Medicurio

Raynaud’s phenomenon is a vasospastic disorder that affects the hands triggered by cold or emotional stress resulting in symptoms of pain, pallor progressing to cyanosis, and coolness of the distal extremities. These changes are thought to be due to intimal layer hypertrophy and inflammation; collagen disposition and fibrosis resulting in vessel lumen occlusion. These vascular alterations have been described in the digital arteries, superficial palmar arch and ulnar artery. Angiographic studies have demonstrated little or no collateral circulation distal to the fibrotic vessels. Radiographic findings in the hands may include soft tissue calcifications when the patient has Raynaud’s as part of CREST syndrome, atrophy of the finger tips, acroosteolysis and intercarpal joint space narrowing. The differential diagnosis for acroosteolysis includes: psoriasis, injury (frostbite or thermal burns), neuropathy (diabetes, leprosy, myelomeningocele), collagen vascular disease, hyperparathyroidism, polyvinyl chloride (PVC) exposure, snake/scorpion venom and familial forms (Hadju-Cheney syndrome).

The importance of the family to family physicians is inherent in the paradigm of family medicine. Family medicine does not separate disease from person or person from environment. It recognizes the strong connection between health and disease, and personality, way of life, physical environment, and human relationships. It understands the strong influence that human relationships have on the outcome of illness and recognizes the family as the crucible of the development of the person. Clinicians can be minimally involved with a patient’s family; they may provide the family with information and advice; they may provide emotional support to help family members deal with the feelings aroused by having a family member with an illness; or they can carry out a systematic assessment of family function and plan an intervention designed to help a family deal with its problems. Cultural norms, differences in the form and function of “family,” and an understanding of the family life cycle, together with an understanding of individual development, must be taken into consideration by the practitioner.

Bringing and building social science theory to understand the social and cultural determinants of health, how society produces health and the lived experience.

The Society, Culture and Health theme contributes new thinking using social science theory to the social and cultural determinants of health. We seek to understand how health is experienced and produced within an ecological public health framework. Much of our research incorporates a focus on health inequalities and questions of health equity.

Our members – who are drawn from sociology, anthropology, epidemiology, economics and psychology – employ novel combinations of qualitative and quantitative methods as part of their own research projects as well as contributing to cross-disciplinary approaches to research within RSPH.

Our research in health, culture and society encompasses many aspects of the social and behavioural sciences in medicine. We are interested in how various psychological and sociological concepts are applied in practice and contribute to our understanding of health, disease and the care they require.

We have a wide range of methodological expertise, including qualitative and quantitative approaches, and specialise in ethnographic research as well as undertaking behavioural and neuroscientific studies.

Our specific interests include:

• Mental health and wellbeing
• Healthcare work practices and cultures
• Health and social inequalities
• Experiences of healthcare
• Psychosocial development

Our work is often collaborative and we engage with a wide range of NHS and third sector organisations. We work with patients, families and carers, healthcare practitioners, and policy makers. Our focus is on improving the practices of care as well as furthering insights across health and medicine.

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Breast cysts are fluid-filled sacs that are among the most common breast lumps a woman may have. They may also be a cause of other breast symptoms—from pain to, potentially, nipple discharge.

Many women develop noncancerous changes in their breast tissue. It’s one of the conditions known as fibrocystic breast disease, which includes fluid-filled cysts. A cyst may show up in one or both breasts at the same time and in different parts of the breast. Some cysts are so small that patients don’t feel a lump.

For many patients, breast cysts don’t have symptoms: Only about 7 percent of women have a breast cyst that may be felt with the hand.

Simple fluid-filled cysts form from fluid buildup in the breast glands. Microcysts are tiny and may only be spotted under a microscope. Macrocysts, on the other hand, may span from 1 to 2 inches.

Then there are complex cysts, which are either solid or filled with fluid and solids. A complex breast cyst may require a biopsy and drainage to check the cells, a procedure designed to determine whether the cyst is cancerous. On rare occasions, complex cysts are cancerous or increase the risk of breast cancer later.

Symptoms

Breast cysts may be found in one or both breasts. Signs and symptoms of a breast cyst include:

• A smooth, easily movable round or oval lump that may have smooth edges — which typically, though not always, indicates it’s benign
• Nipple discharge that may be clear, yellow, straw colored or dark brown
• Breast pain or tenderness in the area of the breast lump
• An increase in breast lump size and breast tenderness just before your period
• A decrease in breast lump size and resolution of other symptoms after your period

Having breast cysts doesn’t increase your risk of breast cancer. But having cysts may make it harder to find new breast lumps or other changes that might need evaluation by your doctor. Your breasts may feel lumpy and painful when you’re menstruating, so it’s important to be familiar with how your breasts feel throughout your menstrual cycle so that you’ll know if something changes.

When to see a doctor

Normal breast tissue often feels lumpy or nodular. But if you feel a new breast lump that doesn’t go away, gets bigger or persists after one or two menstrual cycles, see your doctor right away. Also see your doctor if you have new skin changes on one or both of your breasts.

Causes

Each of your breasts contains lobes of glandular tissue, arranged like petals of a daisy. The lobes are divided into smaller lobules that produce milk during pregnancy and breast-feeding. The supporting tissue that gives the breast its shape is made up of fatty tissue and fibrous connective tissue. Breast cysts develop as a result of fluid accumulation inside the glands in the breasts.

Breast cysts may be defined by their size:

• Microcysts may be seen during imaging tests, such as mammography or ultrasound, but are too small to feel.
• Macrocysts are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5 centimeters) in diameter.

Experts don’t know exactly what causes breast cysts. They may develop as a result of hormonal changes from monthly menstruation.

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Diagnosis

Diagnosis of a breast cyst usually includes a breast exam; imaging tests, such as a breast ultrasound or mammogram; and possibly fine-needle aspiration or a breast biopsy.

Breast exam

After discussing your symptoms and health history, your doctor will physically examine the breast lump and check for any other breast abnormalities. Because your doctor can’t tell from a clinical breast exam alone whether a breast lump is a cyst, you’ll need another test. This is usually either an imaging test or fine-needle aspiration.

Imaging tests

Needed tests may include:

• Mammography. Large cysts and clusters of small cysts can usually be seen with mammography. But microcysts can be difficult or impossible to see on a mammogram.
• Breast ultrasound. This test can help your doctor determine whether a breast lump is fluid filled or solid. A fluid-filled area usually indicates a breast cyst. A solid-appearing mass most likely is a noncancerous lump, such as a fibroadenoma, but solid lumps also could be breast cancer.

Your doctor may recommend a biopsy to further evaluate a mass that appears solid. If your doctor can easily feel a breast lump, he or she may skip imaging tests and perform fine-needle aspiration to drain the fluid and collapse the cyst.

Fine-needle aspiration

During a fine-needle aspiration, your doctor inserts a thin needle into the breast lump and attempts to withdraw (aspirate) fluid. Often, fine-needle aspiration is done using ultrasound to guide accurate placement of the needle. If fluid comes out and the breast lump goes away, your doctor can make a breast cyst diagnosis immediately.

• If the fluid is not bloody and has a straw-colored appearance and the breast lump disappears, you need no further testing or treatment.
• If the fluid appears bloody or the breast lump doesn’t disappear, your doctor may send a sample of the fluid for lab testing and refer you to a breast surgeon or to a radiologist — a doctor trained to perform imaging exams and procedures — for follow-up.
• If no fluid is withdrawn, your doctor will likely recommend an imaging test, such as a diagnostic mammogram or ultrasound. The lack of fluid or a breast lump that doesn’t disappear after aspiration suggests that the breast lump — or at least a portion of it — is solid. A sample of the tissue may be collected to check for cancer.

Treatment

No treatment is necessary for simple breast cysts — those that are fluid filled and don’t cause any symptoms — that are confirmed on breast ultrasound or after a fine-needle aspiration. Many cysts will disappear with no treatment. If a cyst persists, feels firmer or you notice skin changes on the skin over the cyst, follow up with your doctor.

Fine-needle aspiration

Fine-needle aspiration may be used to diagnose and treat a breast cyst if all the fluid can be removed from the cyst during the procedure, and then your breast lump disappears and your symptoms resolve.

For some breast cysts, however, you may need to have fluid drained more than once. Recurrent or new cysts are common. If a breast cyst persists through two to three menstrual cycles and grows larger, see your doctor for further evaluation.

Hormone use

Using birth control pills (oral contraceptives) to regulate your menstrual cycles may help reduce the recurrence of breast cysts. But because of possible significant side effects, birth control pills or other hormone therapy, such as tamoxifen, is usually recommended only for women with severe symptoms. Discontinuing hormone therapy after menopause may also help prevent breast cysts.

Surgery

Surgery to remove a breast cyst is necessary only in unusual circumstances. Surgery may be considered if an uncomfortable breast cyst recurs month after month or if a breast cyst contains blood-tinged fluid or shows other worrisome signs.

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Breast fibroadenomas are the most common type of noncancerous (benign) breast tumor. They are often described as round, moveable, painless breast lumps that feel smooth and rubbery. They can be felt during your monthly breast self-exam and will show up on mammograms and ultrasounds.

Fibroadenomas usually occur in premenopausal women. They may grow during pregnancy, breastfeeding, or estrogen therapy.

Although fibroadenomas have a typical feel on physical examination and appearance on breast ultrasound, the only way to ensure a breast lump is a fibroadenoma is through a biopsy. Proven fibroadenomas may not need treatment unless they are large, fast-growing, or cause bothersome symptoms.

A fibroadenoma is a solid breast lump. This breast lump is not cancer. A fibroadenoma happens most often between ages 15 and 35. But it can be found at any age in anyone who has periods.

A fibroadenoma often causes no pain. It can feel firm, smooth and rubbery. It has a round shape. It might feel like a pea in the breast. Or it may feel flat like a coin. When touched, it moves easily within the breast tissue.

Fibroadenomas are common breast lumps. If you have a fibroadenoma, your health care provider may tell you to watch for changes in its size or feel. You may need a biopsy to check the lump or surgery to remove it. Many fibroadenomas need no further treatment.

Symptoms

A fibroadenoma is a solid breast lump that often causes no pain. It is:

• Round with distinct, smooth borders
• Easily moved
• Firm or rubbery

A fibroadenoma often grows slowly. The average size is about 1 inch (2.5 centimeters). A fibroadenoma can get bigger over time. It may be tender or cause soreness a few days before your period. A large fibroadenoma may hurt when you touch it. But most often, this type of breast lump causes no pain.

You can have a single fibroadenoma or more than one fibroadenoma. They can occur in one or both breasts.

Some fibroadenomas shrink over time. Most fibroadenomas in adolescents shrink over many months to a few years. They then disappear. Fibroadenomas may also change shape over time.

Fibroadenomas may get bigger during pregnancy. They might shrink after menopause.

When to see a doctor

Healthy breast tissue often feels lumpy. Make an appointment with your health care provider if you:

• Find a new breast lump
• Notice other changes in your breasts
• Find that a breast lump you had checked in the past has grown or changed in any way

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Causes

The cause of fibroadenomas is not known. They might be related to hormones that control your periods.

Less common types of fibroadenomas and related breast lumps may not act the same as typical fibroadenomas. These types of breast lumps include:

• Complex fibroadenomas. These are fibroadenomas that can get bigger over time. They can press on or displace nearby breast tissue.
• Giant fibroadenomas. Giant fibroadenomas grow quickly to larger than 2 inches (5 centimeters). They also can press on nearby breast tissue or push it out of place.
• Phyllodes tumors. Phyllodes tumors and fibroadenomas are made of similar tissues. But under a microscope, phyllodes tumors look different from fibroadenomas. Phyllodes tumors typically have features associated with growing faster. Most phyllodes tumors are benign. This means they are not cancer. But some phyllodes tumors may be cancer. Or they could become cancer. Phyllodes tumors often cause no pain.

Complications

Common fibroadenomas do not affect your risk of breast cancer. But your risk might go up a bit if you have a complex fibroadenoma or a phyllodes tumor.

Diagnosis

A fibroadenoma may first be discovered on physical examination or during a routine screening mammogram. On a mammogram, fibroadenomas appear as round or oval smooth-edged masses. The outline will be clearly defined, not blurry, and will not be invading the adjacent spaces. Sometimes they are accompanied by coarse calcifications (calcium deposits). Fibroadenomas can look like cysts or a well-contained tumor.

If you notice a lump during an exam or if an abnormality is seen on mammography, a breast ultrasound is usually the next step. This is especially true if you have dense breast tissue, which can make a lump more difficult to view.

On ultrasound, a fibroadenoma will be easier to distinguish from other tissue because of the way it responds to sound waves. It will appear as a dark area with a definite outline. It will look homogeneous (looks the same throughout), round or oval, and may have smooth-edged bumps.

Your doctor may also order digital breast tomosynthesis (DBT), a specialized form of mammography that creates 3D images of the breast, and allows a more detailed evaluation when compared to a regular mammogram.

Biopsy

While imaging tests may suggest a fibroadenoma, the conclusive diagnostic test is usually a breast biopsy, a procedure to remove a sample of tissue for examination in a lab.

Different types of biopsy procedures include fine-needle aspiration or core-needle biopsy, both of which use needles to extract tissue, and open biopsy, a surgical procedure in which a cut is made in the skin to extract sample tissue. Which type your healthcare provider chooses will depend on the characteristics of the lump, its location, and other factors. In women at increased risk for breast cancer, your healthcare provider may strongly recommend surgical removal.

As with any biopsy, breast biopsies carry a risk of a false-negative result that is, the test detects no cancer when cancer is actually present). This is because a breast biopsy may only sample one part of a lump and could miss the cancerous portion. For this reason, you should continue routine breast cancer screening even if you have had a benign biopsy in the past.

Fibroadenoma Treatment

It’s important to distinguish between the two types of fibroadenomas when choosing the best treatment options because of the difference in associated breast cancer risk.

Fibroadenomas are classified as either:

• Simple: Most fibroadenomas are the simple type; they are more common in younger people. There’s usually just one mass in your breast, with a definite border and very uniform cells. A simple fibroadenoma does not raise your risk for breast cancer.
• Complex: Complex fibroadenomas are less common but become more common as people age. While they may have a definite border, it’s what is inside this kind of fibroadenoma that makes it different. Under a microscope, a complex fibroadenoma will not look organized and uniform like a simple one. There is often evidence of rapidly dividing cells (hyperplasia) that may have an abnormal appearance (atypia). Having a complex fibroadenoma can raise your risk of developing breast cancer,

Aside from fibroadenoma type, other factors may influence treatment choice, such as:

• Symptoms, especially discomfort and pain
• Emotional state, such as undue worry about it being cancer

Be open and honest with your healthcare provider about what you’re experiencing so your concerns can be considered when weighing treatment options.

In considering all of this, your healthcare provider will recommend one of the following fibroadenoma treatment options.

Watch and Wait

Since fibroadenomas are not always troublesome and sometimes shrink on their own, just keeping an eye on their progress is the least invasive way to handle them.

Laser Ablation

In your surgeon’s office, an ultrasound-guided laser device is used to destroy the fibroadenoma, leaving behind only a tiny scar, no sutures, and no change in breast shape. You don’t need general anesthesia, and it’s usually an outpatient procedure, which means no hospital stay.

Cryoablation

Cryoablation is a fast, efficient way to freeze a fibroadenoma. In one office visit, the healthcare provider simply freezes the lump so that healthy tissue can take over. This procedure takes less than 30 minutes and results in a tiny scar.

Radiofrequency Ablation (RFA)

This is a way to remove fibroadenomas without resorting to a lumpectomy. Using local anesthesia and ultrasound guidance, a 6- to 8-millimeter (about 1/4 inch to nearly 1/3 inch) cut is made above the fibroadenoma. Through this cut, a surgical wand is inserted and then tipped by a knife that is heated by radiofrequency current. This helps cut through the breast tissue without causing much bleeding. Once it reaches the target, small wires and robotic arms capture the fibroadenoma and extract it.

Vacuum-Assisted Excision

Breast biopsy systems can now be used as a mostly noninvasive way to remove small fibroadenomas. In less than an hour, and under local anesthesia, a 6-millimeter (1/4 inch) cut is made over the fibroadenoma. Then, with ultrasound guidance, a probe is threaded into the lump, which vacuums out sections of the tissue. Recovery is quick and your scar will be quite small.

High-Frequency Focused Ultrasound (HFU)

This is a relatively new treatment that has been used for fibroadenomas and, sometimes, even for breast cancer. HFU appears to cause the selective destruction of deep tissues without damaging surrounding healthy tissue.

Lumpectomy

Surgical removal can be done if you’re worried about a fibroadenoma. Depending on the relative size of the lump and your breast, a lumpectomy may cause a change in your breast’s size or shape. New fibroadenomas may grow in the area of the first lump, so you should know that surgery is not a guarantee that you’ll never have another fibroadenoma. On the other hand, your fibroadenoma can be carefully examined by a pathologist to make sure your diagnosis is correct.

For pain that may be due to a fibroadenoma, over-the-counter pain medications and applied heat are often used.

Complementary and Alternative Medicine (CAM) Concerns

Certain herbal supplements and diets have been touted as effective treatments for fibroadenomas or their symptoms, but few controlled studies have looked into these remedies. Adopting a healthy lifestyle, including regular exercise and eating lots of fruits and vegetables, is always good advice and may help relieve fibroadenoma symptoms. But remember that these interventions shouldn’t replace proper testing.

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