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.
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)
- Reducing caffeine intake, which some women find helpful
- Evening primrose oil, which has modest evidence of benefit
- In persistent cases, prescription medication can be considered
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.
Get to know your breasts. There is no single "right" way to check them — the important thing is to be aware of how they normally look and feel, so you can notice any changes early.
Noticed a breast change or want a specialist breast examination? Get in touch.
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