Red Alert Health

Breast Problems You Shouldn't Stress About Sure you panic when you find something weird, but before you call 911, check our guide for the common-harmless-things that may be going on
By Barbara Bailey Kelley

THE DANGER SIGNS YOU SHOULDN'T IGNORE
Although almost all breast changes go away by your next monthly period, see your doctor if you experience any of the following:

· A lump, nipple discharge, or pain that is localized in one part of your breast. When pressed with your fingertips, a "dangerous" lump tends to feel hard and immobile, or have an irregular surface. (Benign lumps may feel soft and squishy or harder but mobile.)

· Breast pain that is localized and lasts though a complete menstrual cycle.

· Nipple discharge that is persistent, bloody, on one side only, or spontaneous.

· Any new lump that does not go away after your period starts - or an old lump that is growing or changing.

· A skin infection that doesn't clear up with antibiotics, or an eczema like rash that doesn't go away with hydrocortisone cream.

· Sudden dimpling of the skin.

· A nipple that becomes inverted.

You're taking a shower when you feel a lump. Or you remove your bra and find that a nipple has been leaking. Or your breasts are suddenly sore and achy.
And you panic.
Almost every woman experiences some kind of weird breast change during her twenties, thirties, or forties, says Ellen Mahoney, M.D., a breast surgeon and clinical assistant professor of surgery at Stanford University Medical Center. And though we know that breast cancer largely affects postmenopausal women, it's younger women who worry about it most. Often unnecessarily, says Colleen Conry, M.D., president-elect of the Colorado division of the American Cancer Society. "For a 35-year-old woman, the risk of breast cancer is only about one in 622," says Dr. Conry. "The incidence doesn't start to rise dramatically until after age 50."
So how can you tell if a lump, pain or rash means trouble? By knowing the critical signs that tell when to check things out with a doctor and when to relax.

Monthly Pain
Chances are you have some tenderness in your breasts before or during your period. The pain and swelling may very from month to month, even year to year, says Dr. Mahoney.
What causes it? Hormone shift, either during ovulation or right before the start of your period, cause your breasts to retain fluid, which stretches tissue, causing pain. Usually your body absorbs the fluid and the swelling subsides once your period begins or shortly after, but some women experience tenderness all month long. Stress can also bring on more intense breast pain before or during your period.
Should you worry? As long as the pain is in both breasts, no. "It's hard to get an absolute statement out of any doctor, but I finally decided that's one where I can say never," declares Dr. Mahoney. "Breast tumors are rarely painful, and to have one in each breast causing pain at the same time is so improbably we can safely say it wouldn't happen."
What to do: Chart the pain to make sure you can tie it to your cycle, then deal with the discomfort. Some women report getting relief by taking vitamin E or B-complex vitamins or avoiding caffeine. Anti-inflammatories, such as ibuprofen or acetaminophen, can help, and a firm-support bra can keep tender breasts from bouncing.

Pain on One Side Only
If the ache is in one breast and can't be tied to your period, it may be radiating from the muscles underneath. Such pain is common, says Douglas Marchant, M.D., a breast surgeon and director of the Breast Health Center at Women's and Infant's Hospital at Brown University in Providence.
What causes it? Something as simple as lifting a heavy bag of groceries can strain a chest muscle. Sometimes, though, one-sided pain is nonmuscular: A change in bra style, switching to a different type of birth control pill (which may cause discomfort as your body adjusts to the new dose of estrogen), a blow to the breast, or a cyst (see below) may be the culprit.
Should you worry? Probably not. Although pain that's extremely intense, doesn't disappear by your next period, and affects only one breast can be a sign of a tumor that is irritating a nerve, that's very rare.
What to do: If you can't figure out what you might have done to cause the pain and it lasts longer than one menstrual cycle, see your doctor.

A Smooth Lump
If it pops up just before your period, you're most likely feeling a cyst - a smooth balloon-like blister of fluid that can swell right before you menstruate. "Often it just keeps accumulating fluid until it stretches the adjacent tissue and causes pain," Dr. Mahoney explains. If the cyst is deep within your breast, you probably won't be able to feel it, but it may still hurt.
What causes it? Your breasts regularly produce a clear secretion that flows through their vast network of tubes and ducts. If there's a blockage and the fluid can't drain, a cyst forms.
Should you worry? No. Although any lump may make you nervous, the incident of cancer in a cyst is about 1 in 100,000.
What to do: Most cysts come and go. If the lump or pain doesn't disappear after about day 10 of your next cycle (i.e., a few days after your period ends), see your doctor, who may order an ultrasound to make sure it really is a cyst. If the lump is painful, your doctor may aspirate it - an office procedure in which the fluid is drained though a needle.

Bumpy Lumps
These benign tumors known as fibroadenomas "feel like rubberized pieces of popcorn," says Dr. Mahoney.
What causes them? They're little overgrowths of tissue, which typically originate in puberty. Some reach a certain size and stop growing, while others continue to get larger.
Should you worry? Fibroadenomas never become malignant, nor do they predispose you to caner.
What to do: See your doctor. "You can't assume a lump is benign," says Dr. Marchant. "You have to check it out, maybe with an ultrasound, a needle aspiration, or a biopsy." A fibroadenomas that's been dormant bud suddenly grows should be surgically removed. "It's not the fibroadenomas that's worrisome," says Dr. Mahoney, "but there might be a cancer next to it that's causing the fibroadenomas to get bigger."
Occasionally, a rare, less dangerous form of cancer can look like a large fibroadenomas. "If you follow the rule that if the fibroadenomas gets bigger, it comes out," Dr. Mahoney says, "you won't miss a possible cancer."

Lumpy Breasts
You've probably heard it called "fibrocystic disease," a wastebasket term referring to several benign conditions - lumpiness, swelling, pain - that affect just about every woman at some point.
What causes it? One of the ductal systems in your breast becomes clogged, causing nests of cysts to form, along with swelling. The condition is frequently worse before your period.
Should you worry? Lumpy breasts are perfectly normal.
What to do: If you have pain, take anti-inflammatories or switch to a bra with firmer support. And check any clusters of lumps monthly to make sure they're not growing. If there's any question about whether a lump is changing, see your doctor. A needle biopsy may be done.

Nipple Discharge
Up to a third of all women experience nipple discharge at some time in their lives.
What causes it? "Breasts are always producing small amounts of fluid," Dr. Mahoney says. Liquid that collects close to the nipple may come out as green, while, or yellowish discharge when you squeeze your breast. Birth control pills (especially those with high progesterone content) can also cause discharge.
What really freaks women, though, is bloody discharge. Though it can be caused by a tumor under the nipple, most often the culprit is a benign wart like growth of the lining of the milk duct.
As profuse milky discharge coming out of both breasts can in rare cases be caused by a tumor on the pituitary gland.
Should you worry? "Over 90 percent of nipple discharge is benign, Dr. Marchant says. Note whether the discharge is spontaneous (you wake up in the morning and your nightgown is stained) or provoked (you have discharge after you squeeze your nipple). The type to be concerned about is spontaneous, persistent, bloody, or comes out of one breast only - a sign that the problem is within the breast, rather than the hormone system.
What to do: Even though most nipple discharge goes away on its own, you should still see your doctor. "Usually, women are so worried, I like to see them right away to reassure them everything is okay," Dr. Conry says.

Skin Problems
For most women, a skin problem on the breast is just that - a garden - variety pimple or a patch of eczema.
What causes it? You might be allergic to either the fabric or the metal in your bra, or the detergent you wash it in. Some women are prone to infections of their breast skin that cause their breasts to be red, hot, swollen (if the condition doesn't clear up with hydrocortisone cream or antibiotics, these symptoms may point to a rare type of inflammatory cancer that needs to be treated promptly.) And an itchy, scaly nipple that doesn't get better can be a sign of Paget's disease, another rare form of breast cancer.
Should you worry? , probably not. "People will come in with a little pimple or abscess in the skin of the breast and think it's a sign of cancer," says Dr. Mahoney. "It's usually not."
What to do: If a rash looks like eczema, use hydrocortisone cream. If it doesn't clear up within a week or two, or if a patch of skin suddenly becomes red, hot, and swollen then you should see your doctor. Similarly, see your physician if your skin suddenly becomes dimpled or if your nipple retracts, both possible signs of an underlying tumor.

Barbara Bailey Kelley frequently writes about health.