During on-site clinicals we have had several patients with different breast complaints. One of the diagnosis was on a woman with fibrocystic changes, painful small nodular that were more painful during the menstrual cycle. At the time of evaluation, we did a clinical breast exam, discussed the patients self-breast exams and when she noted the nodules. She reported that she typically only does them once every 2-3 months and would not have done them if she did not have the new pain symptoms. An ultrasound was performed in the office to identify some scar-like tissue and fluid-filled cysts. The patient was set up for a mammogram and toughly discussed medication options for now. The patient was temporarily placed on hormone therapy, (oral contraceptives) to identify if that would help alleviate some of the symptoms. She was instructed to take 800mg of ibuprofen every 8 hours and alternate with 1,000mg of Tylenol for pain. She was also instructed to start primrose at night, and to stop caffeine (including chocolate), until her follow-up to discuss results of the mammogram. When patients come in for their yearly, we perform a full exam including clinical breast exam and document any changes noted. They are all set up for cyclic preventative health programs, either mammograms, colonoscopy, pap-smears, bone density testing all depending on age and needs. Golshan (2019) discusses the first-line treatment for breast pains to start with over-the counter pain medications, alterations in hormone therapy and evening primrose oil to be initiated and evaluated for the first sex months. As the second-line treatment has some serious side effects that may outweigh the benefits of the medication. The Ada Medical Library (2019) further notes that draining the cysts of their fluid or surgical intervention is a potential necessity, yet non-invasive treatment, home remedies of vitamin E oils, wearing sports bras or snug wraps or bras may alleviate some discomfort, and non-invasive treatment and testing should be performed first. The American Cancer Society (2015) states even if the fibrocystic breast changes do not cause the patient pain, they should still be monitored close with testing to identify if needs are more critical. It is essential to treat the patient holistically, with a full history. Some patients may have a past history of cancer, or family history of breast cancer, the information may suggest vigorous testing to prevent stress and anxiety.
Another patient presented with discharge of breast milk or clear yellow lactation. She reported occasional tenderness, but not severe. She was sent for a mammogram, labs were taken to check her prolactin and thyroid as well as a pregnancy test, even though the patient was late 40”s. When her prolactin level came back elevated, she was sent for an MRI of her brain. The preceptor discussed with the patient the information and needs for further testing, to decrease her anxiety about the results. It is essential that we know what tests to order, and what follow-up tests are needed if those show signs of potential issues. The MRI of the head was ordered to identify if there is abnormality or tumor on the pituitary glands causing the increased prolactin levels. Taking care of patients within the women’s health rotation has been very educational. I have enjoyed working along side the preceptor, as he has been able to take the time to teach me a great deal of information.
Fibrocystic breast change is a common public health problem with the current evidence showing
that it occurs on nearly half of all women. I find your post very compelling since you have
provided evidence in regards to fibrocystic breast change presenting issues, diagnos...