Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Standard view
Full view
of .
Look up keyword
Like this
0 of .
Results for:
No results containing your search query
P. 1
Analysis of Breast Pain, 2009

Analysis of Breast Pain, 2009

|Views: 0|Likes:
Published by Tomy Saputra

More info:

Published by: Tomy Saputra on Dec 25, 2012
Copyright:Attribution Non-commercial


Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less





Patients with breast-problems make up a major partof the patient load at a general surgical out-patients’clinics. Majority of patients correlates breast pain withbreast cancer. Virtually, every women with a breastlump, breast pain or discharge from nipple fears thatshe has breast-cancer. The anxiety that result is madeof three components: the unknown course of thediseases, the threat of mutilation and the fear of death;all these, compounded by social and cultural normsamong certain groups, often prevented women fromseeking early medical advice. In recent years, speciallyin the west, public awareness and media publicityabout self-examination and screening and the possibleadvantages of early treatment have encouraged earlierpresentation, which of course is not without itsdisadvantages; the psychological consequences of false- alarms and false-reassurances cannot be ignored alltogether. Unfortunately, the majority of the sufferersin this part of the world are far from being aware of the disease process and thus present only when it istoo late. This is especially applicable in case of breastcancer, “The captain of the breast-disease”.
It is the
 A prospective type of analytical study was carried out on 106 patients with breast pain to analyzethe causes of breast pain. This study was conducted from August, 2002 to January 2004 at breastclinic of Bangladesh Medical College Hospital (BMCH) and at Department of Surgery of BMCH.Sampling was done purposively and a structured questionnaire was used for data collection byinterviewing followed by examining the patient in the first phase. In the second phase,Mammography and FNAC (Fine Needle Aspiration Cytology) was done. Majority of the patients(35.8%) were in the age group of 21- 30 years and the mean age was 27.61± SD10.5 years. About48.1% breast pains were due to ANDI (Aberration of Normal Development and Involution) andamong the other causes nonspecific pain 15.1%, breast abscess 14.2% and carcinoma of breastwere only 1.9%. The performance status of all the patients were in between 0- 1. Mammographywas done in 54 patients and of them 44 was found positive for fibrocystic disease (41 cases) and fibroadenoma (3 cases). FNAC was done in 50 patients and 36 were found positive with fibroadenoma (22 cases), fibrocystic change (8 cases), chronic breast abscess (2 cases), mitoticlesion (2 cases), and neurofibroma (2 cases). So painful breast diseases are helpful in seeking  further medical care for appropriate intervention
 Breast pain, Mastalgia, ANDI.
1.Associate Professor, Department of Surgery, Bangladesh Medical College, Dhaka2.Registrar, Department of Surgery, Bangladesh Medical College, Dhaka3.Assistant Professor, Department of Oncology, Bangladesh Medical College, Dhaka
Correspondence :
Dr. Riaz Ahmed Chowdhury, Associate Professor, Department of Surgery, Bangladesh Medical College,Dhaka
common cancer in the women and the most commoncause of death in women between 35-55 years.
Theincidence of breast cancer is rising but mortality hasnot risen, probably as a result of earlier detection andimproved treatment. Breast cancer is not, however, anew disease; it was recognized by the ancientEgyptians and mastectomy was certainly performedin Roman times.
The other conditions of the breast are the benign breastdisease. A majority of these are coined under ANDI(Aberrations of Normal Development and Involution)by Cardiff Breast Clinic to avoid different terminologiesand confusion.
The common benign breast diseases are fibroadenosisand fibroadenoma, both controlled by hormonal factors;fibroadenoma is common in younger women whilefibroadenosis between 30 to 40 years.
Breast infections most commonly occur duringpregnancy and lactation. Equally, not uncommonbreast condition is Mastalgia or Mastodynia, describedfirst by Sir Astley Cooper.
it may or may not becyclical and may or may not be associated with
J MEDICINE 2009; 10 : 77-81
nodules. Many people still believe that Mastodynia isincompatible with breast cancer but one third of thepatients with sub-clinical breast cancer present withpain.
1, 3
It may be mentioned here that proper analysis of breastpain and its appropriate management is associatedwith sound female health. So keeping this in mind,this study was done to evaluate the causes of breastpain.
Materials and methods:
This prospective analytical study was done on 106patients with a complain of breast pain at breastclinic of Bangladesh Medical College Hospital and atSurgical Department of BMCH from August 2002 toJanuary 2004. By purposive sampling a total of 106patients with breast pain were selected. A structuredquestionnaire was filled up by interviewing on varioussocio-demographic variables, by evaluating theperformance status and examining the patient in thefirst phase. In the second phase Mammography andFNAC were done. Data were compiled, edited andpresented by frequency distribution table using thesoftware SPSS.Performance status was evaluated by following UICC(Union against Cancer Commission) performancestatus:0able to carry out normal activity1 able to live at home, with tolerable symptoms2disabling symptoms but less than 50% of time inbed3severely disabled, greater than 50% of time in bedbut able to stand4very ill confined to bed5death
 Distribution of the age of the respondents (n=106)
 Age GroupNumber of patientsPercent<1021.911-203028.421-303835.831-402321.741-50109.4>5032.8Total106100%The age range of the patients was 10-72 and mean agewas 27.61± SD- 10.5 years.Table-I shows the maximum patient in study groupwere in the age group of 21- 30 years (35.8%).About28.4% and 21.7% were in the age group of 11-20 and31-40 years respectively. Only 1.9% (2 in number)was of <10 years.
 Distribution of patients presented with breast painaccording to the
causes (n=106)
Diagnosis of patientNo of patientsPercentwith breast pain ANDI5148.1Breast abscess1514.2Non-specific Mastalgia-Cyclical- Non-cyclical120411.33.8Fibroadenoma109.4Disease of nipple109.4Carcinoma breast21.9Galactocele10.94Eczema10.94Total106100Table-II shows that out of 106 patients with breastpain majority (48.1%) were due to ANDI. Among theother causes nonspecific pain (15.1%), breast abscess(14.2%), diseases of nipple (9.4%), fibroadenoma (9.4%)carcinoma of breast (1.9%), galactocele (0.94%) andeczema (0.94%).
 Distribution of the performance status (n=106)
Diagnosis of patientsPerformance Status012345 ANDI n= 5140110000Non-specific1060000mastalgia n=16Breast abscess780000n=15Disease of nipple820000n= 10Carcinoma of breast110000n= 2Galactocelen= 1010000Skin lesion( eczema)100000n= 1This table shows that, the performance status of allthe patients were in between 0- 1.
JM Vol. 10, No. 2Analysis of Breast Pain: A Study of 110 Cases
Table-IV shows that, mammography of the breast doneon 54 patients where 44 and 10 patients were foundpositive and negative respectively. Out of 44 positivecases of mammography, 41 patients (93.2%) revealedfibrocystic disease, and three patients (6.8%) hadfibroadenoma.FNAC was done in 50 patients presented with pain.Out of 50 patients, 36 were found positive and 14 werefound negative. Among them 22 patients (61%)diagnosed as fibroadenoma, 8 patients (22.2%) asfibrocystic change, 2 patients (5.6%) as chronic breastabscess, 2 patients (5.6%) as mitotic lesion, 2 patients(5.6%) diagnosed as neurofibroma.
 Age distribution of ANDI (n=51)
 Age( years)Numbers of patientsPercentage<20713.721-302956.931-401223.541-5023.9>5012.0Total51100The table shows maximum patients (56.9%) had ANDI, which were later diagnosed as fibroadenosis,were in the age group of 21 – 30 years. Only one patientout of 51 cases is of more than 50 years.
In this series a total of 106 patients with a complaintof breast pain were studied from August 2002 toJanuary 2004 at breast clinic of Bangladesh MedicalCollege Hospital and at Surgical Department of BMCH.The majority of the patients (35.8%) with breast painbelong to the age group of 21-30 years (Table-1). Thisgeneral age distribution is in agreement with studiesdone by Ekland DA et al who found 74% of his patientswere below 40 years and AMSM Sharfuzzamanl found48% of his patients were in the age group between 21-30 years.
4, 5
In this series, 48.1% patients were diagnosed as Aberration of Normal Development and Involution(ANDI), 15.1% as non-specific mastalgia and 14.2%as breast abscess. The next group was diseases of nipple 9.4%, carcinoma of breast 1.9%, galactocele0.94%, and eczema 0.94% (Table-2). This iscomparable with the study Shresta S, Sen T et al.
They found that overall 36.8% presented with cyclicalmastalgia and 43.1% with noncyclical mastalgia. Thisresult is also comfortably comparable with otherliteratures. Funder Burk et al
in a review of 2582breast lesions in blacks found that maximum cases(30%) were fibrocystic diseases, followed byfibroadenoma 27%, carcinoma 23% and rest 20%.
But the results are slightly different in the studyconducted by Oluwol and Freeman et al
who analyzed282 breast lesions in Black patients and noted thatfibroadenoma was the most common (34.75%) andthen carcinoma(29%) followed by fibroadenosis(17%).
Most of the patients in this study, describe their painas heavy, aching and tender, and these descriptorswere given significantly higher ratings by women with
 Distribution of the investigation yielding positive result
InvestigationNo of patientsPositive resultNegative resultdone with painNo. (%)Mammography54Fibrocystic disease:41 (93.2)Total : 10Fibroadenoma:03 (6.8)Total:44 (100)FNAC50Fibroadenoma:22 (61)Total : 14Fibrocystic change:08 (22.2)Chr. breast abscess:02 (5.6)Mitotic lesion:02 (5.6)Neurofibroma:02 (5.6)Total:36 (100)
 Analysis of Breast Pain: A Study of 110 CasesJM Vol. 10, No. 2

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->