Senology

SENOLOGY – Recognition and timely treatment of breast disorders

What does senology mean?

The term means the “science of the female breast” and originates from the French “le sein = bosom”. The French, in turn, goes back to the Latin “sinus”, meaning curve, known from sine and cosine graphs in mathematics, which are reminiscent of the shape of a breast.

How are breasts structured?

Breasts consist of fatty and connective tissue as well as many glands that look like small almonds, hence their medical term “glandula mammaria”, i.e. “breast almonds”. Anatomically, breasts can be divided into 10-12 lobes, each of which with a mammary gland. These glands consist of numerous alveolar sacs grouped in lobules.

What is senology?

Senology is part of the larger field of gynaecology, but has become recognized as a discipline in its own right. It is concerned with the diagnosis and treatment of benign and malignant diseases affecting the breast. Thanks to ultrasound sonography and mammography, it is now possible to differentiate between most likely benign and most likely malignant lumps. In some cases, magnetic resonance imaging (MRI) may be used. Ruling out malignancy with certainty requires a tissue sample taken under local anaesthetic, known as a biopsy. Under local anaesthetic, forceps are used to take a sample from the tumour tissue. The procedure is generally painless. Afterwards, a compress is applied in order to minimize the risk of bruising.

Every benign lump must be checked regularly according to hospital practice or 6-monthly to annually. Surgical removal is advised for benign events that cause pain or show rapid growth. Classification of diseases of the breast:

Benign Risk lesions Cancer pre-stages Cancer
Breast pain Flat epithelial atypia Ductal carcinoma in situ Paget’s disease
Mastopathy Papilloma Invasive ductal carcinoma
Accumulation of pus Atypical ductal hyperplasia Invasive lobular carcinoma
Cysts Atypical lobular hyperplasia
Fibroadenoma Lobular carcinoma in situ
Phylloides tumour

Effective 09. 2017, Copyright Dr. Armando Farmini

Identifying disorders

Identifying disorders of the breast quickly, stopping their consequences early enough and easing the psychological burden

Pains in the breast cause discomfort and unease. For that reason, they should be investigated by a specialist, not only to identify quickly the cause of these pains, but also to stop the resulting consequences early enough and also to ease the associated psychological burden. For pain-free symptoms, such as breast cysts, screening examinations are crucial.

Below is an overview of the most common disorders of the breast together with their treatment:

Breast pain (mastalgia)

The first indication of a senological problem can be a simple pain in one or both breasts which often occurs before the onset of the monthly period. Not treating the underlying hormonal cause increases the risk of developing benign and/or malignant tumours. The problem arises from a dysbalance between oestrogen and progesterone (   med. corpus luteum hormone). The insufficiently present progesterone levels can no longer balance the growth-stimulating effect on the breast by oestrogens.

Treatment

Oestrogen dominance can be treated with a well controlled bioidentical hormone therapy.

Mastopathy

Mastopathy comes from the Greek and means “disease of the breast”. It is a benign change of the breast tissues that can affect women between 30 and 50 years of age. The mastopathic tissue, generally in both breasts, appears dense and tough on ultrasound or mammography images. The cause is an oestrogen dominance. It may lead to the development of symptoms such as cysts, swellings, fluid discharge from the nipples and definable lumps. On palpation of the breast, the affected tissue is hard and touch-sensitive. It is particularly noticeable in the days prior to menstruation, as progesterone levels drop sharply in these days of the cycle and oestrogens become even more dominant. The risk of developing breast cancer increases.

Treatment

Oestrogen dominance can be treated with a well controlled bioidentical hormone therapy.

Mastitis

The symptoms of mastitis are redness, warmth to the touch, swelling and pain in the breasts.

Treatment

The traditional home remedy, a compress of quark helps to reduce the swelling naturally. An advanced inflammation associated with a fever should be treated with an antibiotic, administered either orally or intravenously, in order to prevent a further spread of the inflammation. When administering antibiotics, it is important also to provide an adjuvant probiotic in order to regenerate the vaginal and intestinal flora weakened by the antibiotic.

Abscess

An abscess is an accumulation of dead cell material and pathogens. They generally develop in consequence of an unhealthy way of life, caused by excessive stress, ready meals and cigarettes. Another risk factor are adornments such as piercings, if they are located in parts of the body that can easily be colonized by bacteria, such as the genital area or the nipples.

Treatment

Surgical treatment is uncomplicated and wounds heal quickly without the need for further action.

Cysts

A breast cyst is an encapsulated space filled with water, blood, pus and sebum. It is harmless and often remains unnoticed for as long as it does not cause pain. However, it may be the first indication of an hormonal imbalance.

Treatment

The indication for a puncture or removal of a cyst may be given in case of pain and associated psychological strain; otherwise, though, bioidentical hormone therapy can achieve ideal results. Puncture of the cyst alone, i.e. the removal of the fluid with a cannula, results in the immediate disappearance of the cyst, but a reaccumulation of fluid remains possible.

Fibroadenoma

A fibroadenoma is the most common form of benign tumour of the breast. It feels hard to the touch. In an ultrasound, it appears smoothly defined and often circular in shape. It consists mainly of connective tissue (collagen). Susceptible are users of synthetic hormones such as the birth control pill, as contraception with synthetic hormones suppresses the body’s own hormone system.

Treatment

Surgical removal is only recommended in case of physical complaints, otherwise an annual ultrasound check-up is sufficient.

Flat epithelial atypia (FEA)

A flat epithelial atypia is a densification of the breast tissue that can only be identified in a mammography. It only constitutes a minimal increase in the risk of developing cancer.

Treatment

Surgical removal is recommended.

Papilloma

A papilloma is not connected to the familiar papillomavirus (HPV), but is a benign breast tumour within the milk ducts; it can cause the discharge of fluid through the nipples. The best way to diagnose it is by galactography (the injection of contrast agent through the milk ducts with subsequent X-ray. Papillomas are harmless, but can contain cancerous tissue.

Treatment

Surgical removal is recommended.

Radial scar

The radial scar takes its name from its pathological appearance which resembles a scar; it is a complex scarred (sclerosing) lesion. Taking a biopsy sample is the only way of differentiating it from breast cancer.

Treatment

Surgical removal is recommended.

Atypical ductal hyperplasia (ADH)

An atypical ductal hyperplasia, ADH in brief, is a benign lesion. Improved diagnostic technology and the introduction of the mammography screening programme make it possible to discover such benign lesions in the breast. An ADH diagnosis is associated with an eightfold increase in the probability of developing breast cancer within 10 years.

Treatment

Surgical removal is recommended.

Atypical lobular hyperplasia

This lesion is one of the group of lobular intraepithelial neoplasia (IN). An atypical lobular hyperplasia is a benign disorder of the breast tissue that can develop into cancer if untreated. The risk of developing cancer increases sevenfold within 10 years.

Treatment

Surgical removal is recommended.

Lobular carcinoma in situ

This lesion is one of the group of lobular intraepithelial neoplasia (IN). It is a growth of tumour cells in the lobuli of the breast glands that can spread to the milk ducts. The risk of developing cancer increases sevenfold within 10 years.

Treatment

Surgical removal is recommended.

Phylloides tumour

Phylloides tumours are benign in 85 percent of cases. They rarely behave aggressively, developing metastases.

Treatment

Surgical removal with a safety margin of at least 2 centimetres. Radiation and chemotherapy have no impact on the recurrence rate.

Ductal carcinoma in situ (DCIS)

DCIS is not cancer, even though the term appears in the name. It is only a lesion that might develop into cancer over time. DCIS is rarely visible in an ultrasound, but can be discovered by mammography. Calcifications frequently point to the presence of this pre-stage.

Treatment

Surgery, radiation and, if hormone receptor-positive, anti-hormone therapy with tamoxifen for at least five years.

“Interpreting the different presentation of breast symptoms ultrasound is one of my specialist areas of expertise. In my work as a doctor, I attach great importance to the accurate documentation of a patient’s medical history, a comprehensive consultation and expert support over the course of the patient’s individual treatment,” Dr Farmini emphasizes.

We can offer appointments at short notice if you are in pain or have concerns. Contact us by email to office@drfarmini.com or give us a call on 0043 (0)660 161 4030.

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Dr. Armando Farmini - Gynäkologe
Dr. Armando Farmini
Ernest-Thun-Straße 12, 2. Stock
Am Max-Ott-Platz
A - 5020 Salzburg

+43 660 161 4030
office@drfarmini.com