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Objectives: Studies show that anxiety and depression are widespread across patients presenting to outpatient services for medical illnesses. We expect similar or even higher prevalence in patients with breast complaints owing to the relevance of breasts in terms of sexuality, identity and confidence. Thus, this study was proposed to estimate the prevalence and identify risk factors for being at risk for anxiety and depression in patients seeking breast services., Design: Descriptive, cross-sectional study., Setting: Tertiary care teaching hospital in Mumbai, Western India., Participants: Patients seeking breast services for either benign or malignant conditions., Outcome Measures: Proportion of those at risk for clinical depression (defined as a score of ≥10 on Patient Health Questionnaire-9) and proportion of those at risk for clinical anxiety warranting further clinical evaluation (defined as a score of ≥10 on Generalized Anxiety Disorder-7) and their predictors., Results: A total of 208 patients were screened, and 192 consenting patients were enrolled. The prevalence of those at risk for anxiety requiring further clinical evaluation was 46.4% (95% CI 39.2% to 53.7%) and for those at risk for major depression that warrants further clinical evaluation by a mental health provider was 29.7% (95% CI 23.3% to 36.7%). The predictors of anxiety were age (adjusted odds ratio (aOR) 1.053; 95% CI 1.024 to 1.083; p<0.001) and postmenopausal status (aOR 2.475; 95% CI 1.200 to 5.103; p=0.014). The predictors of depression were age (aOR 0.954; 95% CI 1.927 to 0.981; p=0.001) and rural place of residence (aOR 2.362; 95% CI 1.023 to 5.433; p=0.044)., Conclusions: There is a high prevalence of being at risk for anxiety and depression among patients who seek breast services warranting further clinical evaluation. The predictors of being at risk for anxiety were higher age and postmenopausal status, and for those at risk for depression were young age and residing in rural areas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Breast diseases are rising in incidence especially in developing countries. However, most research focuses on breast cancer. Analysing the spectrum of breast disease will enable establishment of efficient breast clinics within an existing general surgery out-patient department with minimal additional investment or personnel whilst providing quality care., Objectives: To study the spectrum of breast disease in an urban general surgical centre in India. To use a `Clinic-within-a-Clinic' model to provide affordable care and accurate early diagnosis to patients with breast disorders., Materials & Methods: A prospective study was conducted over 1 year at M. S. Ramaiah Hospital, Bangalore by a single general surgical unit. 903 patients who presented to the OPD with a variety of breast-related symptoms were included in the study (896 women and 7 men). Relevant history was taken; the patients were then examined and investigated according to our protocol and patterns were recognized., Results: Benign breast disease formed the majority of the cases (640 patients, 70.87%). The 21-30 years age group had the most patients (272 patients, 30.12%). ANDI was the commonest diagnosis (522 patients, 57.8%). 92 patients (10.18%) were diagnosed with cancer. More than 50% of these were less than 50 years of age. Majority of the patients (511 patients, 56.58%) could be managed conservatively. The cost of diagnosis and treatment was found to be a small fraction of that in specialized breast units of western countries using our `Clinic-within-a-clinic' model., Conclusion: Research on the demographic and clinical pattern of breast disease can help establish and efficient, effective and affordable diagnostic and therapeutic systems in developing nations.

In spite of the countless benefits of breastfeeding, prevalence of exclusive breastfeeding (EBF) has been far from optimal in the developing world. Breastfeeding problems at or after 4 weeks has been reported as one among the constraints to EBF. The study aimed to determine the breastfeeding problems in the 1 st postnatal week, their predictors and impact on EBF rate at 6 months. Under a prospective cohort design, 400 mother-newborn dyads were assessed for breastfeeding problems before discharge and at 60 ± 12 h of discharge. Nearly 89% of the mother-newborn dyads had one or more BF problems before discharge. Major concern was difficulty in positioning and attaching the infant to the breast (88.5%), followed by breast and nipple problems (30.3%). BF problems continued to persist even after discharge in a significant proportion of the mothers (72.5%). The only independent predictor of BF problems in the 1 st week was the caesarean section (odds ratio: 1.9, 95% confidence interval: 1.3-3.2, P < 0.05). There was a marked improvement in the EBF status (69.5%) at 6 months, and BF problems did not predict EBF failure at 6 months.

The aim of this case series is to evaluate the pattern of breast lumps in males and females with special reference to spectrum of lesions in females below 40 years of age. A 20 years retrospective study was undertaken from the records of the department of Pathology, Bhopal. The lesions were classified into benign and malignant. In young females histological pattern was analyzed in various age groups. A total of 1824 cases were studied. 1724 (94.5%) cases were seen in females and 100 (5.5%) in males. There were 1276 (74%) females below 40 years of age and 448 (26%) were above 40 years of age. In young females 1136 (89%) lesions were benign and 140 (11%) were malignant lumps. Fibrocystic disease in 60 (49%) cases constituted the largest group of benign lumps followed by 30 (24.5%) cases of inflammatory lesion in older females. The mean age of malignant tumors was 34.1 in young females and 51.4 in females above 40. Infiltrating duct carcinoma constituted 83.5% of malignant tumors in young females and 86.1% in older females.

A clinicopathological study of benign breast lesions in prepubertal female children was done retrospectively for 20 years. Thirty-seven cases of benign breast lesions like fibroadenoma in 22 (59.5%) cases, juvenile fibroadenoma in 9 (24.2%) cases, virginal hypertrophy in 3 (8.1 %) cases, cystosarcoma phylloides, duct papilloma and tuberculosis of the breast in one (2.7%) case each were seen. The majority of the cases of breast lesions were from urban area ie, 34 (91 .9%) cases. The commonest age of occurrence of benign breast lesion was observed between 7.5 and 11.5 years. In 2 (5.4%) cases bilateral virginal hypertrophy was seen. The aim of presenting this paper is to study the occurrence of breast lesions in prepubertal age especially before menarche. In rare case even the possibility of malignancy has to be ruled out.

A total of 1315 breast lesions seen in women up to 40 years of age were registered in the files of Pathology Department. Out of these 807 were benign and 508 malignant lesions. Breast carcinoma was very rare up to second decade of life but its incidence progressively increased with age. Among benign tumours fibroadenomas were the commonest tumours. This study shows a higher incidence of inflammatory diseases and malignant tumours in young females as compared to the reports from the West.

A retrospective study of lumps in the breast sent for histopathological examination in Calcutta National Medical College for a period of last 10 years was done. It was found that 2062 cases (6.82%) of histopathological examination of breast lump were studied out of a total 30208 specimens during that period. There were 1528 cases from benign breast lesions and 504 cases from the malignant breast lesions. The most common lesion found histologically was fibro-adenoma in 950 cases. Others included 150 cases of inflammatory breast diseases of which 36 cases were diagnosed as tuberculosis, 386 cases as fibrocystic disease and 42 cases as other benign neoplastic diseases. Out of 504 malignant cases 456 had carcinoma and 48 had sarcoma. Only 30 cases of male breast lesions were sent of which only a single case of infiltrating duct carcinoma was found, 28 cases had gynaecomastia and one case showed the evidence of fibrocystic disease.

Nine hundred and forty cases of breast lesions were subjected to fine needle aspiration. Nine hundred twenty-four of them were females and sixteen were males. Smears from the 60 female cases were rejected as unsatisfactory. Of the remaining 864 female cases (aged 15 to 72 years) 704 (81.4%) were benign. Histopathological correlations were done in 448 cases with diagnostic accuracy of 97.3%. One hundred and sixty (18.5%) out of 864 females were malignant and cytohistological correlation was done in 142 cases with 98.6% corroboration. Ten of the 16 male cases were histologically examined with full corroboration. Overall accuracy considering both males and females was 98.6%. Though there was underdiagnosis involving 12 cases of infiltrating ductal carcinoma when the lesions were small and deeply situated there was no overdiagnosis in this study.

Experience with benign breast disorders has been analyzed in 3 nonwestern populations: Hong Kong, India, and Northern Nigeria. Similarities to and differences from Western experience are found, but of great interest are notable differences between these populations which, as yet, lack explanation. All show "fibroadenosis" and fibroadenoma as common conditions, but the frequency with which phyllodes tumor is diagnosed varies between different centers in India as well as between different racial groups. Tuberculosis is another interesting example--wide differences in the frequency of breast infection are found although tuberculosis itself is common in all 3 countries. The value of prospective studies was shown when mastalgia was studied in this way in India. Often considered a "Western" affliction, these authors have been able to study 112 cases of mastalgia and found it to be twice as common as cancer as a presentation. These differing experiences between populations have been little explored and must hold promise for unravelling some of the enigmas of benign breast disorders in all countries.