European Journal of Cardiovascular Medicine

A palpable breast swelling is a clinical indicator that may signify either benign or malignant conditions within the breast. The intricate development of the breast, driven by hormonal stimuli such as estrogen, progesterone, and prolactin, results in varying patterns of breast diseases across different life stages. Predominantly, the majority of these swellings prove to be benign, with only a small percentage exhibiting malignant characteristics.^[1]

In the realm of breast health assessment, the adoption of a comprehensive strategy known as triple assessment plays a pivotal role in ensuring a meticulous evaluation. This multifaceted approach integrates clinical, histological, and radiological evaluations, aimed at the detection and evaluation of breast swellings.^[2] Clinical examination serves as the initial pillar, while histological assessment involves obtaining tissue samples through fine needle aspiration cytology or core needle biopsy. Radiological assessment, the third dimension of triple assessment, incorporates imaging techniques such as ultrasound for younger women and mammography for older women.^[3]

Beyond the palpation of breast swellings, clinical examination forms the initial pillar of the triple assessment, involving a thorough physical examination by skilled clinicians. Histological assessment, the second facet, involves obtaining tissue samples for microscopic examination using fine needle aspiration cytology or core needle biopsy. Radiological assessment, the third dimension, involves imaging techniques such as ultrasound for younger women and mammography for older women.^[4-5]

The emphasis on triple assessment is underscored by its ability to provide a comprehensive understanding of breast conditions, minimizing the likelihood of misdiagnosis.^[6] This integrated approach ensures a thorough evaluation of both benign and malignant breast swellings, contributing to accurate diagnoses and appropriate management⁷. The research aimed to compare the patterns of breast swelling in premenopausal and postmenopausal women and identify the most common breast lumps in each group. This comprehensive exploration seeks to unravel the intricacies of breast health, fostering early detection, and facilitating tailored interventions for women across diverse life stages.

STUDY OBJECTIVES

Primary Objective

This study aims to investigate and compare the occurrence of breast lumps in premenopausal and postmenopausal women.

Secondary Objectives

1. Identify and differentiate between benign and malignant breast lumps in premenopausal and postmenopausal women.
2. Determine the most prevalent high-risk group for breast carcinoma.
3. Investigate the prevalence of the most common benign and malignant breast swellings in premenopausal and postmenopausal women.

This prospective study was conducted from 2022 to 2023 at GMCH, Sundargarh, Odisha, involved 100 female patients attending the general surgery OPD. They were evenly divided into postmenopausal and premenopausal groups based on menstrual status. Inclusion criteria encompassed clinically palpable breast swelling in females, excluding those with no menstrual bleed for the last 12 months, post-hysterectomy or ovarian issues, unclear menopausal status, or using hormonal medications. The average age of menarche for postmenopausal and premenopausal women was 14.3 and 14.2 years, respectively.

The study, spanning November 2022 to October 2023, employed a prospective study design, focusing on detailed clinical, histopathological, and ultrasound examinations. Selected cases underwent mammograms and MRIs. Fine needle aspiration cytology (FNAC) was administered to all patients, with inconclusive FNAC cases subjected to core needle biopsy. Postoperative specimens underwent histopathological examination. Malignant cases underwent metastatic workup, including chest x-ray, long bone x-rays, liver function tests, and abdominal ultrasound.

The results were categorized into four groups:

• Group 1: Premenopausal women with benign breast disease
• Group 2: Premenopausal women with malignant breast disease
• Group 3: Postmenopausal women with benign breast disease
• Group 4: Postmenopau

Out of the total 100 patients, 82 underwent surgery, and postoperative specimens were analyzed histopathologically, with final reports collected for each patient. In this study, 50 patients were postmenopausal, and the remaining 50 were premenopausal. Among the postmenopausal women, 42% reached menopause at 45 or earlier, while 58% experienced menopause after 45. Patient ages ranged from 25 to 76 years, with a mean age of 47.7 years. The majority, 58%, fell between 40 and 60 years, 25% were under 40, and 17% were over 60. Concerning the duration of symptoms, 56% presented a history of 2-6 months, 22% had complaints lasting over 12 months, and 14% reported 7-12 months of symptoms.

Clinical examination revealed benign breast disease in 68 patients and malignant disease in 32. Ultrasound findings indicated 63 patients with probable benign conditions, 26 with probable malignancy, and 11 with inconclusive results. All patients were recommended histopathological examination correlation. The final diagnoses based on FNAC, core biopsy, and postoperative specimens revealed 60 cases of benign breast disease and 40 cases of malignant disease.

Specific diagnoses among the 100 patients included fibroadenoma, fibrocystic disease of the breast, invasive ductal carcinoma of breast NST, and invasive lobular carcinoma. Among malignant diseases, 60% were invasive ductal carcinoma, 32.5% were invasive lobular carcinoma, 5% were invasive medullary carcinoma, and 2.5% were inflammatory carcinoma.

In terms of percentage distribution, 82% of premenopausal women had benign disease, while 18% had malignant breast disease. In postmenopausal women, 38% had benign disease, whereas 62% had malignant breast disease. Distribution in study groups revealed that 77.5% of total malignant cases belonged to the postmenopausal group, while 22.5% belonged to the premenopausal group. Among benign cases, 31.6% were postmenopausal, and 68.4% were premenopausal.

Specifics in subgroups indicated that premenopausal women with benign diseases had 58.5% fibroadenoma cases, 24.3% fibrocystic disease, and smaller percentages of other benign conditions. Premenopausal women with malignant diseases showed 45% invasive ductal carcinoma, 45% invasive lobular carcinoma, and 10% invasive medullary carcinoma.

Postmenopausal women with benign conditions had 89.4% fibrocystic disease cases and smaller percentages of other benign conditions. Postmenopausal women with malignant diseases exhibited 64.5% invasive ductal carcinoma, 29% invasive lobular carcinoma, and 3.25% invasive medullary carcinoma and inflammatory carcinoma.

The study's comprehensive results offer valuable insights into the distribution and characteristics of breast diseases in premenopausal and postmenopausal women.

In the study, all patients presented with a breast lump as their chief complaint, with some reporting associated breast pain. Approximately 25 patients exhibited features suggestive of malignancy, such as dimpling, nipple retraction, and breast asymmetry. Nipple discharge was observed in about 5 patients. The left breast was affected in 52 cases, while the right breast was affected in the remaining cases. The majority of lumps were located in the outer upper and outer inner quadrants. Confirmation of diagnoses was obtained through histopathological examination of core needle biopsy or postoperative specimens, with fine needle aspiration cytology performed when results were inconclusive in some cases.

All patients underwent breast ultrasound, which identified benign fibrous nodules, complex cysts, suspicious lesions, and those highly indicative of malignancy. The nature of the lesion, whether cystic or solid, was also determined through ultrasound. Selected patients underwent mammograms and breast MRI, while a metastatic workup, including abdominal ultrasound, chest x-ray, long bone x-rays, complete blood counts, renal function tests, and liver function tests, was conducted in cases of malignant breast disease.

The most prevalent malignant breast disease in the general population was invasive ductal carcinoma NST (70%), followed by tubular (2%), colloid (2%), medullary (5%), cribriform (2%), and papillary (1%). Invasive lobular carcinoma accounted for 10% of cases. Out of the total 100 patients studied, 60% had benign breast disease, with the remaining 40% having malignant breast disease. Benign breast disease was more common in premenopausal women (82%) compared to postmenopausal women (38%). Fibrocystic disease of the breast was the most common benign condition, affecting 27 patients.

Among patients with malignant breast disease, invasive ductal carcinoma was the most prevalent (24 cases), followed by invasive lobular carcinoma (13 cases). In premenopausal women, fibroadenoma was the most common benign disease (24 cases), while invasive ductal carcinoma and invasive lobular carcinoma each had four cases. In postmenopausal women, invasive ductal carcinoma was the most common malignant disease (20 cases), and invasive lobular carcinoma followed closely with nine cases.

There was no reported case of carcinoma in situ. The prevalence of malignant breast tumors was higher in postmenopausal women than in premenopausal women. The study facilitated the early detection and treatment of breast cancer, aiding in the identification of histological types and the detection of multifocal and multicentric lesions. The findings indicated an increased incidence of lobular carcinoma compared to the general population, which is associated with poor prognosis and higher recurrence rates due to its multifocal and multicentric nature.

In comparison with other studies, the mean age of presentation for breast carcinoma was a decade earlier in the current study than in Western patients. Risk factors for both pre- and post-menopausal breast cancer were found to be similar, except for late menopause, which was a specific risk factor for postmenopausal patients. Dense breast tissue was a predominant risk factor among all women, and late presentation was a common phenomenon.^[8-10]

Other studies also reported similar risk factors for pre- and post-menopausal breast cancer, with nulliparity being a risk factor for both groups. Late presentation was a common trend among patients. The association of menopausal status with pathological features of tumors in stage I to IIIA breast cancer showed a statistically significant relationship between tumor grade, lymphovascular invasion, and HER2/neu overexpression with menopausal status.^[11-12]

Histological analyses revealed that invasive ductal carcinoma was the most common type of breast cancer, with lobular and mixed ductal-lobular types also identified. The prevalence of different histological types varied among studies, with ductal, lobular, and mixed ductal-lobular types being the most common. Benign breast diseases were classified into various categories, including developmental abnormalities, inflammatory lesions, epithelial and stromal proliferations, and neoplasms. The review emphasized the relationship between common benign lesions and the development of subsequent breast cancer.^[13-14]

The morphological features of the breast change substantially from early adolescence to menopause, with a spectrum of normal histologic features ranging from ducts, lobules, and intralobular and interlobular stroma to fibrous changes and cyst formation. The clinicopathological characteristics of certain molecular subtypes and elevated postoperative cancer antigen 15.3 levels were correlated with menopausal status, providing insights into predicting disease recurrence or overall survival in breast cancer patients.^[15-16]

In summary, this study contributed valuable information on the prevalence, characteristics, and management of breast diseases, with a focus on differentiating factors between pre-and post-menopausal women. The findings underscore the importance of early detection and the need for tailored approaches to breast cancer management based on menopausal status.

The study aimed to investigate the prevalence and characteristics of various breast diseases. Common conditions identified included fibroadenoma, fibrocystic disease of the breast, phyllodes tumor, galactocele, invasive ductal carcinoma, invasive lobular carcinoma, and invasive medullary carcinoma.

Malignant breast diseases were more frequently observed in postmenopausal women, while benign breast diseases were predominant in premenopausal women. Noteworthy findings included the high incidence of fibrocystic disease of the breast among all women and invasive ductal carcinoma NST breast disease as the most common malignant breast disease.

An interesting observation was the increased occurrence of invasive lobular carcinoma in the study group compared to the general population in India. This particular subtype was associated with poor prognosis and a higher likelihood of recurrence due to its multifocal and multicentric nature.

In conclusion, the study contributed valuable insights into the prevalence and characteristics of breast diseases. It emphasized the importance of early detection and treatment, enabling the identification of histological types and the detection of multifocal and multicentric lesions. The heightened occurrence of invasive lobular carcinoma in the study group highlights the need for further investigation into its implications for prognosis and recurrence.

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