Love Breast Day丨Beware of the "number one killer" of women's health! Do you really understand your breasts?

With the accelerated pace of life and the impact of the environment, breast health issues are increasingly attracting people's attention. The high incidence of breast diseases requires every woman to pay more attention to her breast health. Breast cancer has become the "number one killer" of women's health.

October 25th of every year is "Love Breast Day". So, what is the structure of the breast? How to deal with abnormal breast symptoms? Today, let's learn about it together!

01

The structure and development of the mammary gland

The mammary gland is the tissue that makes up the breast, which is composed of nipples, ducts, glands and fat. The mammary gland plays the role of secreting milk in the female body and is an important part of the female reproductive system.

The nipple is the central protrusion of the mammary gland, composed of abundant nerve endings and mammary ducts, which guide the flow of milk.

The surrounding pigmented area is called the areola, which has more sebaceous glands and eccrine sweat glands.

The main part of the breast is composed of mammary glands and adipose tissue. The mammary gland is composed of multiple lobules. The mammary lobule is the basic unit of the mammary gland and is composed of many small alveoli and ducts that produce and store milk.

The long and thin tubes in the mammary gland are called milk ducts, which are responsible for transporting milk from the mammary gland to the nipple.

Basic structure of the breast[2]

Women generally start to have sexual initiation at the age of 10-12, and when they enter puberty, their breasts begin to develop and gradually mature. Regulated by estrogen, the breast glands and ducts grow and branch, and the breasts gradually become fuller.

During pregnancy, the mammary glands develop further, the alveoli in the mammary glands expand and secrete milk to meet the feeding needs of the baby. If a woman does not become pregnant and breastfeed, the mammary glands will gradually regress around menopause, and the fat tissue in the breasts will increase relatively.

Mothers need to avoid using cosmetics containing estrogen ingredients to prevent precocious puberty in children. If a child develops breast development and nipple discharge prematurely before the age of 10, parents need to take their children to a pediatric or endocrinology department for early diagnosis and treatment.

Development of the mammary gland[2]

Note: Tanner stages of the breast: Stage 1, pre-developmental stage, only the breast protrudes; Stage 2, breast eruption stage, the breast bulges, the breast and areola are a single hillock, accompanied by enlargement of the areola; Stage 3, the breast and areola further enlarge, but the two are still on the same hillock level, and the areola pigmentation deepens; Stage 4, the nipple and areola protrude above the breast hillock to form a second hillock; Stage 5, mature stage, the breast enlarges, but the breast and areola are on the same hillock again.

02

Mastitis during lactation and breast health care

During pregnancy and lactation, the female breast develops rapidly to adapt to breastfeeding. However, since breast milk is an ideal culture medium, once milk stasis occurs, it will be conducive to the growth and reproduction of invading bacteria, causing acute mastitis. If the nipple is damaged or cracked, bacteria can invade along the lymphatic vessels. At the same time, bacteria can also enter the milk ducts and ascend to the mammary lobules to cause infection. Lactation mastitis is more common in primiparas 3-4 weeks after delivery. Due to the development of deciduous teeth in 6-month-old babies, it can also occur before and after weaning.

Generally, patients with acute mastitis will feel breast pain, local redness, swelling and fever. Once bacteria invade, they may experience high fever, chills and rapid pulse. Individual manifestations can be unilocular or multilocular. The pathogenic bacteria are mainly Staphylococcus aureus. Patients need to seek medical treatment in time. Generally, penicillin or first-generation cephalosporins, such as cephalexin, cefadroxil, cephradine and other drugs, are given for treatment without waiting for drug sensitivity results.

Generally, breastfeeding should not be stopped during treatment to keep the milk emptying and avoid milk stasis, while trying not to affect the baby's feeding. However, if severe infection or abscess occurs and breast fistula occurs, breastfeeding should be stopped, and even milk withdrawal treatment should be performed.

Breastfeeding women need to strengthen their breast care. The first thing is to maintain good breast hygiene, gently wash the breasts with warm water every day, avoid using overly irritating soaps or detergents, and avoid over-cleaning the nipple area, as this may damage the skin's natural protective layer. If the nipples are inverted, they can be squeezed and lifted frequently to correct them.

Secondly, pay attention to the correct breastfeeding posture, ensure that the baby grasps the areola area correctly when sucking, and avoid excessive pressure and friction on the nipple. The correct breastfeeding posture helps reduce the risk of nipple pain and breast blockage. Avoid nipple pain. If nipple pain occurs, try to change the baby's sucking posture, adjust the baby's position, and use suitable breastfeeding products (such as nipple protectors) to relieve nipple pain.

In addition, breastfeed or pump milk regularly to ensure that the breasts are fully emptied, prevent the baby from falling asleep with the nipple in the mouth, and pay attention to the baby's oral hygiene.

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At the same time, maintaining good nutrition and a balanced diet during breastfeeding is essential for the health of breasts and milk. Increase the intake of foods rich in protein, vitamins and minerals, and maintain adequate water intake. Avoid using tight underwear unless necessary, choose the right size, and make sure it is not too tight, which can reduce breast compression and airtightness.

03

What are the symptoms of breast abnormalities?

How should we respond?

Abnormal breast symptoms mainly include breast lumps, breast pain or sensitivity, nipple discharge or inversion, and changes in the breast skin. Although newly discovered breast problems may cause patients to panic, most breast problems are not caused by breast cancer.

1. Breast lumps

Although most breast lumps in women aged 20 to 50 are not cancer, if you find a breast lump, it is recommended that you have it evaluated by a doctor to see if further testing is needed.

Generally, for women under 30, if you find a lump before your period, you can have another breast examination after your period ends. Most breast lumps are usually caused by hormonal changes and will disappear after the menstrual cycle. If the lump does not disappear, you need to go to the hospital for further evaluation.

For women over 30 who discover a new breast lump, they usually need to go to the hospital for diagnostic mammography and ultrasound examination, and if necessary, a breast biopsy or magnetic resonance imaging (MRI).

2. Breast pain

Most breast pain is caused by the hormones estrogen and progesterone that regulate the menstrual cycle, and occurs in both breasts a few days before the menstrual period begins. Because the pain varies in severity with the menstrual cycle, it is also called "cyclical" breast pain. Cyclic breast pain is usually not caused by breast cancer or other serious breast problems. Breast pain during menopause may also be related to hormonal changes.

Women may experience breast pain that does not follow their menstrual cycle, also known as non-cyclical breast pain. This pain is not related to the menstrual cycle and may only occur in one breast or one area of ​​the breast. Non-cyclical breast pain is usually caused by problems outside the breast, such as muscle or connective tissue sprains, skin injuries, spinal diseases, or problems in other organ systems, such as heartburn, chest pain, etc. Non-cyclical breast pain is only caused by breast cancer in very few women. In addition to seeing a doctor in time to assess whether further examination is needed, you can also consider the use of pain-relieving medications such as acetaminophen or ibuprofen. At the same time, after communicating with your doctor, reduce the dose or stop taking estrogen-containing medications, wear underwear of the right size, eat a nutritious diet, and reduce coffee intake.

3. Nipple discharge

Nipple discharge is the third most common breast complaint after breast pain and breast lumps. Up to 80% of women of childbearing age experience nipple discharge, especially in the first year or two after delivery.

Some patients also experience physiological nipple discharge outside of breastfeeding, which is usually bilateral white or clear discharge, but can also be unilateral and can be a variety of other colors, including yellow (straw color), green, brown or gray, but no blood. This situation is mostly due to high prolactin levels, so there is no need to worry too much. At the same time, hypothyroidism and some drugs can also cause nipple discharge, such as metoclopramide, phenothiazines, sertraline and other selective serotonin reuptake inhibitors, spironolactone, etc.

Once the discharge appears serous (clear or yellow), bloody (bloody), or serosanguineous (slightly bloody), it should be considered pathological nipple discharge and prompt medical attention is required to determine the cause.

4. Other abnormal symptoms

Women need to pay close attention to breast changes, such as protruding nipples, inverted nipples for unknown reasons, or itching, scaling, crusting, swelling, redness, or skin changes on the breasts, such as the so-called "orange peel" changes, which require prompt medical evaluation to avoid delays in diagnosis and treatment.

04

Breast cancer screening

With the growth of China's economic level, Chinese women's awareness of cancer prevention has gradually increased, and the early diagnosis rate of breast cancer has also increased year by year. However, the peak incidence of breast cancer in Chinese women is around 45 years old, which is 10-20 years earlier than that of European and American women. It is generally recommended to start education on relevant breast cancer knowledge and breast self-examination at the age of 18, and to carry out breast cancer imaging screening for women over 40 years old.

For people at high risk of breast cancer, imaging examinations should be performed as early as the age of 25, such as people who carry breast cancer susceptibility genes, or patients with one of the following conditions: (1) a family history of breast cancer in direct relatives (parents, children, brothers, and sisters); (2) women with a history of breast cancer; (3) a history of chest radiotherapy (cumulative radiotherapy dose ≥10 Gy before the age of 30); (4) diagnosed with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma in situ (LCIS) before the age of 40.

References:

[1] Chen Xiaoping, Wang Jianping, Zhao Jizong. Surgery (9th edition)[M]. Beijing: People's Medical Publishing House, 2018: 238-246.

[2] UPTODATE [DB]. http://www.uptodate.com/

[3] Shen Songjie, Sun Qiang, Huang Xin, et al. Chinese female breast cancer screening guidelines (2022 edition) [J]. Chinese Research Hospital, 2022, 9(02): 6-13.

Du Boran, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Editor: Guru