Mastodynia If breast pain is the main complaint, but on examination by a doctor, no specific lump can be detected in the breast, or there is only a mild thickening of the glands, we call it mastodynia. The cause of breast pain is not clear, but may be related to abnormal hormone levels, mental factors and essential fatty acid deficiency. According to the relationship between the onset of breast pain and the menstrual cycle, mastalgia can be divided into two categories: 2/3 of the patients have cyclic breast pain, and 1/3 of the patients have non-cyclic breast pain. Cyclic breast pain is often seen in unmarried or married young women without children, manifested as 3-l4 days before menstruation, bilateral or unilateral breast diffuse soreness or heaviness, with the onset of menstruation and varying degrees of relief, breast examination can be different degrees of hyperplasia of the glands of the nodular sensation, and no obvious lumps. Therefore, some scholars believe that breast pain is a physiological change in women, is the breast as the target organ of ovarian endocrine hormones, with the hormonal changes in the menstrual cycle and the physiological response, without special treatment, with the marriage, pregnancy, breastfeeding and other physiological changes in the environment, mastalgia is often in a few years within the self-relief. Non-cyclic breast pain can occur before or after menopause, the onset of about 10 years later than cyclic breast pain, the average age of 43 years. The average age is 43 years. The course of the disease is also shorter. Clinical manifestations are persistent or intermittent episodes of bilateral or unilateral breast pain, which may be mild or severe, independent of the menstrual cycle. The site of pain is mostly located in the upper outer quadrant of the breast, and 50% of the patients may be accompanied by breast nodules. In postmenopausal patients with unilateral, limited, non-cyclical breast pain, breast cancer should be excluded. For mild breast pain, no medication is needed, and patients only need to adjust their life pattern and keep their mood relaxed, and the symptoms can be significantly improved. If the pain is severe and unbearable, affecting daily life, Chinese medicines or hormone drugs can be used to help improve the symptoms. Cystic Breast Hyperplasia Cystic Breast Hyperplasia is a disease that is neither inflammation nor tumor, but a disorder of the breast structure that is caused by the proliferation of breast fibrous tissue and epithelium with the formation of cysts. Clinical naming of this type of disease is not yet conclusive, also known as breast hyperplasia, fibrocystic breast disease, lobular hyperplasia and so on. Endocrine disorders are the main cause of this disease. When the level of estrogen in the body increases absolutely or relatively, or the level of progesterone decreases relatively or absolutely, it will cause an imbalance in the hormonal internal environment of the body, and ultimately lead to disorders in the structure of the mammary glands. The peak age of onset of this disease is 40 to 50 years old middle-aged women. Patients often seek medical attention due to self-awareness of breast lumps, which can also be accompanied by breast pain and nipple discharge. Physical examination by a specialist reveals bilateral or unilateral breast nodules or single or multiple lumps, slightly soft in texture, mobility, border still clear, ultrasound suggests cystic lumps in the breast with clear borders, and molybdenum target reveals round and oval shadows of varying sizes, with smooth, sharp edges and uniform density. Breast cystic hyperplasia has a certain probability of malignancy, for a single larger cyst, feasible needle aspiration cytology examination or surgical excision to clarify the presence or absence of malignancy. For more and smaller breast nodules, close follow-up and regular examination can be taken to observe the changes of the nodules. There is no effective drug treatment for cystic breast hyperplasia, Chinese medicine or hormone treatment can improve the symptoms, but cannot completely eliminate the lumps. Commonly used early detection methods for breast cancer 1. Mammography Mammography is the only proven effective breast screening method so far. Direct signs of breast cancer mainly include lumps and tiny calcifications, and the latter is especially important in the early diagnosis of breast cancer. About half of all breast cancers with no detectable lumps and 70% of all carcinomas in situ are diagnosed on the basis of microcalcifications on X-ray. Despite the high value of mammography, it may be underdiagnosed and has limitations in determining the benign or malignant nature of abnormal lesions. Mammography must be combined with one or more other screening measures to further improve the sensitivity and specificity of early diagnosis. Breast ultrasonography Ultrasonography has become the most acceptable breast examination method for patients because of its fast, safe and convenient features. In recent years, the accuracy of breast ultrasonography in diagnosing substantial breast lumps has been greatly improved, and combined with molybdenum target radiography can improve the detection rate. 3, breast magnetic resonance examination Breast magnetic resonance examination has higher sensitivity and specificity, but the cost is more expensive, the examination time is also significantly longer than the mammogram and rhodium double-targeted examination, is not suitable for large-scale population census. Breast MRI is mainly applied to breast cancer screening for high-risk women with obvious family history of breast cancer or carrying genes related to breast cancer, and it is also suitable for evaluation before and after treatment of breast cancer. 4, nipple discharge screening Clinically, about 1% of breast cancers have nipple discharge as the first symptom. Commonly used methods include nipple discharge cytology, breast ductography, and breast duct endoscopy. Breast self-examination method: 7-10 days after menstruation every month. 1.Stand in front of a mirror and carefully check the appearance and touch of the breasts for any abnormalities, such as skin dimpling, change in size or nipple overflow. 2.Lie down on your back, put a pillow under your right shoulder and place your right hand under your head. Check the whole right breast with the middle three fingers of the left hand in the up and down direction by making small circles and pressing hard. Then use the right hand to check the left breast in the same way. 3. Raise your right arm and examine the right breast with your soapy left hand, fingers straight, in the same way as described in “2. Lying down”. Examine the left breast with your right hand in the same way. Risk factors for breast cancer 1. Reproductive factors: Women who are celibate, or unmarried, not pregnant, or who give birth for the first time at an age older than 40 will increase the risk of breast cancer. More months of breastfeeding has a protective effect on the occurrence of breast cancer. Family history: Multiple relatives in paternal or maternal line have breast cancer, family history of both breast cancer and ovarian cancer, family history of bilateral or early breast cancer. Menstruation: the risk of breast cancer is more than 4 times for those who have their menarche before 12 years old than those who have their menarche after 13 years old. 45 years old menopause reduces the risk of breast cancer by 30% compared with those who have their menopause at the age of 50 years old. 4, benign breast diseases: non-proliferative lesions do not increase the incidence of breast cancer, while the relative risk of breast cancer in proliferative lesions is elevated, especially when accompanied by lobular or ductal atypical hyperplasia. The risk of cancer in the opposite breast after one side of breast cancer is also increased. Mental factors: breast cancer is also prone to occur when it is stimulated by long-term tension, anxiety, loneliness, depression, sadness, grief and irritation, and when the function of neuroendocrine system is dysfunctional. Breast Cancer Symptoms: The symptoms of breast cancer can be various, and the common ones are: breast lump, breast pain, nipple overflow, vesicles or skin indentation, enlarged axillary lymph nodes, etc. Although these symptoms may not be specific, they are not necessarily the same as the symptoms of breast cancer, and they are not necessarily the same as the symptoms of breast cancer. Although these symptoms are not necessarily specific, understanding these symptoms and recognizing these manifestations will help us in early detection, early diagnosis and early treatment of breast cancer. Breast lump is the most common symptom of breast cancer, and about 90% of patients come to the clinic with this symptom. Breast cancer is most common in unilateral breast lumps. Early lumps are usually small, and sometimes it is not easy to distinguish them from lobular hyperplasia or some benign lesions. However, even a very small lump may involve the suspensory ligament of the breast, which may cause symptoms such as localized skin indentation or nipple retraction, and is easier to be detected at an early stage. The majority of breast cancers have invasive growth, poorly defined borders, non-smooth surface, and a nodular sensation. However, it should be noted that the smaller the lump is, the less obvious the above symptoms are, and most of the breast cancer lumps are hard in texture. Most of the lumps are hard. When the lump is small, the activity is larger, but this activity is the lump and its surrounding tissues together, which is different from the activity of fibroadenoma. If the tumor is involved in a large range, the activity can be reduced, advanced breast cancer can invade the chest wall, it is completely fixed, the lymph nodes around the tumor are invaded, the edema of the skin can be orange-peel, called “orange-peel sign”, and the subcutaneous nodules around the tumor are called “satellite nodules”. Most malignant breast tumors are usually painless. In the early stage of breast cancer, there are occasional pain as the only symptom, which can be dull pain or tugging sensation, especially when lying on the side. When the tumor is accompanied by inflammation, there may be swelling or pressure. In advanced stage, if the tumor invades the nerves or the axillary lymph nodes are enlarged and compress or invade the brachial plexus nerves, there may be shoulder distension and pain. Nipple overflow: 5% to 10% of breast cancer patients have nipple overflow, but only 1% of them have nipple overflow as the only symptom. It is often uniductal, and its character can be various, such as bloody, plasma, watery or colorless. Breast cancer primary in large ducts or form of intraductal carcinoma combined with nipple discharge is more common, such as intraductal papilloma malignancy, papillary eczema-like carcinoma, etc. All of them can have nipple discharge. Nipple erosion: a typical manifestation of Paget’s disease (eczema-like breast cancer), often accompanied by itching, and about 2/3 patients can be accompanied by lumps in areola or other parts of the breast. At first, there is only nipple flaking or small nipple fissures. Nipple flaking is often accompanied by a small amount of secretion and crusting, and when the crust is removed, bright red vesicles are seen, which do not heal over time. Some patients may also have breast lumps first and then nipple lesions. Nipple inversion: when the tumor invades the nipple or subareolar area, the fibrous tissue and duct system of the breast can be shortened, pulling the nipple, making it concave, biased, or even completely shrunk into the back of the areola. At this point, the affected nipple is often higher than the healthy side. It may appear in the early stage of breast cancer, but sometimes it is also a sign of late stage, mainly depending on the growth site of the tumor. Skin adhesion: when the tumor invades the suspensory ligament of the breast, it can make the ligament shrink and become shorter, pulling the skin to form a depression, which is like a dimple, so it is called “dimple sign”. When the tumor is small, it can cause very slight skin adhesion, which is not easy to detect. At this time, under good lighting conditions, gently support the affected breast to increase its surface tension, and when moving the breast, the skin on the surface of the tumor can be seen to have a slight pulling, depression and other phenomena. If you have this symptom, you should be alert to the possibility of breast cancer, but benign tumors seldom have this symptom. Skin edema: Because the subcutaneous lymphatic ducts of breast are blocked by tumor cells or the central area of breast is infiltrated by tumor cells, the lymphatic return of breast is blocked, lymphatic fluid accumulates in lymphatic ducts, the skin becomes thicker, and the mouth of hair follicle is enlarged and sunken, which reveals the “orange peel-like change”. This is often the performance of advanced breast cancer. Enlarged axillary lymph nodes Breast cancer can metastasize to the lymph nodes of the same side of the axilla, resulting in the patient’s self-consciousness of having lumps in the axilla. Lymph nodes often increase gradually from small to large, and the number of lymph nodes increases gradually from small to large. At first, the enlarged lymph nodes can be pushed, and finally merge with each other and become fixed. If the enlarged lymph nodes invade or compress the blood vessels, it may cause edema of the upper limbs on the same side; if it invades the nerves, it may cause shoulder pain.