Mastitis

A condition oft noticed in post partum period, mastitis refers to inflamed and tender breasts. There is redness and intense pain in the breasts. Women suffering from mastitis may also notice feverishness, chills and feeling of fatigue. Mastitis occurs due to engorged breasts or incomplete emptying of milk. Bacteria from the nipple or the baby's mouth can also cause mastitis. It can happen to nursing and non-nursing mothers. New mothers facing cracked or bleeding nipples are more likely to be susceptible to mastitis. It is unwise to leave the symptoms of mastitis unattended lest it leads to breast abscess. Often with swollen and inflamed breasts, a woman might also notice lumpy lymph nodes in the armpits that are swollen and tender. Do not ignore any abnormal discharge from the nipples or any prolonged breast pain. High fever must also be promptly attended to.

Feeding the baby more frequently will keep the milk supply flowing normally and relieve the engorged breasts and reduce the symptoms of mastitis. If the baby does not empty the breast completely, use a breast pump to manually empty the breast. Warm compress and massage can provide some relief. Plenty of rest works wonders for a new mother and will relieve the symptoms of mastitis. Wear a loose fitting bra for added comfort. Drink plenty of fluids and follow a good nutritious diet to rev up your immune system. Antibiotics may be prescribed to treat mastitis.

Breast Calcification

Calcification is a common process where small spots of calcium spots deposit themselves in breast tissue. These deposits can be the result of aging or other breast conditions such as fibroadenoma or cysts. Inflammation or foreign bodies such as implants or stitches can also lead to calcification.

Injury or breast surgery can lead to microcalcification. Surgery such as silicone implants or removal of tissues are other probable causes. If you have undergone radiation treatment in the chest area, you are at higher risk for developing breast calcifications. Calcium deposits within the milk ducts or within the breast arteries are other causes for developing breast calcifications. Any breast infection such as mastitis or dermatitis is yet another cause for calcification within the breast. Breast calcifications are not caused due to dietary calcium.

The best diagnostic tool to detect breast calcification is a high quality mammography done by a radiologist who is skilled in the proper positioning and compression of the breast. Such mammograms are best viewed on high-luminance viewers where extraneous glare and light is eliminated. The morphology is an important determinant in detecting malignancy of breast calcifications. A biopsy can confirm the readings. When instances of calcification are detected, mammograms are routinely taken to determine the stability of the calcifications. Suspicious mammogram must be followed by core needle biopsy, as it is minimally traumatic and relatively less expensive than surgical biopsy.

Breast Density

Breast density compares the amount of fat in the breast to the amount of tissue present. It is a measure used to describe mammogram images and is not a measure of how the breast feels (breast size and firmness). Breast tissue is made up of milk gland, milk ducts and supportive tissues (dense breast tissue) and fatty tissue (non- dense breast tissue).

Higher breast density indicates that the breast and connective tissue are denser when compared to the fat present in the breast. Lower breast density indicates more fat when compared to breast and connective tissue.

BIRADS or BI-RADS means Breast Imaging Reporting and Data System - a standard established by the American College of Radiology. This helps place findings from mammogram screenings into well-defined categories:

BI-RADS type 1: fatty; breast is almost entirely fat. Glandular tissue is less than 25%.

BI-RADS type 2: scattered fibroglandular; breast has scattered areas of fibroglandular density.

BI-RADS type 3: heterogeneously dense; breast tissue is heterogeneously dense.

BI-RADS type 4: dense; breast tissue is extremely dense. The breast contains greater than 75% glandular and fibrous tissue.

Dense breasts may be common and may not always pose a health issue. However women with high breast density are more prone to breast cancer when compared to women with low breast density. It is unclear as to why dense breasts may be more cancer prone. In a few cases women with low breast density are prone to develop breast cancer due to aging or menopause. 2/3 of pre-menopausal and 1/4 of post menopausal women (40%) have dense breast tissue.

A mammogram helps in identifying the density of breast. Women with dense breasts have more dense tissue than fatty tissue. Dense breasts look white or grey. Thus for women with dense breasts it may be difficult to identify cancer using a mammogram as both the dense breast tissue and cancer look grey or white in color in the image. Whereas for women with more fatty breasts it is easy to identify cancer as fatty tissues look black cancer look grey or white in color.

The 'success' rate of Mammogram detecting incidence of cancer depends on several factors:

patient age
breast density
tumor size
location
mammographic appearance

In younger women with denser breasts, mammography is less sensitive than in older women with fatty breasts where mammography can detect at least 90% of malignancies. Smaller tumors especially those without calcifications are more difficult to detect especially in dense breasts. Diagnostic mammography is associated with higher sensitivity but lower specificity as compared to screening mammography.

Factors that affect breast density

Factors increasing breast density

• High breast density is common among younger women and varies based on the age and weight of the woman.
  
  
• Pre-menopausal women tend to have dense breasts.
  
  
• Healthy women are more likely to have dense breast when compared to obese women.
  
  
• Lactation
  
  
• Mastitis
  
  
• Medication like menopausal hormone therapy or other medications that contain hormones may affect the breast density of a woman. These medications tend to increase the breast density of the woman.
  

Factors lowering breast density

• Breast density of a woman lowers as she gets older.
  
  
• Weight gain
  
  
• Acromegaly
  
  
• Vitamin D and calcium intake in pre-menopausal women
  

Women with high breast density

• Discuss after mammogram with their health care provider. In case the woman belongs to a high risk group classified based on gene mutation study or family history, then she should get an MRI done.
  
  
• Adapt a healthy lifestyle.
  
  
• Quit smoking
  
  
• Exercise regularly
  
  
• Limit alcohol consumption
  
  
• Eat a nutritious diet.
  
  
• Should undergo Breast Self Examination regularly.
  
  
• Get a doctor to examine the breasts every year.
  
  
• A digital mammogram every year from the age of 40.
  
  
• MRI and other imaging studies as per doctor recommendation