Page 78 - IDF Journal 2023

IDF – Webinar Series IDF News – Spring 2023
It’s Not Breast Cancer
Mr Simon Marsh
With 55,000 cases of breast cancer diagnosed in the UK every year, it is completely understandable that most information for patients
and doctors focuses on malignancy. Since 1996 the incidence of breast cancer in the UK has risen by around 18%, but the number of referrals has more than tripled, meaning that over 96% of referrals are now for benign conditions1,2. Figure
1 (which is taken from a guide for GPs by Professor Bob Mansell and is now
over 25 years old) is still
the best illustration I have come across to show the incidence of non-malignant, age-related changes (and cancer) at different ages. Diffuse (or focal) nodularity represents normal gland tissue (officially known as the “Marsh Frozen Peas Effect”!), whilst fibroadenomas and cysts occur with the age distribution shown. None of these are related to breast cancer or breast cancer risk.
Breast pain is, probably, the most common symptom seen in a breast clinic. It causes considerable anxiety but there is absolutely no association between breast pain and breast cancer. The causes are obscure but hormonal factors, such as HRT, the oral contraceptive
pill (OCP), pregnancy, breast feeding, menopause, stress, and fatigue can all affect it. Dietary factors, such as caffeine, red wine, and saturated fats have also been implicated. Whilst it often begins
as cyclical pain, it usually ends up
being random. Many women just need reassurance. Others will develop their own strategies to cope with it, combining lifestyle alterations and simple analgesics such as paracetamol and NSAIDs. Some young women find evening primrose oil (EPO) helpful. Drugs such as Danazol
and Tamoxifen have been suggested, both of which can have unacceptable side effects. Post-menopausal women can also present with breast pain. It seems that oestrogen produced in the subcutaneous tissues may undergo a transient rise in level resulting in breast discomfort. There are two other common patterns of breast pain. One is the “itchy
So, most of the time, when we see women with breast problems, we can tell them:
“it’s not breast cancer”.
nipple” syndrome which tends to occur in perimenopausal women and is probably caused by inflammation in the major ducts. The other type of “breast pain”
is costochondritis (often called Tietze’s syndrome). This is a musculoskeletal pain presenting as exquisite tenderness over the costochondral junctions. In both cases NSAIDs can be helpful.
Nipple discharge is another, usually harmless, condition that can cause concern. Like breast pain it is so common as to be considered a variation of normal.
78