This is Part 2 of the Article “What You Must Know About Your Breasts” written to commemorate the Breast Cancer Awareness Month. Part 1 dealt with Breast Changes in Pre-Menopausal Women while the Part 2 here deals with “Breast Changes in Post-Menopausal Women”
Breast Changes | Post-Menopausal Women
Breast symptoms in the post-menopausal period are similar to those in the premenopausal period, especially for women on hormone replacement therapy. Although, cancers are relatively more common in this group, they can be diagnosed with benign diseases or pre-cancerous conditions. Clinical examination and imaging are usually easily interpreted due to the density of the breasts in older women (fatty >glandular tissue). The common conditions in post-menopausal women are-
- Non-cyclical breast pain (mastalgia) is not linked to menstruation and does not follow a definitive pattern. It can be either constant or intermittent, affecting one or both breasts. Either a part of the breast or the whole breast maybe involved. It can be referred pain from the chest wall, oesophagus, neck or upper back. Conditions such as infection, trauma, injury, certain medications, size of the breast, cancer or inflammatory conditions such as costochondritis or arthritis may be the causative factors. Some researchers suggest a deficiency of fatty acids with in the cells to cause breast pain.
- Management would include identifying the condition and treating the cause. A short course of anti-inflammatory drugs (NSAID’s) should suffice for pain due to inflammatory conditions. Lifestyle approaches like wearing a well fitted bra, a sports bra for exercise usually help. Other treatments include medication, EPO, ice packs, warm compresses or a massage. Avoiding caffeine and nicotine have showed symptomatic relief in a few women.
- This can be due physiological or pathological. Causes for nipple discharge in this age group are duct ectasia, papillomas, pre-cancerous or cancerous lesions. It could be clear/green/yellow/brownish in colour. Duct ectasia can be due to age related changes or blocked ducts, which may in-turn to an inverted nipple, nipple discharge when swollen. This may lead to a condition called periductal mastitis which is painful and the breast might turn red. It is commonly seen in smokers. There is no increased risk of cancer.
- Although this is common in pre-menopausal women, it can occur in post-menopausal women as well, especially in those who are on hormone replacement therapy (HRT). This is because of the constant source of Oestrogen, which affects the breast. They are not cancerous but certain types of pathologically proven lesions might have a malignant potential.
- If you develop a lump suddenly overnight, it might be a cyst. Image confirmation and a simple needle aspiration might suffice.
- A lump in the post-menopausal woman needs to be evaluated as they are generally more prone to a cancer. It should however be noted that all lumps are not cancerous. Symptoms such as breast lumps with or without pain, nipple inversion, nipple discharge, skin thickening, redness, dimpling, swelling in the arm pit, change in the shape or size of breast should be evaluated. If diagnosed with breast cancer, you will require a multi-modality approach of management including surgery, radiation, chemotherapy, hormone therapy, targeted therapy, rehabilitation, nutrition and counselors.
- Occasionally, cases might be screen detected. Hence, annual clinical examination and mammograms are suggested.
- Obesity and hormone replacement therapy in this age group increase the risk of breast cancer.
Remember that ‘Breast Self-Examination’ is the most important technique of identifying early breast diseases. It has to be done every month. Make sure you reach out to a doctor if you find any abnormality in your breasts.