Hormones 2016

Breast disorders
CBE is usually part of routine annual care for women > 35; it can detect
7 to 10% of cancers that cannot be seen on a mammogram. In the US, CBE
augments rather than replaces screening mammography. However, in some
countries where mammography is considered too expensive, CBE is the sole
screen; reports on its effectiveness in this role vary.
MRI is thought to be better than CBE or mammography for screening
women with a high (eg, > 15%) risk of breast cancer, such as those with
a BRCA gene mutation. For these women, screening should include MRI as
well as mammography and CBE. MRI has higher sensitivity but may be less
specific. Because specificity is lower, MRI is not considered appropriate for
screening women with average or slightly increased risk.
BSE alone has not been shown to reduce mortality rate, but evidence of its
usefulness is mixed, and it is widely practiced. Because a negative BSE may
tempt some women to forego mammography or CBE, the need for these
procedures should be reinforced when BSE is taught. Patients should be
instructed to do BSE on the same day each month. For menstruating women,
2 or 3 days after their period ends is recommended because breasts are less
likely to be tender and swollen (Kosir, 2013d).
Breast Masses (Breast Lumps)
The term breast mass is preferred over lump for a palpably discrete area
of any size. A breast mass may be discovered by patients incidentally or
during breast self-examination or by the clinician during routine physical
examination. Masses may be painless or painful and are sometimes
accompanied by nipple discharge or skin changes.
Causes
Although cancer is the most feared cause, most (about 90%) breast masses
are nonmalignant. The most common causes include
• Fibrocystic changes,
• Fibroadenomas (Kosir, 2013a).
Fibrocystic changes (previously, fibrocystic disease) is a catchall term that
refers to mastalgia, breast cysts, and nondescript masses (usually in the
upper outer part of the breast); these findings may occur in isolation or
together. Breasts have a nodular and dense texture and are frequently
tender when palpated. Fibrocystic changes cause the most commonly
reported breast symptoms and have many causes. Fibrocystic changes are
not associated with increased risk of cancer.
Repeated stimulation by oestrogen and progesterone may contribute to
fibrocystic changes, which are more common among women who had early
menarche, who had their first live birth at age > 30, or who are nulliparous.
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