he breast cancer awareness month every year helps raise awareness regarding breast cancer and related health concerns. However, it is imperative to continue educating the masses on breast health all year to detect and treat breast cancer early on to save patients’ lives, minimise complications and help with other breast-related health problems.

The most common breast complaint a female presents in her reproductive age is breast pain (mastalgia). The pain ranges from mild to severe, can be intermittent or constant throughout the day and may interfere with the patient’s quality of life. Some women have breast pain associated with the menstrual cycle due to hormonal variation. The pain intensifies a couple of days before the start of periods, decreasing on the day when bleeding starts and subsides over the next few days. Such pain is easily manageable with painkillers. However, if the pain is non-cyclical and is not associated with the menstrual cycle, or is affecting one breast only, it should be discussed with a physician as it signifies some underlying pathology.

Nipple discharge is a typical part of breast function during pregnancy or breastfeeding. It may also be associated with menstrual hormone changes and fibrocystic changes. The milky discharge after breastfeeding usually affects both breasts and can continue for up to two or three years after stopping nursing. However, concern should be raised if a non-lactating non-pregnant lady has nipple discharge. Breast discharge that is non-milky or blood stained can be an early presenting symptom of breast cancer.

Another common complaint which worries women is a breast lump/ swelling. Breast lumps should not be panicked over as many of these are harmless, especially a movable swelling not fixed to underlying structures, with no skin changes and constitutional symptoms like fever, fatigue and weight loss. However, one must definitely consult a doctor if one notices a lump. Self-examination must be known to every girl/woman so that the presence of a lump at initial stages can be identified and evaluated timely by a physician as it can be a sign of something serious. In Pakistan, breast cancer is found to be a chief form of the disease among all other types of cancers. There is an upward trend in the progress and prevalence of breast cancer due to a lack of facilities and awareness among patients.

The risk factors contributing to developing breast cancer include age, breast cancer cases in family members, prolonged exposure to hormones (onset of menses before 12 years of age and menopause after age 55 years). Getting radiotherapy for breast/ chest also increases the risk for breast cancer. Hormone replacement therapy/ oral hormone contraceptives, obesity and alcohol abuse also increase the risk.

Screening for breast cancer

Self-examination of the breast enables women to keep a check for any suspected breast problem. Ultrasound for younger females and mammography for ages above 50 years are useful modalities for the early identification of breast cancer. Those at average risk of having breast cancer must undergo mammography every one to two years after 50 years of age. Mammography is available at many tertiary care hospitals and radiology centres in big cities in Pakistan. The cost at private setups is Rs 2,000-3,500.

Those at average risk of having breast cancer must undergo mammography every one to two years after 50 years of age. Mammography is available at many tertiary care hospitals and radiology centres in big cities in Pakistan. The cost in private setups is Rs 2,000-3,500.

Lifestyle modification can help reduce the risk of developing breast cancer. This includes maintaining normal body weight, quitting alcohol, minimising the use of estrogen-progesterone hormone pills, bearing children and breastfeeding. Being physically active is also a protective element against breast cancer.

Breast cancer also occurs in men though it is very rare. In the United States, breast cancer in men accounts for less than 0.5 percent of all cancer diagnoses in men. By contrast, in Tanzania and some areas of central Africa, male breast cancer accounts for up to 6 percent of all breast cancers. In Pakistan, much less information is available regarding male breast disorders, and research needs to be done to explore the statistics. As with women, the incidence of breast cancer in men rises with age, and men tend to be approximately 5 to 10 years older than women at the time of diagnosis. The annual incidence of breast cancer in men appears to be rising; one report suggests that incidence has increased 26 percent over the past 25 years.

As with breast cancer in women, a family history of breast cancer in a first-degree relative is associated with an increased risk of breast cancer among men. Approximately 15 to 20 percent of men with breast cancer have a family history of the disease compared with only seven percent of the general male population. As is the case in women, breast/ ovarian cancer genes, BRCA1 and BRCA2, give rise to a majority of known cases of hereditary breast cancer. Gynecomastia due to estrogen excess, Klinefelter’s syndrome (a genetic disorder) predisposes men to develop breast cancer. Though there is no recommendation for mammography screening in men, self-examination and timely consultation for any breast swelling or pain is advised. One can consult a family physician or endocrinologist for breast problems.

A common problem faced by lactating mothers is lactational mastitis. It is a condition in which a woman’s breast becomes painful, swollen and red; it is most common in the first three months of breastfeeding. Initially, engorgement occurs because of poor milk drainage, probably related to nipple trauma with resultant swelling and compression of one or more milk ducts. If problems with drainage persist beyond 12 to 24 hours, the stagnant milk becomes infected and lactational mastitis develops (since breast milk contains bacteria); this is characterised by pain, redness, fever and malaise. Mastitis can progress to local abscess formation if not treated promptly. For pain relief, use cold compresses (ice pack or gel pack) or soak a cloth in warm water and place it on your breast. A warm shower or bath may also help. Acetaminophen or ibuprofen can also be used for relief of pain and fever. Rest and drink plenty of fluids. If you are breastfeeding, continue to breastfeed. Start feeds with the sore breast first. Express or pump milk from your breast between feeds. Massage your breast to clear any blockages – stroke from the lumpy or sore area towards your nipple to help the milk flow. Avoid tight-fitting clothes or bras. If it does not improve within 48 hours, consult your physician.

Dr Naureen Kazim is a senior registrar at the Department of Family Medicine, Ziauddin Medical University

Dr Naseem Amin Dhedhi is an assistant professor at the Department of Family Medicine, Ziauddin Medical University