A Specialist's Guide to Breast Health

When we think about breast health, we tend to focus on one thing: finding a lump. While breast lumps are indeed important, they are only one part of a much broader picture. As a gynaecologist who trained at the Breast Diseases Centre at St Louis Hospital in Paris, I see many women who are either unaware of other breast changes to watch for, or who are anxious about symptoms that turn out to be benign.

What changes should prompt a consultation?

You should see a specialist if you notice any of the following:

• A new lump or thickening in the breast or armpit
• A change in the size, shape, or appearance of a breast
• Skin changes: dimpling, puckering, redness, or an "orange peel" texture
• Nipple changes: new inversion, crusting, discharge (especially if bloodstained or occurring from one side only)
• Persistent breast pain that does not follow a cyclical pattern

Not all breast changes are cancer

Most breast symptoms have benign causes. Fibroadenomas (non-cancerous lumps), fibrocystic changes, cysts, and hormonal breast pain are all extremely common and usually require only monitoring or simple management.

However, it is always better to have a change assessed and be reassured than to delay and worry. A clinical breast examination, combined with imaging when appropriate, can usually provide a clear answer quickly.

What happens when you are referred to a breast clinic

If your GP refers you urgently for a breast change, you will typically be seen within two weeks at a breast clinic. The standard approach in the UK is called triple assessment, and it is designed to give a definitive answer, usually in a single visit. It consists of three components: a clinical examination by the breast specialist, imaging (ultrasound for women under 40, mammography for those over 40, and often both), and — if a suspicious area is found — a biopsy, where a small sample of tissue is taken using a needle under local anaesthetic. I find that knowing what to expect takes away much of the anxiety. Most women leave the clinic the same day with reassurance. If a biopsy is performed, results typically come within one to two weeks.

Fibroadenomas in younger women

I see many women in their twenties and thirties who are understandably frightened by a lump that has appeared seemingly overnight. In the majority of cases, these are fibroadenomas — smooth, firm, benign lumps made of glandular and connective tissue. They feel rubbery and move easily under the skin, which is why they are sometimes called “breast mice.” Fibroadenomas are hormone-sensitive, so they can grow during pregnancy or while taking the oral contraceptive pill, and they often shrink after menopause. Most do not need removal. I arrange ultrasound to confirm the diagnosis and, if there is any uncertainty, a core biopsy. Once we are confident it is a fibroadenoma, monitoring is all that is required unless it is growing rapidly or causing discomfort.

Breast awareness, not monthly self-exam

The old advice to perform a structured monthly self-examination has been replaced by a simpler message: know your normal. Get familiar with how your breasts look and feel at different times of the month — in the shower, getting dressed, or lying in bed. There is no special technique required. The goal is simply that if something changes, you notice it early and seek assessment. This approach has been shown to be just as effective as rigid monthly checking, without generating the anxiety that a structured regime can create.

Cyclical breast pain: what’s normal?

Many women experience breast tenderness that fluctuates with their menstrual cycle. This is related to hormonal changes and is typically felt in both breasts, most prominently in the week before a period. While uncomfortable, cyclical breast pain is not a sign of cancer.

Management options include:

• A well-fitted, supportive bra — a professional fitting can make a real difference, and I always suggest wearing a soft sports bra at night if pain is disrupting sleep
• Reducing caffeine intake, which some women find genuinely helpful
• Evening primrose oil (gamolenic acid), taken daily over two to three months — the evidence is modest but some of my patients swear by it
• Simple analgesia such as ibuprofen gel applied directly to the breast
• In persistent severe cases, prescription medications such as danazol or tamoxifen can be considered, though these carry side effects and are rarely needed

When breast pain is concerning

Most breast pain is benign. That said, I always want to hear about pain that is non-cyclical — meaning it does not follow your menstrual pattern — or pain that is localised to one specific spot in one breast. Breast cancer itself rarely presents with pain alone, but persistent focal pain deserves assessment to rule out an underlying cause. If you are unsure whether your pain is cyclical, keeping a brief diary for two to three months is a simple and effective way to find out.

Breast health and HRT

One of the most common questions I receive is about the relationship between HRT and breast cancer risk. The evidence is nuanced: the type, dose, and duration of HRT all matter. Current guidance from the British Menopause Society emphasises that for most women, the benefits of HRT for menopausal symptoms outweigh the risks when started within 10 years of menopause.

Having a thorough discussion of your individual risk factors with a specialist who understands both breast health and menopause is essential for making an informed decision.