till menopause cause significant morphological changes leading to Aberration of Normal Development and Involution (ANDI) causing majority of benign breast diseases. Benign breast disease can occur at any time during the life span of a woman.

Risk factors for breast cancer are assessed based on the histologic classification of a benign breast lesion and a family history of breast cancer.

In women between adolescence and the mid – 20s, the lobules and stroma in the breast may respond to hormonal stimuli in an exaggerated fashion with the development of single and multiple swellings – palpable Fibroadenomas. Fibrocystic disease is another common finding in women with benign breast disease as up to 50 to 60 percent of women without breast disease mainly exhibit patterns of fibrous change and cyst formation on histology.

Triple assessment which includes clinical examination, imaging (Ultrasonography and X-rays) and biopsy (excision, FNAC) is now considered the gold standard approach to the diagnosis of all breast lumps.

Chief complaints in our study are as follows.

Type of complaint	Number
Lump	118
Cyclical breast pain	36
Non cyclical pain	42
Nipple discharge	20
Lump and pain	30
Others	40

Anatomy of a female breast

1) Chest Wall,
2) Pectoralis muscles,
3) Lobules,
4) Nipple,
5) Areola,
6) Milk duct,
7) Fatty tissue,
8) Skin

Type of disease	Number
Accessory mammary gland	8
Fibroadenoma	104
Phyllodes tumour	4
Fibrocystic disease	132
Mastitis	74
Cyclical mastalgia	72
Non cyclical mastalgia	84
Duct ectasia	24
Lactating adenoma	4
Lipoma	8
Cyst	6
Tuberculosis	2
Antibioma	4
Cancer	24
Atypical ductal hyperplasia	4
Galactocele	18

Type of personal history	Number
Family history	106
Breast fed	156
Married	166
Unmarried	120
Have children	160

The spectrum of benign breast disease in our study population does not appear to differ much from other studies with a concern towards the presence of lump accompanied by pain. Fibroadenoma was the most common diagnosis. Breast pain (mastalgia) was another common diagnosis inclusive of the separate entities (cyclical and non cyclical pain). Mean age of presentation of benign breast disease in our study was 20 – 40 years.

It is important to be aware about the manifestations and treatment of benign breast disease because women with proliferative breast lesions without atypia on biopsy have a slightly increased risk of breast cancer, whereas women with atypical hyperplasia on biopsy have a substantially increased risk. The key to diagnosis is early follow up and routine breast check. All females should be starting monthly self breast examinations by the age of 16 years and yearly radiologic imaging from the age of 40 years till 75 years.

How should a breast self-exam be performed?

1) In the Shower : Using the pads of your fingers, move around your entire breast in a circular pattern moving from the outside to the center, checking the entire breast and armpit area. Check both breasts each month feeling for any lump, thickening, or hardened knot. Notice any changes and get lumps evaluated by your healthcare provider.

2) In Front of a Mirror: Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead. Look for any changes in the contour, any swelling, or dimpling of the skin, or changes in the nipples. Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match—few women's breasts do, so look for any dimpling, puckering, or changes, particularly on one side.

3) Lying Down: When lying down, the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit. Use light, medium, and firm pressure. Squeeze the nipple; check for discharge and lumps.

Repeat these steps for your left breast. Mammography can detect tumors before they can be felt, so screening is key for early detection. But when combined with regular medical care and appropriate guideline-recommended mammography, breast self-exams can help women know what is normal for them so they can report any changes to their healthcare provider. If you find a lump, schedule an appointment with your doctor, but don't panic - 8 out of 10 lumps are not cancerous.

Shija Breast and Thyroid Clinics is run by a dedicated Consultant and two dedicated staff nurses and is open for consultation everyday from 10 AM to 1 PM (except Sunday). This abstract was written by Dr. Ajit Lukram, Consultant, Shija Breast and Thyroid Clinics with data collection assistance by staff nurses Mrs. Shelly and Mrs. Roshni.

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* Dr Ajit Lukram wrote this article for Hueiyen Lanpao
Dr Ajit Lukram is MBBS, DNB (General Surgery), Fellow – Colorectal, Breast & Endocrine (Carlisle, United Kingdom), Consultant GI & General Surgeon Shija Hospitals & Research Institute
This article was posted on April 29, 2015.

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