Benign breast disease

Lump, nipple discharge and pain are the major presenting symptoms of breast disease. Around 60% of referrals are for a lump and less than 10% of these will be diagnosed to have breast cancer. Benign diagnoses are: fibroadenoma, a firm mobile lump considered as aberrations of normal development; breast cysts, which are discrete lumps accounting for 15% of all breast lumps; and nodularity, which is the most common cause for referral in all ages. All breast lumps need to undergo triple assessment. Around 8% of referrals are for nipple discharge. Physiological nipple discharge is usually bilateral, multi-duct and coloured white, yellow green or black. Duct ectasia is due to ductal involution and the change is often bilateral and associated with 'slit-like' nipple retraction. Increasing risk of significant pathology is associated with unilateral, single duct, serous and blood stained discharge, which needs to undergo triple assessment. Blood stained discharge may be due to duct ectasis, intra-duct papilloma, epithelial hyperplasia or malignancy. Breast pain is divided into cyclical and non-cyclical mastalgia (including chest wall pain), and 25% of breast clinic referrals will be for breast pain. Cyclical mastalgia is an exaggeration of normal cyclical changes and the patient can be reassured without investigation. If pain is severe treatment is with gamolenic acid, danazol or bromocriptine. Where pain is non-cyclical, unilateral and localized investigation with mammography is required. Chest wall pain is a common end diagnosis for referrals with breast pain and is treated simply with reassurance and simple analgesics or NSAIDs.