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Definition

You can break your hip at any age, but hip fractures are most common in people older than 65. As you age, your bones slowly lose minerals and become less dense. Gradual loss of density weakens bones and makes them more susceptible to a hip fracture.

Women are more likely than men to experience a hip fracture because women lose bone density as they age at a greater rate than men do.

A hip fracture is a serious injury, particularly if you’re older, and complications can be life-threatening. Fortunately, surgery to repair a hip fracture is usually very effective, although recovery often requires time and patience.

Symptoms

Signs and symptoms of a hip fracture may include:

• Severe pain in your hip or groin
• Inability to put weight on your leg on the side of your injured hip
• Stiffness, bruising and swelling in and around your hip area
• Shorter leg on the side of your injured hip
• Turning outward of your leg on the side of your injured hip

Causes

In older adults, a hip fracture is most often a result of a traumatic event, such as falling, and weak bones. In younger adults, major trauma to the hip, such as a sports injury or a car accident, may lead to a hip fracture.

Risk factors

A combination of factors may increase your risk of a hip fracture, including:

• Age. The rate of hip fractures increases substantially with age. As you age, your bone density decreases, your vision and sense of balance decline, and your reaction time slows. If you’re inactive, your muscles tend to weaken as you age. All of these factors combined can increase your risk of a hip fracture.

  Each year, more than one-third of Americans older than 65 experience a fall at some point, and nearly 2 million end up in hospital emergency rooms due to those falls. More than 300,000 Americans fracture their hip, and about half of them are older than 80.

• Chronic medical conditions. Osteoporosis is a major risk factors for hip fracture. In osteoporosis, the structure of your bones becomes weaker because your bones don’t contain as much calcium and other minerals. A weaker structure makes your bones more prone to a fracture, even with relatively minor trauma.

  Other medical conditions also may lead to bone fragility either by slowing bone formation or by speeding up bone loss. These include endocrine disorders, such as hyperthyroidism; gastrointestinal disorders, which may interfere with calcium and vitamin D absorption; and rheumatoid disorders, which often lead to inactivity and loss of bone mass. Low levels of the sex hormones testosterone and estradiol (a form of estrogen) — a condition known as hypogonadism — are associated with an increased risk of osteoporosis.

  Chronic conditions that affect your nervous system can increase your risk of falling, such as Parkinson’s disease and multiple sclerosis. Decreased mental alertness, such as that caused by dementia or depression, also increases the risk of falling.

• Sex. About 80 percent of hip fractures occur in women. Women lose bone density at a faster rate than men do. The drop in estrogen levels that occurs with menopause accelerates bone loss, increasing the risk of hip fractures as a woman moves beyond menopause. However, men also can develop dangerously low levels of bone density.
• Heredity. Genetic factors influence bone size, bone mass and bone density. A family history of osteoporosis or fractures later in life is a strong predictor of low bone mass, although not necessarily of fractures themselves. A small-boned, slender frame may put you at increased risk of osteoporosis. Also, Caucasians and Asians have the highest risk of osteoporosis.
• Nutrition. Lack of calcium and vitamin D in your diet when you’re young lowers your peak bone mass and increases your risk of fracture later in life. Serious eating disorders, such as anorexia nervosa and bulimia, can damage your skeleton by depriving your body of essential nutrients needed for bone building. A high caffeine intake may interfere with the absorption of vitamin D and calcium, resulting in decreased bone density.
• Physical inactivity. Weight-bearing exercises, such as walking, help strengthen bones and muscles, making falls and fractures less likely. If you don’t regularly participate in weight-bearing exercise, you may have lower bone density and weaker bones. Additionally, prolonged bed rest or immobility can lead to bone loss.
• Tobacco and alcohol use. Smoking and excessive consumption of alcohol can interfere with the normal processes of bone building and remodeling, resulting in bone loss.
• Medications. Certain medications can accelerate bone loss, increasing your risk of osteoporosis and hip fracture. Long-term use of corticosteroids, such as prednisone, may lower bone mass. Other medications that may contribute to bone loss or to calcium or vitamin D deficiencies if used for long periods of time include anticonvulsants, thyroid medications, and certain diuretics and blood thinners.

  Some research has suggested that the long-term use of proton pump inhibitors to reduce stomach acid is linked with a higher risk of hip fracture, possibly by affecting the way calcium is absorbed. If you’re taking these medications, ask your doctor if you need to take additional calcium.

  Some drugs may affect your balance and cause dizziness, including certain blood pressure medications, sedatives, tranquilizers, antidepressants, cold and allergy medications, pain relievers and sleep medications.

• Environmental hazards. Loose rugs, cluttered floors, poor lighting, exposed electrical or telephone cords, and stairs with no handrails may increase your risk of stumbling and falling.

Tests and diagnosis

Often your doctor can determine that you have a hip fracture based on your symptoms and by observing the abnormal position of your hip and leg. An X-ray will confirm that you have a fracture and show exactly what part of your hip is fractured.

Most hip fractures occur in one of two locations along your femur, the long bone that extends from your pelvis to your knee:

• The femoral neck. The femoral neck is located in the upper portion of your femur, just below its head, which is the ball part of the ball-and-socket joint.
• The intertrochanteric region. This region is the portion of your upper femur that juts outward.

Complications

A hip fracture is a serious injury. Although the fracture itself is treatable, complications can be life-threatening. If you also have an illness that makes it unsafe to undergo surgery to repair your broken hip, your doctor may use a tension system (traction) to allow your hip to heal.

The risk of traction is that it keeps you immobile for a long period, during which time you can develop blood clots in the veins of your legs. You can also develop a blood clot after hip surgery if you don’t get up and move around very much. It’s possible for a blood clot to become lodged in a pulmonary artery, blocking blood flow to lung tissue. This condition, called pulmonary embolism, can be fatal.

Other risks of traction and being immobile include:

• Bedsores
• Urinary tract infection
• Pneumonia
• Muscle wasting

Additionally, people who’ve had one hip fracture have a significantly increased risk of having another one.

Treatments and drugs

Surgery is almost always the best hip fracture treatment. Doctors typically use nonsurgical alternatives, such as traction, only if you have a serious illness that makes surgery too risky.

The type of surgery you have generally depends on the part of the hip that fractured, the severity of the fracture and your age. Generally, the better your health and mobility before your hip fracture, the better your chances for a complete recovery from a hip fracture.

Femoral neck fractures
Doctors repair this type of fracture by one of three methods:

• Metal screws. If, after the break, the bone is still properly aligned, your doctor may insert metal screws into the bone to hold it together while the fracture heals. This is called internal fixation.
• Replacement of part of the femur. If the ends of the broken bone aren’t properly aligned or they’ve been damaged, your doctor may remove the head and neck of the femur and replace them with a metal prosthesis. This is known as hemiarthroplasty.
• Total hip replacement. This procedure involves replacing your upper femur and the socket in your pelvic bone with a prosthesis. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function prior to the fracture.

In general, the older you are the more likely you are to receive a prosthesis. That’s because older people aren’t likely to wear out a prosthesis and so won’t need additional surgery. Also, it’s even more important for older adults to get moving again quickly after surgery to prevent serious complications.

Intertrochanteric region fractures
To repair this type of fracture, your doctor usually inserts a metal screw (hip compression screw) across the fracture. The screw is attached to a plate that runs down alongside the femur and is attached with other screws to help keep the bone stable. As the bone heals, the screw allows the bone pieces to compress, so the edges grow together.

Hospital stays after hip fracture surgery generally last less than a week. Afterward, you may continue to meet with a physical therapist. Extended care facility stays are often required for those who can’t bear weight on their hip after surgery and who don’t have assistance at home.

Medication
While surgery is the primary treatment for a hip fracture, a 2007 study in the New England Journal of Medicine found that once-yearly infusions with the intravenous medication zoledronic acid (Reclast, Zometa) might be helpful in treatment of hip fracture. When zoledronic acid is started within three months of the fracture, the rates of new fractures were reduced and survival odds improved.

Prevention

You can reduce your risk of a hip fracture by taking steps to prevent osteoporosis and to reduce your risk of falling. Women are more likely than men are to develop osteoporosis, particularly after menopause; however, both women and men can take steps to prevent osteoporosis.

Knowing your bone density
If you’re a woman, you may want to have a baseline bone density test at menopause. Women are at a considerably higher risk of low bone density than men are because women lose bone density at a greater rate than men do and because they have a lower starting bone mass. Knowing that your bone density is low can lead you to take steps to increase your bone density and prevent complications such as a hip fracture.

The higher your peak bone mass, the less likely you’ll be to have fractures later in life. Maximum peak bone mass depends partly on:

• Your inherited ability to make bone
• The amount of calcium you consume
• Your exercise level

Making the right choices
The process of building bone mass usually peaks in your 30s. After that, you start to lose bone mass. Making the right lifestyle choices during peak bone-mass-building years and afterward contributes to a higher peak bone mass and reduces your risk of osteoporosis in later years.

These steps can help you prevent a hip fracture by slowing bone loss:

• Ensure adequate calcium and vitamin D in your diet. These two substances are important in the process of building bone mass, which peaks around age 30. Calcium can also protect against bone loss. Be sure to get enough calcium and vitamin D. Foods containing calcium include milk and other dairy products; dark green vegetables such as broccoli; citrus fruits; shrimp; canned salmon or sardines; and almonds. Vitamin D helps your body absorb calcium. Your body manufactures vitamin D in your skin using the sun’s energy. Fortified foods, such as milk, are another common source of vitamin D.

  If you’re considering calcium or vitamin D supplements, ask your doctor about what’s an appropriate dose for you. The Recommended Dietary Allowance (RDA) for calcium for men and women age 50 and older is 1,200 milligrams (mg) a day. The RDA for vitamin D is 400 to 600 international units (IU) a day for adults older than 50. The amount of extra calcium you need depends on your age, whether you’re taking medications such as corticosteroids, how much milk you drink and other factors. How much supplemental vitamin D you need varies depending on your age, whether or not you have certain chronic medical conditions, how much sunlight exposure you’re getting and your intake of vitamin D in foods. Experts suggest getting 10 to 15 minutes twice a week of unprotected sun exposure to ensure adequate levels of vitamin D.

• Exercise to strengthen bones and prevent falls. Weight-bearing exercises, such as walking, apply tension and pressure to your muscles and bones, encouraging your body to increase bone density to meet the additional stress. Exercise also increases your overall balance and strength, making you less likely to fall. High-impact exercises, such as those involving running or jumping, aren’t recommended if you have weak bones, as they may increase your risk of a fracture or injury. To prevent osteoporosis, exercise at least three times a week for 30 minutes a session.
• Don’t drink excessively or smoke. Preserve your bone density by avoiding the excessive use of alcohol and by not smoking.
• Medical treatment of osteoporosis. Your doctor may prescribe a bisphosphonate — such as alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva) or zoledronic acid (Zometa, Reclast) — to prevent or treat postmenopausal osteoporosis. Raloxifene (Evista) is a selective estrogen receptor modulator and can also be used to prevent or treat postmenopausal osteoporosis. Calcitonin is a naturally occurring hormone involved in bone growth, and when taken as an injection or nasal spray, can be used to treat osteoporosis. Teriparatide (Forteo), an injectable form of human parathyroid hormone, stimulates new bone growth in the spine and hips. It also reduces the risk of vertebral and nonvertebral fractures in women and vertebral fractures in men.

Falls: Reduce your risk
These steps can help you guard against hip fracture by reducing your risk of falls:

• Fall-proof your home. Keep your home well lit and free of hazards that might cause you to trip and fall. Avoid area rugs and exposed electrical cords. Place furniture where you’re unlikely to bump into it. Consider installing grab bars in your bathroom, stair treads on steps and handrails along stairways. Use nonslip mats on the bathtub and on shower floors.
• Wear sensible shoes. If you’re older, wear thinner, hard-soled, flat shoes. Resilient-soled athletic shoes may impair your balance and contribute to falls. Avoid wearing high heels or sandals with light straps. Avoid wearing shoes that are either too slippery or too sticky.
• Avoid strenuous and dangerous activities. Don’t stretch to reach high places. Use a stepladder or ask for help. Avoid lifting heavy objects, climbing and engaging in unusually vigorous activities.
• See your eye doctor. Poor eyesight is a possible cause of falls. Have your eyes checked at least once a year, or sooner if you’re having trouble seeing. Wearing proper glasses and being able to see well around your home makes it more likely that you’ll see objects that you might trip over.
• Be mindful of side effects of medications. Feeling weak and dizzy, which are possible side effects of many medications, can increase your risk of falling. Talk to your doctor about side effects caused by your medications.

Hip protectors
Another step that won’t prevent you from falling but may protect you if you do is to wear a hip protector. These padded, externally worn protectors are similar to what hockey players wear to avoid injury. However, one study found that these devices probably weren’t effective at preventing hip fractures.

Lifestyle and home remedies

Recovering from a hip fracture involves a lengthy period of rehabilitation. The goal of rehabilitation is to help you regain mobility. You’ll learn how to gradually place more weight on your hip until it can handle your full weight without pain. You’ll also learn how to sit, stand and walk so that you don’t re-injure your hip or damage your prosthesis, if you have one.

Help with walking and other activities
After a hip fracture, you’ll need the help of a walking aid, such as a cane, walker or crutches, for a while. You may also need help getting around your home and doing daily tasks, such as bathing, dressing and cooking. Or, you may need to enter an extended care facility while recuperating to get assistance that’s not available at home.

You can help speed the healing process and increase your chances for a full recovery by following your doctor’s and therapist’s instructions and taking good care of yourself.

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Definition

If you think you’ve sustained a broken wrist or a broken hand, seek prompt medical attention. It’s important to treat a broken wrist or broken hand as soon as possible. Otherwise, the bones may not heal in proper alignment, which can affect your ability to perform everyday activities, such as grasping a pen or buttoning a shirt.

Treatment for a broken wrist or a broken hand depends on the exact site and severity of the injury. A simple break (fracture) may be treated with a splint, ice and rest. However, a more complicated broken wrist or broken hand may require surgery to realign the broken bone and to implant wires, plates, rods or screws into the broken bone to maintain proper alignment during healing.

Symptoms

If you have a broken wrist or broken hand, you may experience these signs and symptoms:

• Severe pain, which may increase during gripping or squeezing
• Swelling
• Tenderness
• Bruising
• Obvious deformity, such as a bent wrist or crooked finger
• Stiffness or inability to move your finger or thumb
• Numbness or coldness in your finger or thumb

Causes

The terms “broken wrist” and “broken hand” are used to describe a range of fractures in this area of your body:

Causes of a broken wrist
Your wrist is made up of eight small hand bones (carpal bones) plus two long bones in your forearm — the radius, on the thumb side of your arm, and the ulna, on the pinky side of your arm. Together, these bones allow your wrist to bend, straighten and rotate, so you can bang a hammer, pitch a ball or swing a jump-rope.

It’s possible to break any of the bones that make up your wrist, but the radius is the most commonly broken wrist bone. This type of fracture, often called a distal radius fracture or Colles’ fracture, usually occurs when you fall forward onto an outstretched hand, during a bike accident, ski accident or fall from a roof or ladder. It can also happen during a car collision. Fractures of the ulna bone also are common and also occur from a direct blow to your arm.

The most commonly injured carpal bone is the scaphoid bone — which is the carpal bone located near the base of your thumb. Scaphoid fractures usually occur during a fall, but can result from a blunt blow to your wrist.

Causes of a broken hand
There are a lot of bones to break in your hands: Each finger consists of one hand bone (metacarpal) and three finger bones (phalanges). Each thumb consists of one metacarpal bone and two phalanges. Any of these bones can break during a fall, a direct blow or a crushing injury.

It’s also common for hand bones to be injured during sports activities. For proof, you don’t have to look any further than the names of fractures in this part of your body: There’s the “boxer’s fracture,” a punching injury that usually affects the metacarpal bone leading to your little finger. Other common injuries include the “skier’s thumb” and the “baseball finger.”

Risk factors

These factors may put you at risk of a broken wrist or broken hand:

• Participating in certain sports activities. Contact sports, such as basketball, football rugby, wrestling and hockey, are common causes of a broken wrist or broken hand. Recently, more wrist and hand fractures are due to adventure sports, such as snowboarding and skiing.
• Having certain health conditions. Osteoporosis, bone disease and calcium deficiency may make you more susceptible to a broken wrist or broken hand.

When to seek medical advice

See your doctor if you have any signs or symptoms of a broken wrist or broken hand, including numbness, swelling or trouble moving your fingers. Delays in diagnosis and treatment can lead to poor healing, decreased range of motion and decreased grip strength.

Seek emergency medical attention if your hand or wrist is very painful or severely deformed. Also seek urgent evaluation of your hand or wrist if you see any skin cut or laceration with bone protruding through the skin near your injury. An exposed bone can lead to a severe infection if not treated promptly.

Tests and diagnosis

If you suspect that you have a broken wrist or broken hand, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound.

He or she may also do some maneuvers to measure your range of motion and grip strength, compared with your healthy hand. Plus, you’ll need X-rays — and sometimes more-detailed images from a computerized tomography (CT) scan or magnetic resonance imaging scan (MRI) — to definitively diagnose a fracture or ligament injury and pinpoint the exact location of any break.

A thorough evaluation of your injury also helps your doctor classify your fracture into one of the following categories, which helps determine your treatment:

• Closed fracture. The bone is broken, but the surrounding skin remains intact. In general, a closed fracture is the least severe type of fracture.
• Open or compound fracture. The bone is broken, and the skin is pierced or cut by the broken bone. An open fracture is a serious condition that requires immediate, aggressive treatment to decrease your chance of an infection.
• Displaced fracture. In this fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign the bones properly.
• Comminuted fracture. The bone is broken into more than two pieces. This type of fracture may also require surgery for complete healing.

Complications

Complications of a broken wrist or broken hand are rare, but may include:

• Ongoing stiffness, aching or disability. You may experience ongoing stiffness, pain or aching in the affected area even after your broken bone has healed. This generally goes away a month or two after your cast is taken off or after surgery, but you may have some permanent stiffness or aching if your injury was severe. It may also take a few months to regain your ability to use your hand and fingers normally. Be patient with your recovery, and talk to your doctor about hand exercises that might help.
• Osteoarthritis. Fractures that extend into the joint can cause arthritis years later. If your wrist or hand starts to hurt or swell long after a break, see your doctor for an evaluation.
• Poor healing. Some hand or wrist fractures — such as scaphoid fractures — may be tougher to heal because of poor blood supply to this area of your body. Smoking cigarettes is also a risk factor for poor healing of fractures. If you smoke, consider stopping to give yourself the best chance of healing.
• Bone infection (osteomyelitis). If you have an open fracture, your bone may be exposed to fungi and bacteria that can cause infection. Prompt treatment of an open fracture is critical.
• Nerve or blood vessel damage. Trauma to the wrist or hand can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems.
• Compartment syndrome. This neuromuscular condition causes pain, swelling and sometimes disability in affected muscles of the legs or arms. This is a rare complication of high-impact injuries, such as a car or motorcycle accident.

Treatments and drugs

Initial treatment for a broken wrist or broken hand often begins in an emergency room or urgent-care clinic. Here, doctors typically evaluate your injury and immobilize your wrist or hand with a splint.

• If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.
• If you have a closed fracture, you’ll probably be sent home with the splint and directions to rest and ice the injury until you see your regular doctor or an orthopedic specialist for further treatment in a few days.
• If you have a more serious fracture, you may be admitted to the hospital for immediate attention.

Treatment for a broken wrist or broken hand depends on the site and severity of the injury, as well as your age and overall health, but treatment typically involves the following components:

Immobilization
Restricting the movement of a broken bone in your hand or wrist is critical to healing. This may involve splints, casts or braces for three to eight weeks, depending on your injury. Your doctor may request regular X-rays throughout the healing process to make sure the bones stay aligned.

Surgery
Immobilization heals most broken bones. However, some fractures require stabilization. You may need surgery to implant internal fixation devices, such as wires, plates, nails or screws, to maintain proper position of your bones during healing. Surgery may be recommended if you have the following injuries:

• Multiple fractures
• An unstable or displaced fracture
• Loose bone fragments that could enter a joint
• Damage to the surrounding ligaments
• Fractures that extend into a joint
• Open skin related to the fracture
• A fracture that is the result of a crushing accident

Most internal fixation materials are left in place. Others may be removed after your bone heals, while some are made of materials that are absorbed into your body. Complications are rare, but can include wound-healing difficulties, infection and lack of bone healing.

One of the biggest advancements in treatment for wrist fractures is the palm-side (volar) approach to surgery for distal radius fractures. In this treatment, a surgeon enters your skin from the palm side and screws a plate to the radius to hold the fracture in place, which allows the use of your fingers and hand while the fracture heals. The newer approach may disturb less soft tissue and lead to a faster recovery. If you have a distal radius fracture, ask your doctor if this newer surgery is a good option for you.

For some injuries, your doctor may also recommend an external fixation device — a set of metal bars outside your skin, which is attached to pins that go through your skin and insert into bone. This device provides stability during healing. It’s usually removed after about six to eight weeks. And there is a risk of infection around the surgical pins connected to the external fixation device.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) or a combination of the two. If you’re experiencing severe pain, you may need an opioid medication, such as codeine, for a few days.

Ask your doctor before you take any medications. For some fractures, you may need to avoid ibuprofen. Some studies have suggested that nonsteroidal anti-inflammatory drugs, such as ibuprofen, may slow down healing.

Rehabilitation
Rehabilitation begins soon after initial treatment. In most cases, it’s important to begin some motion to minimize stiffness in your hand while you’re still wearing your cast.

After your cast or splint is removed, your doctor may recommend additional rehabilitation exercises or physical therapy to reduce stiffness and restore movement in the injured area. It can take several months to regain full use of your hand or finger, depending on the severity of the injury.

Prevention

It’s impossible to prevent the unforeseen events that often cause a broken wrist or broken hand. But these basic tips may offer some protection:

• Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, can help build strong bones. In general, a regular diet with the recommended calcium intake is best, even after a fracture. For women, the recommended amount of calcium increases with age and with menopause. Talk to your doctor about how much calcium you need.
• Prevent falls. Falling forward onto an outstretched hand is the No. 1 cause of a broken hand or broken wrist. To prevent this common injury, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and handrails on your stairways, if necessary.
• Use protective gear for athletic activities. Wear wrist guards for high-risk activities, such as in-line skating, snowboarding, rugby and football.
• Ease into adventure sports. As snowboarding and in-line skating become more popular, so do hand and wrist injuries associated with these sports. If you want to try snowboarding or other adventure sports, consider professional instruction and know your limits.

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Definition

You go into the bathroom, look in the mirror — and you’re stunned to find the white part of your eye is bright red. It looks frightening and painful, and yet it doesn’t hurt, and your vision is unaffected. In fact, if you hadn’t looked in the mirror, you probably wouldn’t even have suspected a problem. What you’re seeing is likely a subconjunctival hemorrhage, sometimes called red eye.

A subconjunctival hemorrhage occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva). The conjunctiva can’t absorb the blood quickly, so you’re left with the equivalent of a bruise, except the blood is trapped under this transparent surface instead of the skin. This may create a rather frightening picture, but a subconjunctival hemorrhage is usually a harmless condition that disappears within 10 to 14 days.

Subconjunctival hemorrhage often occurs without any injury to the eye, or it may be the result of a strong sneeze or cough causing a broken blood vessel. No specific treatment is needed for a subconjunctival hemorrhage.

If you have recurrent subconjunctival hemorrhages or other bleeding, talk to your doctor. Be sure to tell your doctor about any medications or supplements you take.

Symptoms

The most obvious sign of a subconjunctival hemorrhage is a bright red patch on the white (sclera) of the eye. Despite its bloody appearance, a subconjunctival hemorrhage should cause no change in your vision and no discharge from your eye. Your only discomfort may be a scratchy feeling on the surface of your eye.

Causes

The cause of subconjunctival hemorrhage is usually unknown. However, the following actions may be enough to cause a small blood vessel to rupture in your eye:

• Violent coughing
• Powerful sneezing
• Heavy lifting
• Vomiting

Risk factors

People with diabetes or high blood pressure (hypertension) tend to be most at risk. The condition is also common among newborns, who may be subjected to pressure changes during delivery.

Certain blood-thinning medications, such as warfarin and aspirin, can increase the risk of subconjunctival hemorrhage.

In addition, the following herbal supplements have been found to increase the potential for bleeding, primarily by inhibiting the actions of platelets, the type of blood cells involved in clotting:

• Ginseng
• Ginkgo
• Garlic
• Ginger
• St. John’s wort
• Cayenne

When to seek medical advice

If a bright red patch appears on your eye or on the eye of your child, contact your doctor to be sure that the problem is not more serious than a subconjunctival hemorrhage.

Tests and diagnosis

The best way for your doctor to diagnose subconjunctival hemorrhage is by looking at your eye. You’ll likely need no other tests. However, your doctor may ask you some questions about your general health, take your blood pressure and give you a routine blood test to make sure you don’t have a potentially serious bleeding disorder.

Complications

While you may feel self-conscious about the appearance of your eye, health complications from a subconjunctival hemorrhage are rare.

Treatments and drugs

You may want to use eyedrops or artificial tears to soothe any scratchy feeling you have in your eye. Beyond that, the blood in your eye will absorb within 10 to 14 days, and you’ll need no further treatment.

Prevention

There’s no known way to prevent subconjunctival hemorrhage unless there is a clearly identifiable cause for the bleeding, such as might occur if you’re taking more blood-thinning medications than you should be.

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Definition

A broken arm is a common injury. In adults, this type of fracture often occurs during a sports activity or car accident. In children, a broken arm is usually the result of falling onto an outstretched hand while running, hopping, skipping or monkeying around on the monkey bars. If you think you or your child has sustained a broken arm, seek prompt medical attention. It’s important to treat a broken arm as soon as possible for proper healing.

Treatment for a broken arm depends on the exact site and severity of the injury. A simple break may be treated with a sling, ice and rest. A more complicated broken arm may require surgery to realign the broken bone and to implant wires, plates, nails or screws into the broken bone to maintain proper alignment during healing.

Symptoms

Most people know right away if they break their arm, because there’s often a loud snap or cracking sound. But some fractures can be more subtle.

Broken arm symptoms include:

• Severe pain, which may increase with movement
• Swelling
• Tenderness
• Bruising
• Obvious deformity, such as a bent arm or wrist
• Stiffness or inability to move your arm, wrist or elbow
• Inability to turn your arm from palm up to palm down or vice versa

Toddlers or young children with a broken arm may simply stop using it, even if they can’t explain why.

Causes

The term “broken arm” is used to describe a range of fractures in your upper limbs.

Arm anatomy
Each arm contains three bones:

• Humerus. This is your upper arm bone. It’s also the largest bone in your arm.
• Ulna. This is the forearm bone on the pinky side of your arm.
• Radius. This is the forearm bone on the thumb side of your arm.

It’s possible to break any of these bones on the end closer to the hand (distal end) or the end closer to the shoulder (proximal end). Or you can break these bones across the length (shaft). Children are more likely to break the lower arm bones. In fact, forearm fractures account for nearly half of all childhood fractures. Overall, the most common arm fracture is a distal radius fracture — a break in the radius bone near the wrist, which may also be called a Colles’ fracture.

Causes of a broken arm
This common injury has many common causes, including:

• Falls. Falling onto an outstretched hand or elbow is the most common cause of a broken arm.
• Sports injuries. Direct blows and injuries on the field or court are a common cause of all types of arm fractures.
• Elbow dislocations. In this common condition, the elbow joint is forced from its normal position, usually because of a blow or hard fall. When the upper arm bone slides back into place after dislocation, it can fracture the proximal radius.
• Significant trauma. Any of your arm bones can break during a car accident, bike accident or other direct trauma.
• Child abuse. In children, a broken arm may be the result of child abuse.
• Osteoporosis. This condition causes bones to become weak and brittle. And this makes bones more susceptible to fractures.

Risk factors

These factors may increase your risk of a broken arm:

• Participating in certain sports activities. Contact sports, such as basketball, football rugby, wrestling, soccer and hockey, are common causes of a distal radius fracture. Recently, radius fractures due to adventure sports, such as snowboarding and skiing, have become increasingly common.
• Having osteoporosis. In older adults with osteoporosis, even a relatively minor fall can result in a broken arm.

When to seek medical advice

If you have enough pain in your arm that you can’t use it normally, see a doctor right away. And do the same for your child. Delays in diagnosis and treatment of a broken arm can lead to poor healing.

If you think you or your child may have sustained a broken arm, try not to use the affected arm while you’re waiting for medical attention. This can decrease the risk of damage to blood vessels, nerves or other tissues. You can create a makeshift splint to immobilize the injured arm by placing something firm, such as a piece of wood or rolled-up magazines, underneath it. Then fasten your homemade splint into place with a cloth, belt or adhesive tape.

Tests and diagnosis

Your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound. X-rays are taken to determine the extent of a fracture, pinpoint its exact location and determine the extent of injury to any adjacent joints. Occasionally, your doctor may also recommend more-detailed images from a computerized tomography (CT) scan, bone scan or magnetic resonance imaging (MRI) scan.

If your child or adolescent breaks an arm bone, the doctor may check for damage to the growth area (growth plate) near the end of the bone, the area that allows a child’s bone to grow. Growth plate fractures need to be identified early and monitored carefully to make sure there aren’t any problems with your child’s arm growth.

Types of fractures
A thorough evaluation of the injury also helps your doctor classify a fracture into one of the following categories, which helps determine the best treatment for you or your child:

• Closed fracture. The bone is broken, but the overlying skin remains intact. In general, a closed fracture is the least severe type of fracture.
• Incomplete fracture. The bone is cracked but isn’t separated into two parts.
• Open (compound) fracture. The bone is broken, and the skin is pierced or cut by the broken bone. An open fracture is a serious condition that requires immediate, aggressive treatment to decrease your chance of an infection.
• Displaced fracture. In this fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign and stabilize the bones properly.
• Comminuted fracture. The bone is broken into more than two pieces. This type of fracture may also require surgery for proper alignment and healing.
• Greenstick fracture. In this type of incomplete fracture, the bone cracks but doesn’t break all the way through — like when you try to break a green stick of wood. About half of broken forearm bones in children are greenstick fractures, because a child’s bones are softer and more flexible than those of an adult, so they’re more likely to bend than to break completely.
• Buckle (torus) fracture. In this type of fracture, one side of the bone is compressed, which causes the other side to bend (buckle). This type of fracture is also more common in children.

Complications

The prognosis for most arm fractures is very good. But complications may include:

• Ongoing stiffness, aching or disability. You may experience ongoing stiffness, pain or aching in your arm after your broken bone has healed. If your injury was severe, you may even have some permanent stiffness or aching.
• Osteoarthritis. Fractures that extend into the joint can cause arthritis in that joint years later. If your arm starts to hurt or swell long after a break, see your doctor for an evaluation.
• Refracture. Recurrent fractures occur in up to one in six kids who sustain a forearm fracture because of a repeat fall or injury before the fracture has sufficiently healed. Unfortunately, there’s not much that can be done to avoid this.
• Frozen shoulder. This is a complication of proximal humerus fractures. It can cause painfully limited range of motion of the shoulder in all directions.
• Poor healing. In rare cases, arm fractures may not heal properly. Smoking cigarettes is a risk factor for poor healing of fractures. If you smoke, consider stopping to give yourself the best chance of healing.
• Bone infection (osteomyelitis). If you have an open fracture, your bone may be exposed to fungi and bacteria that can cause infection. Prompt treatment of an open fracture is critical.
• Nerve or blood vessel injury. Rarely, a fractured arm can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems.
• Compartment syndrome. This neuromuscular condition causes pain, swelling and sometimes disability in affected muscles of the legs or arms. This is a rare complication of high-impact injuries, such as a car or motorcycle accident. But it’s important to be aware of the possibility of compartment syndrome, because this condition can lead to significant long-term disability and loss of function if unnoticed and untreated.

Treatments and drugs

Initial treatment for a broken arm often begins in an emergency room or urgent-care clinic. Here, doctors typically evaluate you or your child and immobilize the arm with a splint. If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

If you or your child has a closed fracture, you’ll probably be sent home with the splint and directions to rest and ice the injury until you see an orthopedic specialist for further treatment in a few days, after swelling has gone down. If the injury is more serious, you or your child may be admitted to the hospital for additional treatment. Treatment for a broken arm depends on the site and severity of the injury, as well as the age and overall health of the patient, but treatment typically involves the following components.

Immobilization
Restricting the movement of any broken bone in your arm is critical to healing. To do this, you or your child may need to wear a splint, sling, brace, short-arm cast or long-arm cast for three to 10 weeks, depending on the injury. Your doctor may also request additional X-rays during the healing process to make sure the bones stay aligned.

Today’s casts can be made from either plaster or fiberglass. There are no true waterproof casts, but some are available with waterproof liners or shields. Talk to your doctor about the pros and cons of different casting options. And make sure you understand how to care for the cast while your bone heals. Keeping your cast in good condition will help your recovery.

Surgery
Immobilization heals most broken bones. However, some fractures require stabilization through surgery. Children are less likely to need surgery for fractures, because they have a unique ability to remodel their bones as they heal.

Internal fixation
You may need surgery to implant internal fixation devices, such as wires, plates, nails or screws, to maintain proper position of your bones during healing. Surgery may be recommended if you have the following injuries:

• Multiple fractures
• An unstable or displaced fracture
• Loose bone fragments that could enter a joint
• Damage to the surrounding ligaments
• Fractures that extend into a joint
• Open skin related to a compound fracture
• A fracture that has already begun to heal in an improper position

Most internal fixation materials are left in place permanently. Others may be removed after your bone heals, while some are made of materials that are absorbed into your body. Complications are rare, but can include infection and lack of bone healing.

One of the biggest advancements in treatment for distal radius fractures is the palm-side (volar) approach to surgery. In this treatment, a surgeon enters the skin from the palm side and screws a plate to the radius to hold the fracture in place, which allows the use of your fingers and hand while the fracture heals. The newer approach may disturb less soft tissue and lead to a faster recovery. If you or your child has a distal radius fracture, ask your doctor if this surgery is a good option.

External fixation
For some forearm injuries, your doctor may also recommend an external fixation device — a set of metal bars outside the skin, which is attached to pins that go through the skin and insert into bone. This device provides stability during healing. It’s usually removed after about six to eight weeks. And there is an increased risk of infection around the surgical pins connected to the external fixation device.

Other surgeries
In some cases, surgery may be necessary to remove small fragments of bone surrounding the fracture. These fragments can occur in a distal radial head fracture.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) or a combination of the two. If you’re experiencing severe pain, you may need a prescription opioid medication, such as codeine, for a few days.

Ask your doctor before you take any medications. For some fractures, you may need to avoid ibuprofen. Some studies have suggested that nonsteroidal anti-inflammatory drugs, such as ibuprofen, may slow down healing.

Rehabilitation
Rehabilitation begins soon after initial treatment. In most cases, it’s important to begin some motion to minimize stiffness in your arm, hand and shoulder while you’re still wearing your cast or sling. After your cast or sling is removed, your doctor may recommend additional rehabilitation exercises or physical therapy to restore muscle strength, joint motion and flexibility.

Prevention

A broken arm usually happens in an unplanned, unexpected instant. It’s usually impossible to foresee or prevent that instant, but these basic tips may offer some protection.

• Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, can help build strong bones. In general, a regular diet with the recommended calcium intake is best, even after a fracture. For women, the recommended amount of calcium increases with age and with menopause. Talk to your doctor about how much calcium you need.
• Prevent falls. Falling forward onto an outstretched hand is a leading cause of a broken arm. To prevent this common injury, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and hand rails on your stairways, if necessary.
• Use protective gear for athletic activities. Wear wrist guards for high-risk activities, such as in-line skating, snowboarding, rugby and football.
• Ease into adventure sports. As snowboarding and in-line skating become more popular, so do arm injuries associated with these sports. If you want to try snowboarding or other adventure sports, consider professional instruction and know your limits.

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Definition

Many people experience a broken bone (fracture) at some point in their lives. A broken ankle or broken foot is common. After all, you have 26 bones in each foot and three bones in each ankle joint. And these bones are susceptible to stress, stubbing, twisting and trauma.

The seriousness of a broken ankle or broken foot varies. Breaks in this part of your body can range from less-serious fractures, involving tiny cracks in your bones, to severe, shattering breaks that pierce your skin.

Treatment for a broken ankle or broken foot depends on the exact site and severity of the fracture. A severely broken ankle or broken foot may require surgery to implant wires, plates, rods or screws into the broken bone to maintain proper alignment during healing.

Symptoms

If you have a broken ankle or broken foot, you may experience these signs and symptoms:

• Immediate, throbbing pain
• Pain that increases with activity and decreases with rest
• Swelling
• Bruising
• Tenderness
• Deformity
• Inability to walk or bear weight
• Cuts, puncture wounds or protrusion of bone fragments

Some people feel or hear a snap at the time of injury and assume that means something has broken. However, a snapping sound or feeling can be a sign of either a fracture or a sprain.

Causes

The terms “broken ankle” and “broken foot” are used to describe a range of fractures in this area of your body:

Causes of a broken ankle
Your ankle joint is made up of three bones — the shinbone (tibia), the lower leg bone (fibula) and the ankle bone (talus). One or more of these bones can break during a fall or blow to your ankle. However, the most common type of broken ankle is a fracture in one of the knobby bumps (each called a malleolus) at the lower ends of the tibia and fibula. These bones help support the joint where your ankle bone connects to your heel bone (calcaneus), which allows your foot to rock from side to side. They’re often injured when your ankle rolls inward or outward.

Causes of a broken foot
Each foot contains 26 bones. The most common foot fractures involve your toe bones and the long bones of your midfoot that connect to your toes (metatarsal bones). Both of these types of bones can be crushed by a falling object. (8, 11) Toe bones are also commonly broken by stubbing, while metatarsal fractures often occur during a fall or car accident.

Stress fractures
These tiny cracks can develop in the weight-bearing bones of your feet or ankles, such as the metatarsals. Stress fractures are usually caused by repetitive force or overuse, such as running long distances. But they can also occur with normal use of a bone that’s been weakened by a condition such as osteoporosis.

Risk factors

These factors may put you at risk of a broken ankle or broken foot:

• Being overweight. Carrying too much weight can make you more susceptible to rolling your ankle or stressing the bones in your feet.
• Participating in high-impact sports. The stresses, direct blows and twisting injuries that occur in football, hockey, gymnastics, ballet, tennis and soccer are common causes of foot and ankle fractures.
• Using improper sports equipment. Faulty equipment, such as shoes that are too worn or too stiff, can contribute to stress fractures and falls. Improper training techniques, such as not warming up, also can cause foot and ankle fractures.
• Working in certain occupations. Certain work environments, such as a construction site, put you at risk of falling from a height or injuring your feet.
• Keeping your home cluttered or poorly lit. Walking around in a house with too much clutter or too little light may lead to foot or ankle injuries.
• Having certain conditions. Osteoporosis or poor sensation in your feet (neuropathy) can put you at risk of injuries to your foot and ankle bones.

When to seek medical advice

Seek medical attention for any foot or ankle injury. Prompt realignment and treatment of any ankle or foot fracture is key to complete healing. However, broken toes often go undiagnosed. And many people mistake an ankle fracture for an ankle sprain — a less serious injury that involves stretching or tearing of ligaments. Many signs and symptoms of an ankle sprain may be similar to those of a fracture, but sprain and fracture injuries require different treatments.

Seek immediate medical care if you see bone protruding through the skin near your injury. This can lead to severe infection, if not treated promptly.

Tests and diagnosis

If you suspect that you have a broken ankle or broken foot, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound. You’ll also need X-rays to definitively diagnose a fracture and pinpoint the exact location of the break. If the fracture is difficult to see — such as a stress fracture — you may also need a bone scan or other imaging techniques.

A thorough evaluation and X-ray of your injury also helps your doctor classify your fracture into one of the following categories, which helps determine your treatment:

• Closed fracture. The bone is broken, but the surrounding skin remains intact. In general, a closed fracture is the least severe type of fracture.
• Open or compound fracture. The bone is broken, and the skin is pierced or cut by the broken bone. An open fracture is a serious condition that requires immediate, aggressive treatment to decrease your chance of an infection.
• Displaced fracture. In this fracture, the bone fragments on either side of the break are out of line. A displaced fracture may require surgery to align the bones properly.

Complications

Complications of a broken ankle or broken foot are rare, but may include:

• Nerve or blood vessel damage. Trauma to the foot or ankle can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems.
• Bone infection (osteomyelitis). If you have an open fracture, your bone may be exposed to fungi and bacteria that cause infection.
• Compartment syndrome. This neuromuscular condition causes pain, swelling and sometimes disability in affected muscles of the legs or arms. Compartment syndrome usually occurs in high-impact injuries, such as a car or motorcycle accident.
• Arthritis. Fractures that extend into the joint can cause arthritis years later. If your ankle or foot starts to hurt long after a break, see your doctor for an evaluation.
• Persistent pain. You may experience ongoing pain in the affected area even after your broken bone has healed. Your doctor can evaluate persistent pain to see if a rehabilitation program can help.
• Poor healing. Smoking cigarettes is a risk factor for poor healing of fractures.

Treatments and drugs

Initial treatment for a broken ankle or broken foot often begins in an emergency room or urgent-care clinic. Here, doctors typically evaluate your injury and immobilize your foot or ankle with a splint. If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

If you have a closed fracture, you’ll probably be sent home with the splint and directions to rest and ice the injury until you see your regular doctor or an orthopedic specialist for further treatment in a few days. If you have a more serious fracture, you may be admitted to the hospital for immediate attention. Treatment for a broken ankle or broken foot depends on the site and severity of the injury, but typically involves the following components:

Immobilization
Restricting the movement of a broken bone in your foot or ankle is critical to healing. This may be as simple as taping your broken toe to the neighboring toe — a technique called buddy-taping. Or it may involve splints, walking boots, leg braces or casts for several weeks or months, depending on your injury. You may also receive crutches and strict instructions on the amount of time you’re allowed to spend walking or standing on the affected leg.

Surgery
Immobilization heals most broken bones. However, you may need surgery to implant internal fixation devices, such as wires, plates, nails or screws, to maintain proper position of your bones during healing. Surgery may be recommended if you have the following injuries:

• Multiple fractures
• An unstable or displaced fracture
• Loose bone fragments that could enter a joint
• Damage to the surrounding ligaments
• Fractures that extend into a joint

Some internal fixation materials are removed after your bone heals. Others may be left in place, while some are made of materials that are absorbed into your body. Complications are rare, but can include wound-healing difficulties, infection and lack of bone healing.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). If you’re experiencing a lot of pain, you may need an opioid medication, such as codeine.

Rehabilitation
After your cast or splint is removed, you’ll probably need to loosen up stiff muscles and ligaments in your ankles and feet. A home exercise program of stretching, strengthening and range of motion exercises can help you ease back into your regular routine. Your doctor can suggest the best exercises for your particular injury or refer you to a therapist who can help.

Prevention

These basic sports and safety tips may help prevent a broken ankle or broken foot:

• Wear proper shoes. Use hiking shoes on rough terrain. Wear steel-toed boots in your work environment, if necessary. Choose appropriate athletic shoes for your sport. And never go barefoot on paved streets or sidewalks.
• Replace athletic shoes regularly. Discard sneakers as soon as the tread or heel wears out or if the shoes are wearing unevenly.
• Start slowly. That applies to a new fitness program and each individual workout.
• Cross-train. Alternating activities can prevent stress fractures. Rotate running with swimming or biking.
• Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, really can do your body good.
• Clean up spills immediately. Slippery floors can cause dangerous falls.
• Use night lights. Many broken toes are the result of nighttime stumbling.

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Definition

Breast pain (mastalgia) is a common type of discomfort among women — affecting as many as seven in 10 women at some point in their lives.

About 10 percent of women have moderate to severe breast pain more than five days a month. In some cases, severe breast pain lasts throughout the menstrual cycles. Postmenopausal women can experience breast pain, but the symptom occurs more frequently in younger, premenopausal women and perimenopausal women. When it’s severe, breast pain can have a major impact on daily activities, work and relationships.

Breast pain alone rarely signifies breast cancer. Still, if you have unexplained breast pain that persists, causes worry about breast cancer or otherwise disrupts your life, get checked by your doctor.

Symptoms

Most cases of breast pain are classified as either cyclic or noncyclic. Each type of breast pain has distinct characteristics.

Extramammary breast pain
Extramammary breast pain feels like it originates in the breast, but its source is actually somewhere else. Pulling a muscle in your chest, for example, can cause pain in your chest wall or rib cage.

When to see a doctor
Make an appointment with your doctor if you have breast pain that persists daily for more than a couple of weeks, if your breast pain seems to be getting worse over time or if your breast pain interferes with daily activities.

Also see your doctor for evaluation if you have pain in one particular area within your breast. Although it’s not a common symptom of breast cancer, breast pain does occur in about 2 to 7 percent of women with breast cancer.

Causes

Most of the time, it’s not possible to identify the exact cause of breast pain. Likely contributors are:

• Reproductive hormones. Cyclic breast pain appears to have a strong link to hormones. The fact that cyclic breast pain often decreases or disappears with pregnancy or menopause lends support to the theory that hormones play a role. However, no studies have identified a particular hormonal abnormality as a contributor to cyclic breast pain.
• Anatomical factors. The cause of noncyclic breast pain is likely to be anatomical rather than hormonal, triggered by breast cysts, breast trauma, prior breast surgery or other factors localized to the breast. Noncyclic breast pain may also originate outside the breast — in the chest wall, muscles, joints or heart, for example — and radiate to the breast.
• Fatty acid imbalance. An imbalance of fatty acids within the cells may affect the sensitivity of breast tissue to circulating hormones. This theory provides the rationale for taking evening primrose oil capsules as a remedy for breast pain. Evening primrose oil contains gamma-linolenic acid (GLA), a type of fatty acid. GLA is thought to restore the fatty acid balance and decrease the sensitivity of breast tissue to circulating hormone levels.
• Medication use. Certain hormonal medications, including some infertility treatments and oral contraceptives, may be associated with breast pain. Also, breast tenderness is a possible side effect of estrogen and progesterone hormone therapy, which could explain why some women continue to have breast pain even after menopause. There have also been reports of breast pain associated with prescribed antidepressants, including selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft).
• Breast size. Women with large breasts may have noncyclic breast pain related primarily to the size of their breasts. This type of breast discomfort is typically accompanied by neck, shoulder and back pain. Some studies have shown that breast reduction surgery can reduce these symptoms. Breast surgery itself, however, also causes pain, which may linger after the incisions have healed.

Preparing for your appointment

You’re likely to start by first seeing your family doctor, a general practitioner or other care provider. However, in some cases when you call to set up an appointment, you may be referred immediately to a breast health specialist.

What you can do
The initial evaluation of your breast pain focuses on your medical history. You’ll discuss with your doctor the location of the breast pain, its relation to your menstrual cycle and any other relevant breast history that might explain the cause of your pain. You can facilitate this discussion by preparing ahead of time:

• Take note of all your symptoms, even if they seem unrelated to the reason for which you scheduled the appointment.
• Review key personal information, including major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you regularly take.
• Write down questions to ask your doctor. List your questions from most important to least important in case time runs out.

What to expect from your doctor
Your doctor may ask you questions about:

• How long you’ve experienced the breast pain
• The severity of your pain on a 10-point scale
• Whether the pain occurs in one or both breasts
• When you had your last mammogram
• Whether you have other signs or symptoms, such as a breast lump, area of thickening or nipple discharge
• If you have skin changes, such as redness or a rash

Your doctor also may assess your personal risk of breast cancer, based on factors such as your age, family medical history and prior history of precancerous breast lesions.

Tests and diagnosis

Tests to evaluate your condition may include:

• Clinical breast exam and physical exam. During this exam, your doctor checks for unusual areas in your breasts, visually and manually examining your breasts and the lymph nodes located in your lower neck and underarm area. Your doctor will probably listen to your heart and lungs and check your chest wall and abdomen to be certain the pain originates from your breast and isn’t related to some other condition. If your medical history and the physical exam reveal nothing unusual, you may not need additional tests.
• Mammography. If your doctor detects a breast lump, unusual thickening in your breast tissue, or a focused area of pain, you need to undergo mammography — an X-ray exam of your breast tissue. Even if your physical exam is normal, your doctor may recommend mammography if you’re age 30 or older, to double-check for suspicious areas in your breast that may be too small to feel.
• Ultrasound. An ultrasound exam uses sound waves to produce images of your breasts and is often performed in conjunction with mammography. Younger women — those under age 30 — might undergo ultrasound to evaluate a focused area of pain even if the physical exam appears normal.
• Breast biopsy. Suspicious breast lumps, areas of thickening or unusual areas seen during imaging exams may require a biopsy before your doctor can make a diagnosis. During a biopsy, your doctor (radiologist) obtains a small sample of breast tissue from the suspicious area and sends it for microscopic analysis.

Treatments and drugs

Often, breast pain resolves on its own within a few months. Very few women require specific treatment.

Treatment for breast pain may include:

• Eliminating the underlying cause or aggravating factors, which may involve a simple adjustment, such as wearing a bra with extra support, or a significant change, such as switching birth control methods.
• Using a topical nonsteroidal anti-inflammatory medication, applied directly to the area affected by noncyclic breast pain.
• Taking an oral contraceptive, or adjusting the dose if you already take one.
• Reducing the dose, or stopping the medication completely, if you’re taking postmenopausal hormone therapy.
• Taking a prescription medication, such as danazol, bromocriptine or tamoxifen for relieving severe cyclic breast pain.

Lifestyle and home remedies

Even though there is little formal research to show the efficacy of these self-care remedies, they help many women manage their breast pain. Some may be worth a try:

• Use hot or cold compresses on your breasts.
• Wear a firm support bra, fitted by a professional if possible.
• Wear a sports bra during exercise and while sleeping, especially when your breasts may be more sensitive.
• Experiment with relaxation therapy, which can help control the high levels of anxiety associated with severe breast pain.
• Limit or eliminate caffeine, a dietary change many women swear by, although medical studies of caffeine’s effect on breast pain and other premenstrual symptoms have been inconclusive.
• Decrease the fat in your diet to less than 20 percent of total calories, which may improve breast pain by altering the fatty acid balance.
• Use a pain reliever (analgesic), such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), to alleviate breast pain.
• Keep a journal noting when you experience breast pain and other symptoms, to determine if your pain is cyclic or noncyclic.

Alternative medicine

Vitamins and dietary supplements lessen breast pain symptoms and severity for some women. Ask your doctor if one of these might help you:

• Evening primrose oil. This supplement appears to change the balance of fatty acids in your cells, which may reduce breast pain. Some doctors recommend taking a 1,000-milligram capsule up to three times a day.
• Vitamin E. Early studies showed a possible beneficial effect of vitamin E on breast pain, but the medical literature to date remains inconclusive. Some doctors recommend taking 400 international units up to three times a day.

If you try a supplement for breast pain, stop taking it after two or three months if you don’t notice any improvement in your breast pain.

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Definition

Mastitis is an infection of the breast tissue that causes pain, swelling and redness of the breast. Mastitis most commonly affects women who are breast-feeding, although in rare circumstances this condition can occur outside of lactation.

Often, mastitis occurs within the first six weeks after birth (postpartum), but it can happen later during breast-feeding. The condition can leave you feeling exhausted and rundown, making it difficult to care for your baby.

Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But you can continue breast-feeding while you have mastitis.

Symptoms

With mastitis, signs and symptoms can appear suddenly and may include:

• Breast tenderness or warmth to the touch
• General malaise or feeling ill
• Swelling of the breast
• Pain or a burning sensation continuously or while breast-feeding
• Skin redness, often in a wedge-shaped pattern
• Fever of 101 F (38.3 C) or greater

Although mastitis usually occurs in the first several weeks of nursing, it can happen any time during breast-feeding. Mastitis tends to affect only one breast — not both breasts.

Causes

Mastitis occurs when bacteria enter your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin’s surface and baby’s mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Risk factors

Things that put you at increased risk of mastitis include:

• Sore or cracked nipples, although mastitis can develop without broken skin.
• A previous bout of mastitis while breast-feeding — if you’ve experienced mastitis in the past, you’re more likely to experience it again.
• Using only one position to breast-feed, which may not fully drain your breast.
• Wearing a tightfitting bra, which may restrict milk flow.

When to seek medical advice

In most cases, you’ll feel ill with flu-like symptoms for several hours before you recognize that there’s a sore red area on one of your breasts. As soon as you recognize this combination of signs and symptoms, it’s time to contact your doctor.

Your doctor will probably want to see you to confirm the diagnosis. Oral antibiotics are usually very effective in treating this condition. If you’ve had mastitis before, your doctor may prescribe antibiotics over the phone. If your signs and symptoms don’t improve after the first two days of taking antibiotics, see your doctor right away to make sure your condition isn’t the result of a more serious problem.

Tests and diagnosis

Your doctor diagnoses mastitis based on a physical examination, taking into account signs and symptoms of fever, chills and a painful area in the breast. Another clear sign is a wedge-shaped area on the breast that points toward the nipple and is tender to the touch. As part of the examination, your doctor will make sure you don’t have a breast abscess — a complication that can occur when mastitis isn’t treated promptly.

Complications

Complications that may arise from mastitis include:

• Recurrence. Once you’ve had mastitis, you’re more likely to get it again, either breast-feeding the same infant or a future child. Delayed or inadequate treatment is usually to blame for mastitis recurrence.
• Milk stasis. When the milk isn’t completely drained from your breast during breast-feeding, milk stasis can occur. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation.
• Abscess. When mastitis is inadequately treated, or if it’s related to milk stasis, a collection of pus (abscess) can develop in your breast. An abscess usually requires surgical draining. To avoid this complication, talk to your doctor as soon as you develop signs or symptoms of mastitis.

Treatments and drugs

Mastitis treatment usually involves:

• Antibiotics. Treating mastitis usually requires a 10- to 14-day course of antibiotics. You may feel well again 24 to 48 hours after starting antibiotics, but it’s important to take the entire course of medication to minimize your chance of recurrence.
• Self-care remedies. Resting, continuing breast-feeding and drinking extra fluids can help your body overcome the breast infection.

If your mastitis doesn’t clear up after taking antibiotics, check back with your doctor. A rare form of breast cancer — inflammatory breast cancer — can also cause redness and swelling that could initially be confused with mastitis. You may need a biopsy to make sure you don’t have breast cancer.

Prevention

Minimize your chances of getting mastitis by fully draining the milk from your breasts while breast-feeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses only for a few minutes on the second breast — or not at all — start breast-feeding on that breast the next time you feed your baby.

Alternate the breast you offer first at each breast-feeding, and change the position you use to breast-feed from one feeding to the next. Make sure your baby latches on properly during feedings. Finally, don’t let your baby use your breast as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they’re not hungry.

Lifestyle and home remedies

If you have mastitis, it’s safe to continue breast-feeding. Breast-feeding helps your breast clear the infection.

To relieve your discomfort:

• Maintain your breast-feeding routine.
• Avoid prolonged engorgement before breast-feeding.
• Use varied positions to breast-feed.
• Drink plenty of fluids.
• If you have trouble emptying a portion of your breast, apply warm compresses to the breast or take a warm shower before breast-feeding or pumping milk.
• Wear a supportive bra.
• While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

If breast-feeding on the infected breast is too painful, try pumping or hand-expressing milk.

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Definition

Breast cysts are fluid-filled sacs within your breast. You can have one or many breast cysts. They’re often described as round or oval lumps with distinct edges. In texture, a breast cyst usually feels like a soft grape or a water-filled balloon, but sometimes a breast cyst feels firm.

Breast cysts are common in women in their 30s and 40s. If you have breast cysts, they usually disappear after menopause, unless you’re taking hormone therapy.

Breast cysts don’t require treatment unless a cyst is large and painful or otherwise uncomfortable. In that case, draining the fluid from a breast cyst can ease your symptoms.

Symptoms

Signs and symptoms of breast cysts include:

• A smooth, easily movable round or oval breast lump with distinct edges
• Breast pain or tenderness in the area of the lump
• Increased lump size and tenderness just before your period
• Decreased lump size and resolution of other signs and symptoms after your period

Having one or many simple breast cysts doesn’t increase your risk of breast cancer.

Causes

Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-feeding. Small ducts conduct the milk to a reservoir just beneath your nipple. Supporting this network is a deeper layer of connective tissue called stroma.

Breast cysts develop when an overgrowth of glands and connective tissue (fibrocystic changes) block milk ducts, causing them to dilate and fill with fluid.

• Microcysts are too small to feel but may be seen during imaging tests, such as mammography or ultrasound.
• Macrocysts are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5 centimeters) in diameter. Large breast cysts can put pressure on nearby breast tissue, causing breast pain or discomfort.

The cause of breast cysts remains unknown. Some evidence suggests that excess estrogen in your body may play a role in breast cyst development.

When to seek medical advice

Normal breast tissue in healthy women often feels lumpy or nodular. If you detect the presence of any new breast lumps, however, or if a previously evaluated breast lump seems to have grown or otherwise changed, make an appointment with your doctor to get it checked out.

Tests and diagnosis

Screening and diagnosis of a breast cyst usually begins after you or your doctor has identified a breast lump. The process may involve the following tests or exams:

• Clinical breast exam. Your doctor physically examines the breast lump and checks for any other problem areas in your breasts. Questions to anticipate include when you first noticed the lump, whether its size has changed, if you have any breast pain associated with the breast lump, whether you have nipple discharge and how your menstrual cycle affects the lump. However, your doctor can’t tell from a clinical breast exam alone whether a breast lump is a cyst, so you’ll need another test, either an ultrasound or fine-needle aspiration — or maybe both.
• Breast ultrasound. Breast ultrasound can help your doctor determine whether a breast lump is fluid-filled or solid. The radiologist — a doctor who specializes in imaging methods — performing the ultrasound makes this determination based on certain characteristics seen during the imaging exam. A fluid-filled area usually indicates a breast cyst. A solid-appearing mass most likely is a fibroadenoma, but it could also be breast cancer.

  Some doctors skip breast ultrasound and perform fine-needle aspiration instead.

• Fine-needle aspiration. During this procedure, your doctor inserts a thin needle into the breast lump and attempts to withdraw (aspirate) fluid. If fluid comes out and the breast lump goes away, your doctor can make a breast cyst diagnosis immediately.

  Unless there appears to be blood in the fluid, it requires no further testing or treatment after draining. If the fluid is bloody, a laboratory may need to test it. 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, and a sample of cells may be collected and sent for analysis to check for the presence of cancer (fine-needle aspiration biopsy).

Mammography usually isn’t indicated for a breast cyst. However, you may undergo a mammogram if your doctor suspects, during the course of evaluating your breast lump, that the lump is caused by something other than a breast cyst.

Treatments and drugs

No treatment is necessary for simple breast cysts. Your doctor may recommend nothing more than closely monitoring a breast cyst to see if it resolves on its own.

Fine-needle aspiration
Fine-needle aspiration, the procedure used to diagnose a breast cyst, also may serve as treatment, if your doctor removes all the fluid from the cyst at the time of diagnosis.

First, your doctor feels your breast to locate the cyst and hold it steady. Next, he or she inserts a thin needle into the breast lump and withdraws (aspirates) the cyst fluid. Often, fine-needle aspiration is done using ultrasound to guide accurate placement of the needle.

• If the fluid is nonbloody and the breast lump disappears, you need no further treatment. Your doctor will probably recommend a visit in four to six weeks to see if the cyst returns.
• If the fluid appears bloody or the breast lump doesn’t disappear, your doctor may send a sample of the fluid for laboratory testing and refer you to a breast surgeon or to a radiologist — a doctor who specializes in imaging studies — for follow-up.

If you have breast cysts, you may need to have fluid drained more than once. Recurrent or new cysts are common.

Hormone use
Using oral contraceptives to regulate your menstrual cycles may help reduce the recurrence of breast cysts. Discontinuing hormone replacement therapy during the postmenopausal years may reduce the formation of cysts as well.

Surgery
Surgical removal of a breast cyst is an option only in a few unusual circumstances. If an uncomfortable breast cyst recurs month after month, or if a breast cyst contains blood-tinged fluid and displays other worrisome signs, surgery may be considered.

Lifestyle and home remedies

• Wear a supportive bra. If you have breast pain from a breast cyst, good support to surrounding breast tissue may help relieve some discomfort.
• Avoid caffeine. There’s no scientific proof that caffeine consumption is linked to breast cysts. However, many women find relief from their symptoms after eliminating caffeine from their diets. Consider reducing or eliminating caffeine — in beverages as well as in foods such as chocolate — to see if your symptoms improve.
• Reduce salt in your diet. Although studies on salt restriction and cyst formation aren’t conclusive, some experts suggest that reducing salt in your diet may help. Consuming less sodium reduces the amount of excess fluid in your body, which in turn may help alleviate symptoms associated with a fluid-filled breast cyst.

Alternative medicine

Evening primrose oil is a fatty acid (linoleic acid) supplement that’s available over-the-counter. Some evidence suggests that evening primrose oil may help minimize discomfort associated with breast cysts. Although the exact mechanism isn’t clear, some experts believe that women deficient in linoleic acid are more sensitive to hormonal fluctuations during the menstrual cycle, resulting in breast pain associated with breast cysts.

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Definition

Breast cancer isn’t just a woman’s disease. Men also have breast tissue that can undergo cancerous changes. While women are about 100 times more likely to get breast cancer, any man can develop breast cancer. Male breast cancer is most common between the ages of 60 and 70.

The prognosis for male breast cancer is the same as for breast cancer in women. In the past, male breast cancer was often diagnosed at a more advanced stage, which may have led people to believe it had a worse prognosis. Although male breast cancer and breast cancer in women are similar, important distinctions such as breast size and awareness affect early diagnosis and survival in cases of male breast cancer.

Symptoms

Knowing the signs and symptoms of breast cancer may help save your life. The earlier the disease is discovered, the more treatment options and the better chance of recovery you have.

The most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often the lump is painless. Other male breast cancer symptoms include:

• Skin dimpling or puckering
• Development of a new retraction or indentation of the nipple
• Changes in the nipple or breast skin, such as scaling or redness
• Nipple discharge

Causes

Cancer is a group of abnormal cells that grow more rapidly than do normal cells. Cancer cells also have the ability to invade and destroy normal tissues, either by growing directly into surrounding structures or after traveling to another part of your body through your bloodstream or lymphatic system. Microscopic cancer cells form small clusters that continue to grow, becoming more densely packed and hard.

In most cases it isn’t clear what triggers abnormal cell growth in breast tissue in men. But doctors do know that about one in six cases of breast cancers in men are inherited, compared with about 5 percent to 10 percent of breast cancers in women. Defects in breast cancer gene 1 or 2 (BRCA 1 or BCRA 2) put you at greater risk of developing breast cancer. Other inherited genes also may increase your risk of developing breast cancer. Knowing your family history is important to determine your chance of inheriting an abnormal gene.

Most genetic mutations related to breast cancer aren’t inherited, but instead develop during your lifetime. These acquired mutations may result from radiation exposure, such as receiving chest radiation therapy in childhood, or from other, as yet unknown, factors.

Risk factors

A risk factor is anything that makes it more likely you’ll get a particular disease. But not all risk factors are created equal. Some, such as your age, sex and family history, can’t be changed. Others, including smoking and a poor diet, are personal choices over which you have some control.

Having one or even several risk factors doesn’t necessarily mean you’ll become sick — some men with more than one risk factor never get breast cancer, whereas others with no identifiable risk factors do.

Factors that may make you more susceptible to breast cancer include:

• Age. Breast cancer is most commonly diagnosed in men between the ages of 60 and 70, with an average age range of 65 to 67.
• Family history. If you have a close relative, such as a mother or sister, with breast cancer, you have a greater chance of also developing the disease. About one in five men with breast cancer have a relative who’s had it, too. Just because you have a family history of breast cancer doesn’t mean it’s hereditary, though.
• Genetic predisposition. In men, nearly 20 percent of breast cancers are inherited. Defects in one of several genes, especially BRCA1 or BRCA2 put you at greater risk of developing breast and prostate cancers. Usually these genes help prevent cancer by making proteins that keep cells from growing abnormally. But if they have a mutation, the genes aren’t as effective at protecting you from cancer.

  Men with a BRCA2 mutation have a 6 percent lifetime risk of breast cancer — about 100 times more than other men’s risk. Inherited mutations in the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene also make it more likely that you’ll develop breast cancer.

• Radiation exposure. If you received radiation treatments to your chest as a child or young adult, you’re more likely to develop breast cancer later in life.
• Klinefelter’s syndrome. This condition results from an abnormality of the sex chromosomes, X and Y, present at birth (congenital). A male normally has only one X and one Y chromosome. In Klinefelter’s syndrome, two or more X chromosomes are present in addition to one Y chromosome. The Y chromosome contains the genetic material that determines the sex of a child and related development.

  The extra X chromosome that occurs in Klinefelter’s syndrome causes abnormal development of the testicles. As a result, men with this syndrome produce lower levels of certain male hormones — androgens — and more female hormones — estrogens, which can cause noncancerous breast growth (gynecomastia). Men with this condition may be at greater risk of breast cancer, though this connection is still unclear.

• Exposure to estrogen. If you take estrogen-related drugs, such as those used as part of a sex change procedure, you have a much higher risk of breast cancer. Estrogen drugs may also be used in hormone therapy for prostate cancer. Such drugs may slightly increase your risk of breast cancer, though not enough to outweigh the benefit of treating prostate cancer.
• Liver disease. If you have liver disease, such as cirrhosis of the liver, your body’s androgen activity may be reduced and its estrogen activity greater. This can increase your risk of gynecomastia and breast cancer.
• Excess weight. Obesity may be a risk factor for breast cancer in men, because it increases the number of fat cells in the body. Fat cells convert androgens into estrogen, increasing the amount of estrogen in your body and, therefore, your risk of breast cancer.
• Excessive use of alcohol. If you drink heavy amounts of alcohol, you have a greater risk of breast cancer.

When to seek medical advice

Most breast lumps in men are a result of enlarged breasts (gynecomastia), not breast cancer. However, it’s important to have lumps evaluated promptly. If a problem exists, you can have it identified and treated as soon as possible. See your doctor if you discover a lump or any of the other warning signs of breast cancer.

Tests and diagnosis

Because male breast cancer is rare, routine screening mammograms (mammography) generally aren’t recommended for men. If, however, you have a strong family history of breast cancer, consider talking to your doctor about developing a breast-screening program.

If your doctor suspects breast cancer, to diagnose your condition he or she may conduct a number of tests including breast examination (clinical breast exam), mammograms (mammography) or other tests:

• Clinical breast exam. During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you missed and will assess how large the lumps are, how they feel, and how close they are to your skin and muscles. Your doctor will also examine the rest of your body for signs that the cancer has spread, such as an enlarged liver or lymph nodes.
• Mammogram. A mammogram uses a series of X-rays to show images of your breast tissue. This test may be even more accurate in men than in women, because men don’t have dense breast tissue that can make it difficult to distinguish abnormal from normal tissue or breast cysts. During a mammogram, your breasts are compressed between plastic plates while a radiology technician takes the X-rays. If you find the compression too uncomfortable, tell the technician.
• Breast ultrasound (ultrasonography). Your doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to form images of structures within the body.
• Nipple discharge examination. Your doctor may collect nipple discharge if you’re experiencing it. The discharge is then examined for cancerous cells.
• Biopsy. A biopsy is the only way for your doctor to know whether a lump or abnormality is cancer. Biopsies can provide important information about an unusual breast change and help determine whether treatment is needed and, if so, the type of treatment required. To obtain a tissue sample, your doctor may use one of several procedures.

  Fine-needle aspiration biopsy is used for lumps you or your doctor can feel. During the procedure your doctor uses a thin, hollow needle to withdraw cells from the lump. He or she then sends the cells to a lab for analysis.

  In core needle biopsy, a radiologist or surgeon uses a hollow needle to remove tissue samples from a breast lump. A number of samples, each about the size of a grain of rice, may be taken, and a pathologist then analyzes them for malignant cells. The advantage of a core needle biopsy is that it removes tissue, rather than just cells, for analysis.

  In surgical biopsy, your surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is larger, only a sample will be taken (incisional biopsy). The biopsy is generally performed on an outpatient basis in a clinic or hospital.

• Estrogen and progesterone receptor tests. If a biopsy reveals malignant cells, your doctor will recommend additional tests — such as estrogen and progesterone receptor tests — on the malignant cells. These tests help determine whether female hormones affect the way the cancer grows. About 90 percent of male breast cancers have estrogen receptors, and more than 80 percent have progesterone receptors. If the cancer cells have receptors for estrogen or progesterone or both, your doctor may recommend treatment with a drug such as tamoxifen, which prevents estrogen from binding to these cells and stimulating growth.
• HER2 testing. If the biopsy shows malignant cells, your doctor may also test the sample for the presence of a protein called human epidermal growth factor receptor-2 (HER2), which promotes the growth of cancer cells. About 30 percent of male breast cancers have too much of this protein. Such cancers are usually more aggressive, growing and spreading more quickly than do other breast cancers. Once identified, this type of cancer is treated with a drug called trastuzumab (Herceptin). This medication keeps the protein from stimulating the growth of breast cancer cells.

Staging tests
If your doctor finds cancer, he or she will examine you further to determine if and how far the cancer has spread. Staging tests help determine the size and location of your cancer and whether it has spread. They also help your doctor determine the best treatment for you. Cancer is staged using the numbers 0 through IV:

• Stage 0 cancers are also called noninvasive or in situ (in one place) cancers. Although they haven’t spread to other parts of your body or invaded normal breast tissue, it’s important to have them removed, because they eventually can become invasive cancers. Finding and treating a cancerous lump at this stage offers the best chance for a full recovery.
• Stage I to IV cancers are invasive tumors that have the ability to spread to other areas. A stage I cancer is small and well localized and has a very successful treatment rate. But the higher the stage number, the lower the chances of cure. By stage IV, the cancer has spread beyond your breast to other organs, such as your bones, lungs or liver. Although it may not be possible to eliminate the cancer at this stage, its spread and some symptoms may be controlled with radiation, hormonal therapy, chemotherapy or all three.

Tests to determine a cancer’s spread may include:

• Chest X-ray. Your doctor may take a chest X-ray to see whether the cancer has spread to your lungs.
• Computerized tomography. A CT scan is an X-ray technique that produces more-detailed images of your internal organs than do conventional X-ray exams. Conventional X-ray exams produce 2-D images. But CT uses an X-ray-sensing unit that rotates around your body and a large computer to create cross-sectional images (like slices) of the inside of your body. A CT scan can help your doctor see if cancer has spread to your liver or other organs. Some CT scans require you to ingest a contrast medium before the scan. A contrast medium blocks X-rays and appears white on images, which can help emphasize some structures in your body.
• Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images. Most MRI machines are large, cylindrical-shaped magnets. The strong magnetic field is produced by passing an electric current through wire loops or coils, which are located inside a protective housing. Other coils in the housing send and receive radio waves. When you’re in the machine, your body produces very faint signals in response to the radio waves. These signals are detected by coils within the machine, or by additional coils designed to surround a specific body part needing examination. A computer then processes the signals and generates an image. The collected signals create a composite, 3-D representation of your body.
• Positron emission tomography (PET) scan. Unlike other scanning techniques, a PET scan doesn’t produce clear structural images of organs. Instead, it shows images containing areas of more or less intense color to provide information about chemical activity within certain organs and tissues. Tumors often use more energy than healthy tissues do and may absorb more of a radioactive tracer, which allows the tumors to appear on the scan.

Genetic testing
The discovery of BRCA2 and other genes that may increase breast cancer risk has raised a number of emotional and legal questions about genetic testing. A simple blood test can help identify defective BRCA genes, but it’s not 100 percent accurate. And it’s important to know that having a defective BRCA gene doesn’t mean you’ll get breast cancer. In addition, test results can’t determine at what age you might develop cancer, how aggressively the cancer might progress or what your risk of death might be.

In general, testing is most beneficial if the results will help you make a decision about how you might best reduce your chance of developing breast cancer, such as modifying your lifestyle or closer screening. It may also help family members decide if they should be tested or evaluated for the presence of an abnormal gene. Be sure to thoroughly discuss all your options with a genetic counselor before any testing is done, so that you can understand the risks and the benefits of such testing.

Treatments and drugs

Breast cancer in men is generally treated the same as it is in women. In most cases no one right treatment exists. Instead, you’ll want to find the approach that’s best for you. To do that, you’ll need to consider many different factors, including the stage of your cancer and your age.

Before making any decisions, learn as much as you can about the many treatment options. Talk extensively with your health care team. Consider a second opinion. Don’t be afraid to ask questions. In addition, look for breast cancer books, Web sites, and information from organizations such as the American Cancer Society and Susan G. Komen for the Cure. Talking to others who have faced the same decision also may help. This may be the most important decision you ever make.

Treatments exist for every type and stage of breast cancer. Some men may need only surgery. Others will need surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy.

Surgery
Breast-sparing procedures are often an option for women, but are not typically feasible for men. This is because a man’s breast doesn’t contain much tissue, so removing the cancer usually means removing all of the breast. Breast cancer operations include the following:

• Simple mastectomy. During a simple mastectomy, your surgeon removes all of your breast tissue — the lobules, ducts, fatty tissue, and a strip of skin with the nipple and areola. Depending on the results of the operation and follow-up tests, you may also need treatment with radiation to the chest wall, chemotherapy or hormone therapy.
• Modified radical mastectomy. Most men with breast cancer require a modified radical mastectomy. In this procedure, a surgeon removes your entire breast and some underarm (axillary) lymph nodes, but leaves your chest muscles intact. If the cancer has spread into the chest wall, your doctor may need to do a radical mastectomy that removes the chest wall muscles. Serious arm swelling (lymphedema) is more likely to occur in modified radical mastectomy than in simple mastectomy with sentinel node biopsy. Your lymph nodes will be tested to see if the cancer has spread. Depending on those results, you may need further treatment.
• Sentinel lymph node biopsy. Breast cancer first spreads to the lymph nodes under the arm. That’s why you need to have these nodes examined. If your surgeon doesn’t plan to do this, be sure you understand the reason. Until recently surgeons would remove as many lymph nodes as possible. But this greatly increased the risk of numbness, recurrent infections and serious swelling of the arm. That’s why a procedure has been developed that focuses on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to develop cancer. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small, and no other nodes need to be removed. This spares the need for a more extensive operation and decreases the risk of complications. It’s important that the procedure be performed by an experienced team.

Radiation therapy
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It’s administered by a radiation oncologist at a radiation center. It may be used to shrink the tumor before surgery or to eliminate any remaining cancer cells in the breast, chest muscles or armpit after surgery.

Most men who undergo radiation therapy for breast cancer receive external beam radiation. In this procedure you receive radiation directed at the cancerous area from a machine outside your body. Radiation is usually started three to four weeks after surgery, to allow some time for your body to heal.

If your doctor recommends chemotherapy, the radiation will be delayed until all of the chemotherapy treatments are completed. You’ll typically receive treatment five days a week for about six consecutive weeks. The treatments are painless, and each treatment takes just a few minutes. The effects are cumulative, however, and you may become quite tired toward the end of the series. Your breast may be pink, puffy and somewhat tender, as if it had been sunburned.

Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Your doctor may recommend chemotherapy after surgery to kill any cancer cells that may have spread outside your breast. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both. You may have treatments every two or three weeks for three to six months.

For many people, chemotherapy can feel like another illness. The side effects may include hair loss, nausea, vomiting and fatigue. These effects occur because chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow — as well as cancerous ones. Not everyone has side effects, however, and there are now better ways to control some of them.

New drugs can help prevent or reduce nausea. Relaxation techniques, including guided imagery, meditation and deep breathing, also may help. In addition, exercise has been shown to be effective in reducing fatigue caused by chemotherapy.

One side effect of chemotherapy that has only recently been described is called “chemobrain.” This refers to the difficulties some patients have with thinking or concentrating while receiving chemotherapy or after. It’s uncertain how commonly this occurs, or if this is even due to the chemotherapy. Many people who receive chemotherapy don’t experience this side effect. Those who do may have difficulty with word finding, memory, multitasking and learning new things. Studies suggest it may effect between 20 percent and 30 percent of people undergoing chemotherapy. There’s no way to predict who will experience this mild cognitive impairment, and it’s not clear whether the treatment or the cancer is the actual cause of chemobrain.

In rare cases, certain chemotherapy medications may lead to cancer of the white blood cells (acute myeloid leukemia) — usually within one to two years after treatment ends. Some chemotherapy medications have the potential to damage the heart.

Hormone therapy
Estrogen receptor positive cancer means that estrogen might encourage the growth of breast cancer cells in your body. Estrogen is present in men, though in smaller amounts than in women. But 90 percent of breast cancers in men have estrogen receptors. Normally estrogen binds to certain cells in your breast and in other parts of your body. Hormone-blocking agents such as tamoxifen block this binding of estrogen to those receptors. This may help destroy cancer cells that have spread or reduce the chances that your cancer will recur.

The primary medication used to reduce the effect of estrogen in your body is tamoxifen (Nolvadex). This synthetic hormone belongs to a class of drugs known as selective estrogen receptor modulators (SERMs). It’s used as a treatment for men with hormone-sensitive metastatic breast cancer and as an adjuvant therapy for men with early-stage estrogen receptor positive breast cancer. You take tamoxifen daily, in pill form, for five years.

The male hormones — androgens — also play a role in the growth of breast cancer in men, although the role is unclear. Limiting androgens through the use of certain drugs does appear to effectively reduce the spread of the cancer. These drugs include:

• Luteinizing hormone-releasing hormone analogues. These drugs cause the testicles to reduce their androgen production.
• Anti-androgen drugs. Anti-androgens block the effect of male hormones on breast cancer cells.

Side effects of hormonal therapies may include hot flashes, decreased sexual desire, loss of erection, weight gain and mood swings.

A new group of hormonal therapy medications called aromatase inhibitors (anastrozole, exemestane and letrozole) are used to treat hormone-sensitive breast cancer in postmenopausal women. At this time, no data exist as to the usefulness of these medications in the treatment of male breast cancer.

Herceptin therapy
One new medication, trastuzumab (Herceptin), is a monoclonal antibody that attacks and blocks the activity of a certain protein made by some breast cancers. Only about one-third of breast cancers make too much of this protein called HER-2-neu. This protein stimulates the cancer cells to grow. Trastuzumab binds onto this protein and blocks its effect and kills the cancer cells. This treatment only works in those breast cancers that make too much HER-2-neu. Side effects of trastuzumab are uncommon, but may include heart problems, fever, chills, nausea and vomiting, weakness, diarrhea and headache.

Biological therapy
Sometimes called biological response modifier or immunotherapy, this treatment tries to stimulate your body’s immune system to fight cancer. Using substances produced by the body or similar substances made in a laboratory, biological therapy seeks to enhance your body’s natural defenses against specific diseases. Many of these therapies are experimental and available only in clinical trials.

Prevention

To help reduce your risk of breast cancer, maintain a healthy body weight and avoid heavy alcohol use. Early detection also increases your chances of surviving the disease. So if you develop a breast lump or other abnormality, seek prompt care.

Coping and support

After a diagnosis of breast cancer, it may take some time to sort through all your emotions. But you can still feel in charge of your life. One of the best ways to regain control is to educate yourself about breast cancer and its treatment. You’ll have many decisions to make in the weeks and months ahead. The more you know, the better prepared you’ll be to make the best choices.

In addition to talking to your medical team — your surgeon, a specialist in chemotherapy and hormone therapy (medical oncologist) and a specialist who administers radiation therapy (radiation oncologist) — you may also want to talk to a counselor or medical social worker. Or you may find it helpful and encouraging to talk to other men with cancer.

There are also excellent books about breast cancer and many reputable resources on the Internet. Be sure to look for the most current information, however. Breast cancer treatments are changing rapidly, and information quickly becomes dated. It’s important not to rely on just one source. There are many different approaches to breast cancer treatment.

Telling others
Unfortunately, treatment decisions aren’t the only decisions you’ll face. Every day may present new challenges. One of the first will likely be how and when to tell those closest to you. If you have children, telling them — no matter what their ages — can be difficult. Yet it’s best to be as honest as you can. You don’t have to give all the details. How much and what you say will depend on each child’s age and ability to understand. But trying to hide your illness isn’t a good idea. Instead, tell your children you’re doing everything possible to get well.

The decision to tell friends and co-workers isn’t easy either. Especially in the beginning, you may not want anyone outside your family to know. But over time you may find it helpful to confide in a few close friends or co-workers. Still, how much and whom to tell is up to you.

Keep in mind that people may not always react as you expect. Some may have many of the same feelings you do — anger, fear, grief. Others may be incredibly supportive. And some may not say much at all or may even avoid you. That’s not because they don’t care, but because they may not know what to say. Let them know that there are no right words and that their concern is enough.

Maintaining a strong support system
More and more studies show that strong relationships are crucial in dealing with life-threatening illnesses. In fact, friends and family are often an integral part of your treatment. Sometimes, though, you may want or need different kinds of support. If so, you may find the concern and understanding of other men with cancer especially helpful. Your doctor or a medical social worker may be able to put you in touch with a group near you. Or contact one of the many cancer organizations.

Taking care of yourself
During your treatment, you’ll need to plan your schedule carefully. Allow yourself time to rest. And don’t be afraid to ask for help. Your friends and family want to help, but they may not always know what to do. Be specific about your needs.

At the same time, you’ll likely want to stay as independent as possible. Sometimes in their desire to help, other people may try to take over your life. Or they may act as if you’re terribly fragile. Both can be detrimental to your recovery. Don’t hesitate to tell friends and loved ones how you want to be treated.

If you haven’t done so before, now is a good time to start eating a healthy diet, getting regular exercise and reducing stress. In fact, stress-reduction techniques and exercise may help relieve some of the side effects associated with radiation and chemotherapy.

Take time to examine what’s most important to you. Think about the things you want to accomplish and how you can achieve your goals. And make it a priority to live your life to the fullest.

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