1. What are the main benign breast diseases? Why do women suffer from these diseases? What breast diseases are women of different age groups prone to?
Mammary gland hyperplasia: the most common benign breast disease, accounting for more than 80% of benign diseases seen in outpatient clinics. Mammary gland hyperplasia consists of a complex series of proliferative lesions of the breast epithelium and mesenchyme. Clinically, the following are common: lobular hyperplasia, adenopathy, cystic hyperplasia (formation of cysts and fibrosis on the basis of adenopathy), adenopathy with fibroadenoma formation, etc. It is mainly seen in adult women between the ages of 25 and 55, and its causes are related to endocrine disorders, mental stress and depression, and improper diet (high-fat, estrogen-like foods, etc.). Young women suffer less from breast hyperplasia, which generally manifests as painful lobular hyperplasia.
Benign tumors: The common ones are simple fibroadenoma and ductal tumor. The former is mostly seen in adolescent women, and fibroadenomas in middle-aged women are usually combined with mastopexy. Lipomas and malignant tumors are usually seen in middle-aged and older patients. The etiology of benign tumors is unknown, and fibroadenomas are associated with estrogen.
Inflammatory lesions: Acute mastitis during lactation is common and is closely related to the susceptibility of the breast to infection during lactation and the entry of unhygienic bacteria from the nipple or broken skin. Subacute or chronic mastitis with complaints of breast masses and pathological inflammatory granulomatous changes are also frequently seen clinically in women after childbirth and are associated with previous mastitis and bruising during lactation.
Others: parasthesia, macromastia, trauma, fat necrosis, cumulus cysts, etc. Paromastia is related to development, divided into true paromastia (with complete breast structure including nipples) and pseudo paromastia (only ectopic glands).
2.What are the factors that can cause benign breast disease in modern life style? Does breast augmentation in women cause breast diseases?
Modern lifestyle does contribute to the occurrence of breast diseases. The main ones are: stressful work or family life leading to mental depression, which leads to endocrine disorders; modern diet is mainly high in protein and fat, which becomes the main reason for obtaining exogenous estrogen, which is closely related to most breast diseases. Injection of chemical agents such as Omnidene breast augmentation can easily lead to mastitis, nodules and induce cancer, and this kind of breast augmentation has been banned. Silicone gel breast implants are safe and are usually placed behind the pectoralis major muscle and do not come in contact with the mammary glands. Breast augmentation with autologous fat injection is also safe, but is prone to nodal calcification and other manifestations at the implant site.
Example: A 35-year-old patient complained of bilateral breast pain for 3 years, which was evident in the premenstrual period, but recently had pain before and after menstruation, and imaging showed hyperplastic changes with no occupying lesions. Ask for medical history of recent work stress and menstrual disorders. Treatment advice: self-regulation, no medication. 3 months later, the pain was significantly relieved on review.
3. Can benign breast disease be completely cured? Is it easy to recur? What are the common treatments available in clinical practice?
Most benign breast diseases are difficult to cure completely. Mastoproliferative diseases usually accompany adult women throughout their reproductive cycle, and medications and other treatments generally serve to relieve symptoms but are difficult to cure. Parametrial, simple fibroadenoma, and lipoma can be cured by surgery, but some fibroadenomas are prone to recurrence (new, to be precise, in patients with multiple fibroadenomas, which appear in batches).
Those who have suffered from acute mastitis during lactation are prone to develop inflammatory granulomatous disease after several years. Common treatments include medications, physical therapy and surgical techniques, the latter of which are: conventional surgery, minimally invasive excision with concealed incisions for cosmetic purposes, radiofrequency ablation, ultrasound focused knife (HIFU), McMurdo vacuum suction biopsy system, and lumpectomy. Each technique has its own advantages and disadvantages, and should be chosen reasonably according to the condition.
Example: Female, 32 years old, complained of a mass found in her right breast for 5 months, a 3×3 cm hard mass on the right outer breast with unclear border and hard texture, ultrasound showed irregular hypoechoic occupancy with abundant blood supply. She was admitted with a right breast mass, breast cancer? The patient was admitted. Past: 5 years ago, she had mastitis in the right breast with poor breastfeeding. The right breast mass was excised and the postoperative pathology was inflammatory granuloma.
4.Does the treatment of benign breast disease (e.g. medication, surgery, etc.) have any effect on a woman’s sex life? What do patients need to pay attention to?
The treatment of benign breast disease has no significant effect on women’s sexual life. Nipple areola surgery (e.g., ductal tumor excision requiring nipple incision) can have some effect on nipple sensitivity or erection. We observed no significant effect of circumareolar incision (only one segment) on nipple sensitivity.
5. Do benign breast diseases progress to breast cancer? Are women with these diseases more likely to develop breast cancer and what should be taken care of in their life?
A small number of benign breast diseases may develop into breast cancer. These diseases have a common feature: the lesions occur or are partially in the ductal or lobular epithelium of the breast, which is the site of breast cancer. The risk of developing breast cancer varies from one benign breast disease to another. Atypical hyperplasia of breast ducts or lobular epithelium and papillomatosis are definite precancerous breast lesions and have 5 times higher risk of developing breast cancer than the general population. In contrast, lipomas, inflammatory lesions, cysts, and common adenopathy are not associated with the development of breast cancer. Patients should be evaluated by a breast specialist to assess their condition and risk of breast cancer and take targeted measures, as well as learn general health knowledge such as breast self-examination.
Example 1: A 48-year-old female with fibroadenoma of the right breast for 20 years, which increased significantly in the last six months. The pathology of surgical resection was: fibroadenoma carcinoma. Received comprehensive treatment.
Case 2: A 35-year-old female with an irregular mass in her left breast underwent local surgery and the pathology was papillomatosis; recurrence occurred 1 year later, and the pathology was the same as before in another local surgery. The patient did not agree. The patient evolved into invasive ductal carcinoma after another 1 year and received comprehensive treatment.
Case 3: A 40-year-old female with breast hyperplasia for 10 years, with clinical manifestations of intermittent breast pain and thickened glands in the upper part of both breasts but no obvious masses were palpated. In the past six months, she felt that her left breast had worsened. She received comprehensive treatment.
6.Does the use of hormone-containing cosmetic products and health care products cause disease in women? What should we pay attention to in terms of daily diet and medication?
Whether the use of hormone-containing beauty products and health care products can cause disease varies from person to person. Generally speaking, estrogen-containing products or foods have a mild effect on certain breast diseases such as breast enlargement and breast cancer. Breast cancer patients and those with high risk factors (pre-cancerous diseases, family history of breast cancer, etc.) should avoid these products or supplements. Daily diet should follow the principles of healthy diet: a reasonable mix of starch, protein, fat and crude fiber, low fat, less fried and pickled products, less hormone-fed fish and poultry, etc. The medication should be guided by a specialist.
Many patients ask whether drinking soy milk is beneficial for breast disease. Beans contain a kind of estrogen-like substance called isoflavones, the main component of which is trihydroxyisoflavones (genistein). Its effects are twofold: most believe that isoflavones antagonize estrogen by competing for receptors, which has a protective effect on the breast; however, some studies have found that low concentrations of isoflavones promote the growth of breast tumors.
To date, there is no authoritative and unified conclusion on whether isoflavones are beneficial or detrimental in the prevention or treatment of breast cancer. Estrogen is closely related to the development and progression of breast hyperplasia and breast cancer. My opinion is that breast cancer patients (especially estrogen-dependent breast cancer) and those at high risk of breast cancer should not consume too much soy foods in their diet, and supplementation with the phytoestrogen soy isoflavones is not recommended.
7.What kind of breast examination should women have every year and when is the best time for examination?
The purpose of breast health checkup is to detect breast diseases, especially early breast cancer, because most early cancers are curable. According to the age distribution of breast cancer incidence in Chinese (the peak age group is 40-55 years old), women over 30 years old should receive breast checkup at least once a year. The method of examination is important. Many people attend simple physical examination organized by their units every year, which is not helpful for early detection of breast cancer.
It should be reminded that simple physical examination and transillumination techniques such as near infrared light are not significant to detect early cancer. Color Doppler ultrasound and mammography are valuable for early diagnosis, and their combined application can improve the detection rate; CT, MRI, PET-CT and other expensive tests are done at the doctor’s discretion when necessary. Mammography and CT have minor radiation side effects and are not recommended for frequent examinations. The best time for mammogram is 1 week after the end of menstruation.