Breast Health Diagnosis 2

Current clinical data shows that more than 90% of the breast tenderness, hard lumps, and nodules discovered by women during daily self-examination are benign hyperplasia, cysts, fibroadenoma and other non-malignant lesions, so there is no need to panic.； The core logic of distinguishing benign and malignant lesions is the three-level judgment standard of "dynamic change observation + medical imaging grading + pathological biopsy". There is no method that can 100% confirm the diagnosis by relying on a single symptom.

Last week, a 28-year-old Internet operator came into the clinic. His eyes were swollen like walnuts. He said that he had endured a big project for three months. Last week, he felt a moving hard lump in his left breast when he took a shower.

Let me tell you a piece of trivia that many people don’t know: 80% of the “lumps” you feel are actually the wrong ones. When many people perform self-examinations, they pinch breast tissue with their fingers. What they pinch is a normal gland mass, which suddenly scares them into getting sick. Correct palpation is to press your fingertips flat against the breast and press in circles. If you are unsure about palpation while standing, lie down and place a small pillow under your shoulders until the glands are spread out and palpated accurately. I have summarized a few tips for initial diagnosis over my many years of clinical practice: if the hard lump is painful, can be pushed, and has a slippery border, it will be half smaller or even gone after the surgery. 99% of the cases are benign, so don’t panic.

However, this cannot be said in vain. Last year, I met a 32-year-old patient. The lump was painful and still movable. I originally thought it was hyperplasia. However, the color Doppler ultrasound showed a 4a result. The puncture showed that it was an intraductal papilloma. Although it was benign, there was a risk of malignant transformation, so it was removed through minimally invasive surgery. Therefore, self-judgment can only be used as a preliminary screening and cannot replace formal examination.

When it comes to post-examination treatment, there are actually two different ways of thinking in clinical practice. There is no absolute right or wrong. It just depends on your personal situation. One is the "conservative follow-up school" that most tertiary breast surgeries prefer. As long as the BI-RADS grade is 3 or below, there is no family history of breast cancer, and there is no rapid enlargement in a short period of time (1-2 months), a review is enough in 3-6 months, without medication or intervention. After all, most benign lesions will not become malignant at all, and over-treatment will harm the body. The other is the "early intervention school" that is more supported by endocrinology departments and some Chinese medicine practitioners. If you already have obvious premenstrual swelling and pain, emotional outbursts, and poor sleep, even if it is benign, you can use hormone adjustment, traditional Chinese medicine to disperse knots, and lifestyle adjustments to intervene in advance to prevent subsequent nodules from continuing to grow and relieve discomfort.

Oh, by the way, there is another controversial point: can breast massage be done? I have seen two sides quarreling with each other. One group said that regular relaxing massage can relieve local circulation, and it is really comfortable after massage when there is swelling and pain. ； The other group says that if you have high-risk nodules, indiscriminate pressing may stimulate the spread of the lesions. If you encounter an irregular institution that applies estrogen-containing "nodule dispersing cream" to you, it will aggravate the proliferation. My personal suggestion is to first do a color ultrasound to confirm that there are no high-risk nodules of level 4 or above, and then find a regular institution for relaxing massage. Don’t believe the propaganda about “pressing and dispersing nodules”. If the nodules can be pressed and dispersed, our surgeons will be laid off.

Many people have asked me whether drinking soy milk will aggravate breast hyperplasia. This is really a rumor that has been circulating for many years. The isoflavones in soybeans are phytoestrogens, which are regulated in both directions. If the estrogen in your body is high, it will help you lower it, and if it is low, it will help you supplement it. Drinking a cup every day is good for the breast glands, so there is no need to blindly eat. On the contrary, what you should avoid is royal jelly, breast enhancement products with unknown ingredients, and excessive sweets and milk tea. These are the things that can really disrupt hormone levels.

In fact, after being a breast surgeon for so long, the things I see the most are not malignant lesions, but little girls who scare themselves, and middle-aged women who don't take it seriously until it's late. The breast is an organ that can be said to be delicate. It will be the first to protest when you feel sulky and stay up late every day. It can be said to be skin-resistant. As long as you have a regular breast ultrasound every year and add a mammography target if you are over 40 years old, if any problems are discovered and dealt with early, the prognosis will be very good. Don't blindly believe in folk remedies on the Internet, and don't force yourself to take them when you feel uncomfortable, that's enough.