The 33-year-old Xiaolin, a white-collar worker who is usually cheerful and optimistic at work, has recently become anxious.
The company’s main focus is on the development of a new product, the Multiplex. “
Remembering the frequent mention of the high incidence of breast cancer in WeChat articles, Xiao Lin was worried, fearing that she might have been hit by this unlucky disease.
In fact, Xiaolin’s anxiety is not an empty one, and it also plagues most young and middle-aged women. According to data from the 2014 China Analysis of Malignant Tumor Incidence and Death by Regionreport released by the National Cancer Center in 2018, breast cancer is the number one tumor with the highest incidence among Chinese women, with nearly 280,000 new cases each year.
“Breast nodes”, “breast cysts”, “breast fibroadenoma” …… These medical examination report forms The actual fact is that many of the breast diseases that look like tumors are mostly benign lesions and should not be easily equated. The first thing you need to do is to get a good idea of what you are getting into.
Today, let’s talk about which of these breast diseases we often see are real relatives of breast cancer and which are fake relatives ……
01Mastocytosis
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Mastocytosis, which is actually a symptom and cannot be considered a disease, is a benign breast disorder resulting from a malfunction in the normal development and degeneration process of the breast. In essence, mastocytosis is a disruption of the normal structure of the breast due to varying degrees of hyperplasia of the main and interstitial mammary glands, as well as incomplete rejuvenation, and the cause of the disease appears to be primarily endocrine dysfunction.
Similar to the age range for the development of breast cancer, mastocytosis also occurs in women aged 30 to 50 years. The most important thing is that it is not just a matter of the time, but also a matter of the time. For patients with breast enlargement, it is important to maintain a comfortable mood. If there is anxiety, depression and other emotional disorders, you can seek help and confide in your loved ones or friends. Some studies have shown that building a positive and relaxed mindset is the best defense against breast enlargement!
So, mastocytosis is a benign breast condition, but isn’t it something you don’t have to worry about at all? Of course not.
Some clinical studies have found that the histopathological patterns of mastocytosis are complex and varied, and the risk varies from case to case. For example, the cancer rate of cystic hyperplasia of the breast is 1% to 5%, and the risk of breast cancer is significantly increased only when biopsy confirms atypical hyperplasia. However, approximately 80% of patients with atypical hyperplasia will never develop breast cancer in their lifetime!
So, although the chance of breast enlargement becoming breast cancer is not high, once it is selected it is 100%, so remember to review and follow up regularly and don’t take it lightly.
02 Mastitis
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Mastitis, as the name implies, is usually an inflammation of the breast caused by an infection.
Women of any age can get it, but it is most common in breastfeeding women and usually occurs in the first 3 months after delivery. We often hear that there will be many patients with mastitis who stop breastfeeding after delivery, but in fact it is safe to continue breastfeeding without adversely affecting the baby, and it helps clear the infection.
Mastitis usually involves one breast, symptoms progress quickly, and if not treated promptly, the symptoms of mastitis may worsen and the infected area forms a cyst containing pus that manifests as a hard, painful lump called a breast abscess, which is relatively easy to cure with medication if caught early.
Generally, mastitis does not lead to breast cancer, but breastfeeding or pregnancy is indeed a high incidence of inflammatory breast cancer. If there are cancer cells infiltrating the lymphatic vessels and inducing inflammation leading to inflammatory breast cancer, it just so happens that this is a period of endocrine fluctuation and decreased immunity in a woman’s body, and the cancer cells can take advantage of the situation to develop malignant mutations and become menacing.
If it evolves into inflammatory breast cancer, the symptoms are mainly red, hot, swollen and painful skin, and there is also an uneven orange peel-like epidermis, which is a definite cause for alarm!
For mastitis patients, more rest, more water, and hot or cold compresses on the painful part of the affected breast will help reduce pain and improve the mastitis condition.
One more long-winded tip: Most patients can continue breastfeeding! To prevent mastitis, new mothers can dry their nipples and use cream after each breastfeeding session to prevent nipple cracking, avoid tight clothing, especially when their breasts are full, and gradually stop breastfeeding after weaning.
03 Breast nodules
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Breast nodules, in fact, is a “catch-all” term that refers to the size of the lesion, not the nature of the lesion. A lesion smaller than 3 cm can be called a nodule on imaging. Breast nodules can be benign, such as breast cysts, breast hyperplasia, or breast fibroadenoma, and some nodules are malignant if they are breast cancer. The diagnosis of malignancy or benignity can only be made through biopsy and then sent to pathology.
Does a surgical biopsy have to be done if a nodule is found? No, it does not. Benign or malignant nodules will appear differently on ultrasound or mammogram. Nodules found on imaging generally have a grade (0 to 6), which are the letters we see on the report card, BIRADS (Breast Imaging Reporting and Data System).
Based on the specific classification, you can probably tell if the nodule is good or bad. Ultrasound or mammogram suggesting BIRADS(3) or below, or even to 4a is not to be nervous, it is very likely to be benign and can be kept under observation. And if it gets to BIRAD(4C) or even 5 or 6, the chances of breast cancer increase and doctors will usually recommend a biopsy for diagnosis.
So there is no need to be nervous about breast nodules found on physical examination, especially multiple nodules less than 5 mm, most of them are benign and can usually be observed first and reviewed regularly, every 3 to 6 months. Nodules larger than 5 mm need to be combined with the BIRADS classification of imaging to determine this.
04 Breast cysts
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Does it sometimes feel bumpy or ropey when you touch your breast? Does it sometimes feel swollen or painful to the touch, especially in the upper outer part? If so, you may have a very common condition called breast cysts, also known as “fibrocystic changes of the breast”. In this case, it refers to two naturally occurring conditions in the breast: the presence of fibrous tissue and benign (non-cancerous) cysts.
A breast cyst is a fluid-filled lump or sac that can move around in the breast. If fluid builds up, it stretches the surrounding tissue. The cyst is harmless, but may be painful.
These breast cysts are normal and not cancerous, and the risk of developing cancer is not increased by having fibrocystic breast change, which occurs in about half of women between their 20s and 50s. The condition is rare after menopause, but it can occur if one is on hormone therapy.
Usually, breast cysts do not require any treatment. Your doctor may puncture and drain the cyst, which can relieve pain and pressure, but the fluid will recollect. Sometimes, cysts also go away on their own. Some women find that their symptoms are relieved if they avoid caffeine. Studies have not yet proven the association, but if there is fibrocystic change of the breast, try reducing caffeine intake, it may help.
05 Breast fibroadenoma
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Fibroadenoma of the breast, a common tumor in young women (15 to 30 years old), occurs in about 10% of women and accounts for about 3/4 of benign breast tumors. When patients find a lump in their breast, it can easily trigger panic and negatively affect their life and work, so it is best to seek prompt medical attention.
So far, the exact etiology of breast fibroadenoma is unclear. The key mechanism may be the overstimulation of fibroblasts in the lobules of the breast by estrogen, and the pathogenic mechanism is mainly reflected in the abnormal sensitivity of breast cells to estrogen, or abnormally elevated estrogen levels. Breast fibroadenomas have good biological behavior and usually do not invade surrounding tissues or metastasize to distant sites. Only rarely may they become cancerous, forming breast sarcoma or breast cancer.
However, because of the risk of cancer and the possibility of a significant increase in size during pregnancy, doctors usually recommend that patients with large lumps have surgery as soon as possible after diagnosis. During surgery, the tumor is removed as completely as possible. After surgery, pathological examination of the excised sample is required to determine the nature of the lesion.
06 Intraductal papilloma of the breast
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The female breast has 15 to 20 milk ducts that open to the nipple. Intraductal papilloma is a benign tumor that occurs in the ductal epithelium and is second only to breast fibroadenoma and breast cancer in incidence.
According to the 2003 WHO classification of breast tumors, intraductal papillomas are classified into central and peripheral types. The central type papilloma occurs mostly in the grade 1 and 2 milk ducts approximately 1.5 cm below the milk duct pot belly, also known as large intraductal papilloma, located in the central region of the breast below the areola, and is generally considered to have no increased risk of breast cancer. Peripheral papillomas are multiple intraductal papillomas that occur in the terminal duct-lobular system and are located in the peripheral quadrant of the breast and are generally considered to be pre-cancerous with a 5% to 12% cancer rate.
Multiple intraductal papillomas, most commonly seen in postpartum women and usually involving women aged 35-55 years, are clinically common benign breast tumors that occur as a benign (noncancerous) wart-like growth in the milk ducts of the breast, usually seen near the nipple, and may cause nipple discharge, as well as breast pain and the formation of palpable lumps. The presence of a single papilloma does not increase the risk of breast cancer.
The most effective treatment for intraductal papilloma is surgical excision. If the mass is palpable on clinical examination, surgical removal of the diseased duct for examination is sufficient, and the next step in treatment will be considered when pathology is returned.
07 Atypical hyperplasia of the breast
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In general, the development from normal cells to tumor cells goes through such a journey, i.e. normal-proliferative- atypical hyperplasia-in situ carcinoma-infiltrating carcinoma, then atypical hyperplasia is actually a transit point from benign change to malignant change stage.
Atypical hyperplasia of the breast, a proliferation of abnormal cells in the ducts (ductal atypia) or lobules (glandular lobular atypia) of the breast, is sometimes detected by breast biopsy. Although the disease is not cancerous, women who develop atypical hyperplasia have a 4- to 5-fold higher risk of breast cancer compared to women without breast abnormalities.
08 Carcinoma in situ of the breast
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Is breast carcinoma in situ breast cancer? Both yes and no.
Why is that? In situ carcinoma in the breast is actually a pre-cancerous or non-invasive cancer that occurs in the breast, also known as stage 0 breast cancer, and if you have carcinoma in situ in the breast, it means that abnormal cells are found in one or more of the breast ducts. The term “in situ” means that the abnormal cells have not yet invaded the surrounding breast tissue outside of the ducts.
Carcinoma in situ of the breast, including lobular carcinoma in situ and intraductal carcinoma in situ. Although they are both noninvasive cancers, there are significant differences in their pathogenesis, biological behavior, and outcome regression, and therefore different treatment options. Approximately 20-30% of ductal carcinoma in situ of the breast will progress to breast cancer if it is not treated.
Lobular carcinoma in situ, which occurs in the terminal ducts of the lobules of the breast, is generally considered to be more likely to be combined with invasive carcinoma than classical lobular carcinoma in situ, and is perhaps a precancerous lesion of polymorphic lobular carcinoma.
The primary treatment principle for intraductal carcinoma in situ is to minimize the risk of progression to invasive carcinoma and to reduce the impact of treatment on quality of survival, which is more important in low-risk patients. Based on data from the US SEER database for patients with intraductal carcinoma in situ from 1991 to 2010, 43% of patients received breast-conserving surgery combined with radiation therapy, which is the primary treatment.
It is important to note that in pure intraductal carcinoma in situ, the diagnosis is established only if the absence of an infiltrative component is confirmed in all specimens, and once an infiltrative component is found, the reference is to invasive carcinoma. Currently, breast management in the treatment of intraductal carcinoma in situ mainly ranges from minimally invasive biopsy, mastectomy, and then breast-conserving treatment.
In conclusion,for breast carcinoma in situ, it must be considered in the context of tumor type and other circumstances, and the physician will develop a reasonable treatment plan with reference to the patient’s wishes.
09 invasive breast cancer
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Invasive breast cancer, which can spread to other parts of the body through the blood and lymphatic systems, is cancer that spreads from the site of the originating breast to surrounding normal tissue.
Currently, the most common type of invasive breast cancer is invasive ductal carcinoma, which starts in the lining of the ducts (the thin tubes that carry milk from the lobules of the breast to the nipple). The other type is invasive lobular carcinoma, which starts in the (breast) lobules.
A new finding by internal medicine scientists from the Seidman Cancer Center and Case Western Reserve University Case Comprehensive Cancer Center, published in the journal Breast Cancer Research and Treatment in August 2012, suggests that chronic lack of sleep leads to more invasive breast cancers. If you have a habit of staying up late, change it before it’s too late!