LEARN: My Approach to Breast Health in Clinic
My Approach to Breast Health in Clinic
In my clinic, breast health care is grounded in knowledge, reassurance, and appropriate vigilance not fear, and not dismissal. Alongside hormone therapy (the most common reason I see patients in my Rooms), I always discuss breast health. Breast symptoms are very common, and even more so in perimenopause. So I look at it from 3 main angles.
1️⃣ To alleviate symptoms where possible
Many breast symptoms are real, distressing, and treatable, even when they are benign.
This includes:
• breast pain or tenderness
• cysts
• cyclical or hormonally driven lumpiness
• breast heaviness or discomfort related to size or density
Benign does not mean “nothing to do.”
Symptom relief, education, and support matter.
2️⃣ To distinguish benign from malignant breast disease
Most breast changes, particularly in perimenopause - are not cancer, but reassurance must be earned through appropriate assessment, not assumption.
My role is to:
• take a careful history
• examine thoughtfully
• recognise patterns of benign disease
• and ensure timely imaging or referral when indicated (this is often the case)
This approach avoids both unnecessary alarm and delayed diagnosis.
3️⃣ To identify patients with increased breast cancer risk
Some individuals benefit from enhanced surveillance or preventive strategies, based on:
• family history
• personal medical history
• breast density
• hormonal and metabolic factors eg history/current obesity
• risk of decreased imaging accuracy eg post surgery, augmentation/reduction
Identifying risk allows us to:
• personalise screening
• consider earlier or more frequent imaging
• and, where appropriate, discuss risk-reducing strategies
Sadly, our imaging and screening is not 100% for breast cancer, so this is where I like to discuss how and what is the best way to move forward. I believe breast screening needs individualisation.
Where possible, I like to practise proactive care, not reactive medicine.
The underlying principle
Breast health care should:
• reduce suffering
• increase understanding
• provide reassurance grounded in evidence
• and support long-term health
Perimenopause is a time of significant breast change, and women deserve care that understands this context, without minimising concerns or escalating fear.
My approach to breast health focuses on symptom relief, accurate distinction between benign and malignant disease, and early identification of increased risk, so care can be proactive, personalised, and reassuring.
Breast pain, estrogen patches, and hormonal fluctuation
In one case, a patient developed significant breast pain while using an estrogen patch, even at a relatively low dose (50 mcg). On detailed history-taking, it became clear that her symptoms aligned with up-and-down hormone exposure, rather than consistently high estrogen levels.
Transdermal patches can, in some people, lead to more noticeable peaks and troughs, particularly in hormonally sensitive individuals. We changed her estrogen delivery from a patch to gel, allowing for smoother, more adjustable absorption.
And her breast pain resolved over 2-3 weeks!
Working closely with the breast team
In my practice, I regularly discuss cases with a local breast surgeon, particularly where there are breast symptoms, imaging questions, or clinical uncertainty. This allows us to:
- align on appropriate examination and imaging pathways
- sense-check management decisions
- share evolving knowledge and best practice
- ensure patients are supported with the right level of care, at the right time
This collaborative approach means patients benefit from both medical continuity and specialist input, without unnecessary delay or escalation.
Good care is rarely about one clinician’s “art” alone - it’s about shared expertise, clear communication, and thoughtful decision-making.
