By Eva Khan, ARNP

Lumps, bumps, pain and wanting a different size. What is the common source of these problems? If you haven’t guessed, it’s a woman’s breasts.

Breast issues can range from serious, like breast cancer, to cosmetic, which might include changing one’s breast size. Throughout a woman’s reproductive years and continuing after menopause, women have questions about breast health and may need medical evaluation for these types of issues.

Breast lumps
Although the majority of breast lumps don’t turn out to be cancer, having one can be an anxious experience for women and, although rare, men as well. The key to evaluating a breast lump is a thorough evaluation that includes a clinical exam, breast imaging (usually a mammogram and ultrasound) and sometimes a breast biopsy. Breast tissue is often lumpy and some breast lumps felt by women turn out to be normal glandular tissue. Other benign lumps are caused by cysts, which are fluid-filled lumps in the breast. Another type of non-cancerous lump is a ‘fibroadenoma,’ which is often found in younger women.

If mammogram and ultrasound do not answer the question of what is causing a lump, a biopsy is usually ordered. Breast biopsies are performed with a needle using a mammogram or ultrasound to guide placement or they can be done surgically by removing the entire lump.

Breast infections
Breast infections can occur when a woman is breastfeeding and even in a woman who is not breastfeeding. This is called ‘mastitis.’ It usually appears as a red, painful, swollen breast that is sometimes accompanied by fever and body aches. Although treated with antibiotics, it’s always important to document that the symptoms and abnormal appearance of the breast is resolved since a rare type of breast cancer – inflammatory breast cancer – also presents with a red, swollen breast.

Breast pain
Breast pain is a common problem and rarely a sign of breast cancer. It may be caused by hormonal changes or breast cysts and often resolves itself on its own. If the pain is always in the same place and persistent, it should be evaluated by exam and breast imaging. It may also be helpful to keep a calendar of the breast pain to see how it relates to a woman’s menstrual cycle.

Breast size
Wanting to change the size of one’s breasts is another reason to see a specialist, which will usually be a plastic surgeon who specializes in cosmetic breast surgery. Breast enlargement is called ‘augmentation’ and can be done with silicone or saline implants. However, breasts that are too large can also be a problem if they cause back or neck pain and result in poor posture. Breast-reduction surgery can be a welcome change that fixes this issue.

Breast imaging and screening
Breast imaging is an important component of breast care. Screening mammogram is done to look for cancer in the absence of symptoms. Diagnostic mammogram, which is often done in conjunction with a breast ultrasound, is performed when there is a specific diagnostic question to answer. 3D mammography is a type of mammogram that may help radiologists see through dense breast tissue to find cancer. Screening breast MRIs are a type of highly sensitive imaging that is used for women at high risk of cancer or who have already been diagnosed with breast cancer, and whole-breast ultrasound is a new way of screening for cancer that uses ultrasound.

Breast health services available at Virginia Mason
Virginia Mason offers breast evaluations at their Breast Clinics in University Village, downtown Seattle and Federal Way. Breast imaging is done at multiple locations and includes screening mammogram, 3D mammography, ultrasound, breast MRI and whole-breast ultrasound. In addition, the Virginia Mason Breast Center offers women leading-edge breast cancer care, including Oncoplastic Breast Cancer Surgery and Intraoperative Radiation Therapy (IORT).

Eva Khan, ARNP, is an Adult Nurse Practitioner who specializes in breast health. She practices in the Breast Clinic at Virginia Mason University Village Medical Center (2671 NE 46th St, Seattle, WA 98105; 206-525-8000); www.virginiamason.org/universityvillage.

Online resources
For more information on breast health, here are some good resources:
• Office on Women’s Health, U.S. Department of Health and Human Services (www.womenshealth.gov)
• U.S. National Library of Medicine (www.nlm.nih.gov)
• National Breast Cancer Foundation, Inc. (www.nationalbreastcancer.org)
• Virginia Mason’s free email newsletter, Breast Health (www.virginiamason.org/subscribetobreasthealth)

Eva Khan practices at Virginia Mason University Village Medical Center.