The incidence of breast disease has dramatically increased over the last decade. Benign breast diseases are a heterogeneous group of lesions, including a variety of tissue abnormalities that are differentially associated with breast cancer risk . With the increase use of mammography more and more, women are diagnosed with benign and malignant breast diseases . Breast carcinoma is now the leading cause of cancer related deaths in women worldwide after lung cancer. In the year 2010 Breast cancer accounted for an estimated 28% of all new cancer cases in United States .
Benign breast diseases are the most common breast lesions evaluate in this study. This was also the findings of previous studies [1, 4, 14, 15]. In this study, majority of biopsies which were sent to histopathological department, were of fibroadenomas. These findings reveal high rate of lesions as compare to past studies [1, 16–18]. Its peak incidence is in 2nd and 3rd decade of life, but can also occur after menopause due to hormone replacement therapy. These findings were consistent with other studies .
In our study Phyllodes tumor accounts for 1.2% of all the breast lesions and have a peak incidence in pre-menopausal age. These findings were comparable with other study also . Phyllodes tumor present histologically as intraductal growth of intralobular stroma with leaf life projections .
FIbrocytic change is one of the breast lesions with peak range of incidence at 31–35 years. Our findings were consistent with past study . It occurs during ovulation and just before menstruation. During these times, hormone level changes, which often causes the breast cells to retain fluid and develop into nodule or cyst which feels like a lump when touched. These nodules and cysts spread through out the breast. As hormone level rises just before and during menstruation, mammary blood vessels swell, alveoli expand and cell growth proliferates .
There is 11.9% of inflammatory lesion which was much higher as compare to past studies [14–16]. All inflammatory lesions were revealed in early 30s with a mean age from 24.7 ± 6.444 to 30.77 ± 8.77 for mastitis, breast abscess and ulcer. Acute and chronic mastitis constitute 5.8% of breast lesion which is in accordance with past studies [16, 20, 21]. Similar to observation in all past studies, gynecomastia was the most commonly encounter male breast disease constituting 3.9% of all the cases, as indicate in previous studies [4, 20]. Frequency of Gynecomastia was found to be present on its peak in 2nd decade of life, which was earlier as compare to African study . It should not be considered as a disease because enlargement of breast is a common problem. Cause of gynecomastia in most cases is not known, many being idiopathic. It mainly occurs due to excessive estradiol related to testosterone . Higher occurrence may be related to higher incidence of liver cirrhosis following hepatitis B, leading to hyperesterinism and malignancy in susceptible males .
Granulomatous inflammatory changes in the breast can be related to specific infectious agents such as Mycobacterium Tuberculosis, non-infectious disease such as sarcoidoses, foreign material as silicon, paraffin or suture material or trauma. It is present in pre-menopausal age. In this study there were four cases of granulomatous mastitis, which was comparable with the past study .
Breast cancer is the most common non-cutaneous neoplasia in women. It is a heterogeneous disease, such that it may have different prognostic and therapeutic responses despite similarities in histological types, grade and stage of various subtypes. There are 19 subtypes of breast carcinoma according to World Health Organization (WHO) 2003 classification . Mechanism of developing breast cancer is still unclear but the contribution of mutation in BRCA1 and BRCA2 have been reported to be associated with a dominantly increased risk of disease . Breast cancer susceptibility gene l (BRCA 1) is involved in inhibition of cell growth, cell cycle regulation, gene transcription, DNA damage repair and apoptosis. It was evaluated that dislocation of the cytoplasmic BRCA1 protein in breast cancer cells, is related to the occurrence and metastasis of breast cancer and is expressed in cytoplasm of breast cancer of both younger and elder people . Estrogen, estrone, and estradiol are catabolized to catechol estrogens and their metabolites, such as 4-hydroxyestrone and 4-hydroxyestrone have been involved in breast carcinogenesis. Catechol-O-methyltransferase (COMT) catalyzes the O-methylation of these carcinogenic estrogens to methoxyes tradiols and methoxyestrones. Transition from G to A in COMT gene results in an amino acid change (Val/Met) at codon 108 of soluble COMT and codon 158 of membrane-bound COMT. This shifting in amino acids has been result in a 3–4-fold decrease in enzymatic activity. It has been assesed that individuals who inherit the low activity COMT gene may be at increased risk for breast cancer, because of an increased accumulation of the catechol estrogen intermediates, clearing the pathogenic pathway of developing breast cancer . A principal finding of our study was malignancy rate of 11%, which were consistent with past studies of Pakistan [15, 24]. They were not consistent with findings reported in study of Saudi Arabia and Ghana [16, 17]. Mean age of its presentation was in 4th decade which was same as indicated in past study . In our study invasive ductal carcinoma becomes the most common and only variety of breast cancer as indicated in past studies [2, 24]. Invasive breast carcinoma is associated with a high mortality rate due to invasion in lymph nodes, adjacent tissues and due to metastasis. Invasive ductal carcinoma is the most common histological type with a poor prognosis rate of 30-35% 10 year survival rate. Peritumor lymphatic and blood invasion are the main factors related to presence of metastasis to lymph nodes and they are more closely related to tumor size and histological grade .
Most of the patients clinically present with lumps in the breast followed by pain, enlargement of breast, fever and nipple retraction. Our findings were comparable with past studies [11, 26, 27].
We establish the baseline data for longitudinal study prospective study and current study also adds additional information to the international research literature. Our study was a cross sectional study encircling a small part of the population of Karachi and may not be representative of whole nation.
Breast cancer and breast diseases screening programs should be developed at the hospitals. These programs should ideally include clear objectives, plans and managements. Programs should be free of cost, to encourage large number of women to enroll in such screening programs.