Talk of women’s health in India and maternity and child health problems top the list. However, followed closely are the women’s problems of breast diseases. Today in my lecture I have highlighted some of the issues related to the morbidity in the breast. Indeed breasts are organs of self-esteem and extremely important symbol of femininity. Unfortunately, a great scourge of mankind is its affection by cancer. Cancer of the breast is the number one killer in women all around the world. Its prevalence is the 1st in 16 in the western world whereas only 1 in 50 in India. Early age at marriage and early 1st child birth along with breast feeding confer protection against breast cancer in India. The western media is preoccupied with the problem of breast cancer that is a major public health issue in those countries. Indeed, there are greater health problems specially related to women in India that need priority. Extrapolations from western media in has leaf to unnecessary threat of breast cancer in women in India. This leads to a large number of breast disease related consultants from general practitioners. Women who solicit advise regarding a breast problem from their doctor often have a trivial symptom. The doctor in turn in their enthusiasm or defense tend to prescribe investigations, mammograms and biopsy. These often mislead rather than providing relief that leads to confusion and frustration in the patients. A well informed doctor must know that in this era of information and media boom a large number of women with their breast related problem simply need “an assertive reassurance”.
On a public health note related to breast disease I wish to emphasise the following 3 points :
- Breast nodularity: Nodularity or granularity in breasts is a common occurrence and should be regarded as a variation of normal. The size of breasts, feeling of heaviness and pain and nodularity are often related to menstrual cycle. Breast that become tender to touch before periods are mostly normal. As long as the doctor is satisfied that there is no discrete lump the patients should be simply reassured and reassesses at intervals rather than prescribe investigations.
- Breast cancer: Although there are certain predisposing factors to breast cancer for example early menarche, late 1st pregnancy and non breast feeding and family history and genetic predisposition – these are somewhat less common and most important of all is the occurrence of sporadic breast cancer. Painless discrete breast lump, thick and hard skin, nipple retraction, bloody nipple discharge are some of the important features of breast cancer.
- Breast examination: Women should get themselves examined by knowledgeable professionals. Misconceptions regarding management of breast problems are replete amongst practitioners. Authentic literature for breast self examination should only be consulted.