Painful Breast

Question 1

Breast pain

Answer 1

Especially important to clarify whether there is a relationship to the menstrual cycle - more common during luteal phase

Rarely a sign of breast cancer if only symptom / sign

Question 2

Types

Answer 2

Cyclical - linked to changing hormonal levels. Described as heaviness may radiate into the axilla or down the arms

Non-cyclical - cause often unclear but settles on its own in around 50% of cases

Do a bilateral screening mammography to investigate (fat - dark, fibroglandular tissue - white)

Question 3

Breast density

Answer 3

RF for breast cancer

Also more difficult to detect breast cancers - obscured by the breast tissue

Question 4

Mastitis

Answer 4

Can be infectious or non-infectious

Lactational mastitis common in breast feeding women - due to milk stasis caused by overproduction or insufficient removal of milk

Development of focal lump and systemic symptoms - abscess? Predisposing factors - baby not attaching well to breast, use of dummy / bottle, tight bra

Non lactational abscesses - smokers, diabetics, immunocompromised

Question 5

Management of abscess

Answer 5

Ultrasound guided drainage in breast unit under local anaesthetic
Flucloxacillin - only trace found in breast milk
Support and advise re attachment (breastfeeding counseller)
Encouraged to keep expressing milk to avoid stasis

Question 6

Inflammatory Breast Cancer

Answer 6

Rare - grows along the lymph vessels

Symptoms - redness, swelling, pain, hot, orange peel skin, nipple pain / discharge

Can spread quicker than other types of cancer. Urgent tx - chemo, radio, surgery, targeted therapy, hormonal therapy