Breast lump

Answer 1

DefinitionA breast lump is a swelling, protuberance, or lump in the breast. Alternative Names

Breast mass

Considerations

Normal breast tissue is present in both males and females of all ages. This tissue responds to hormonal changes and, therefore, certain lumps can come and go.

Breast lumps may appear at all ages:

• Infants may have breast lumps related to estrogen from the mother. The lump generally goes away on its own as the estrogen clears from the baby's body. It can happen to boys and girls.
• Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
• Teenage boys may develop breast enlargement and lumps because of hormonal changes in mid-puberty. Although this may distress the teen, the lumps or enlargement generally go away on their own over a period of months.
• Breast lumps in an adult woman raise concern for breast cancer, even though most lumps turn out to be not cancerous.

Common Causes

Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts.

Fibrocystic changes can occur in either or both breasts. These changes are common in women (especially during the reproductive years), and are considered a normal variation of breast tissue. Having fibrocystic breasts does not increase your risk for Breast cancer. It does, however, make it more difficult to interpret lumps that you or your doctor find on exam. Many women feel tenderness in addition to the lumps and bumps associated with fibrocystic breasts.

Fibroadenomasare noncancerous lumps that feel rubbery and are easily moveable within the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender and, except in rare cases, do not become cancerous later. A doctor may feel fairly certain from an exam that a particular lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy it.

Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period. Cysts may be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears completely after it is drained, no further treatment is needed. If the fluid is bloody, it is sent to the lab to look for cancer cells. If the lump doesn't disappear, or recurs, it is usually removed surgically.

Other causes of breast lumps include:

• Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.
• Breast cancer, found on mammogramor ultrasound, then a biopsy. Men also can get breast cancer.
• Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These lumps tend to get better on their own in a matter of days or weeks. If not, your doctor may have to drain the blood.
• Lipoma -- a collection of fatty tissue.
• Intraductal papilloma -- a small growth inside a milk duct of the breast. This often occurs near the areola, the colored part of the breast surrounding the nipple, in women ages 35-55. It is harmless and often cannot be felt. In some cases the only symptom is a watery, pink discharge from the nipple. Since a watery or bloody discharge can also be a sign of breast cancer, your doctor should check this.

Home Care

For fibrocystic changes, Birth Control pills are often helpful. Other women are helped by:

• Avoiding caffeine and chocolate
• Limiting fat and increasing fiber in the diet
• Taking vitamin E, vitamin B complex, or evening primrose oil supplements

Call your health care provider if

Call your doctor if:

• The skin on your breast appears dimpled or wrinkled (like the peel of an orange)
• You find a new breast lump during your monthly self-exam
• You have bruising on your breast, but did not experience any injury
• You have nipple discharge, especially if it is bloody or pinkish (blood-tinged)
• Your nipple is inverted (turned inward) but normally is not inverted

Also call if:

• You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination
• You are a woman over age 40 and have not had a mammogram in the past year

What to expect at your health care provider's office

Your doctor will get a complete history from you, with special attention to factors that may increase your risk of breast cancer. The health care provider will perform a thorough breast examination. If you don't know how to perform breast self-examination, ask your health care provider to teach you the proper method.

Medical history questions regarding breast lumps include:

• When and how did you first notice the lump?
• Do you have other symptoms such as pain, nipple discharge, or fever?
• Where is the lump located?
• Do you do breast self-exams, and is this lump a recent change?
• Have you had any type of injury to your breast?
• Are you taking any hormones, medications, or supplements?

Tests that may be performed include:

• Biopsy of the lump
• Mammogram
• MRI
• Needle aspiration of a cyst and examination of the fluid under a microscope
• Study of nipple discharge under a microscope
• Ultrasound to see if the lump is solid or a cyst

Treatment of a breast lump depends on the cause. Solid breast lumps are often removed surgically. Cysts can be drained. Breast infections require antibiotics. If breast cancer is diagnosed, most women receive surgery, radiation, chemotherapy, or hormonal therapy. Discuss these options carefully and thoroughly with your doctor.

If you have a family history of breast cancer, your doctor may also suggest testing for genes that make you more likely to get breast cancer.

Prevention

Breast cancer screening is an important way to find breast cancer early, when it is most easily treated and cured.

• Get regular mammograms.
• If you are over age 20, consider doing a monthly breast self-exam (See: Breast self exam)
• If you are over age 20, have a complete breast exam by your provider at least every 3 years -- every year if you are over 40.

Having fibrocystic breast tissue, mastitis, or breast tenderness related to PMS does NOT put you at greater risk for breast cancer. Having fibrocystic breasts does, however, make your self-exam more confusing, because there are many normal lumps and bumps.

To prevent breast cancer:

• Exercise regularly
• Reduce fat intake
• Eat lots of fruits, vegetables, and other high fiber foods
• Do not drink more than 1 or 1 1/2 glasses of alcohol a day

References

Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75-89.

Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002;29(1):1-20.

Klein S. Evaluation of palpable breast masses. Am Fam Physician. 2005;71(9):1731-1738.

Answer 2

DefinitionA breast lump is swelling, a growth, or a lump in the breast.

Breast lumps in both men and women raise concern for breast cancer, even though most lumps are not cancer.

Alternative Names

Breast mass

Considerations

Both males and females of all ages have normal breast tissue. This tissue responds to hormone changes. Because of this, lumps can come and go.

Breast lumps may appear at any age:

• Both male and female infants may have breast lumps from their mother's estrogen when they are born. The lump will usually go away on its own as the estrogen clears from the baby's body.
• Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
• Teenage boys may develop breast enlargement and lumps because of hormone changes in mid-puberty. Although this may be upsetting to boys, the lumps or growth almost always go away on their own over a period of months.

Common Causes

Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts.

Fibrocystic changes are painful, lumpy breasts. Fibrocystic breast changes do not increase your risk of breast cancer. Symptoms are usually worse right before your menstrual period, and then improve after your period starts.

Fibroadenomasare noncancerous lumps that feel rubbery. They move easily inside the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender. Except in rare cases, they do not become cancerous later. A doctor can feel during an exam whether a lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy the lump.

Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period.

Other causes of breast lumps include:

• Breast cancer
• Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These lumps tend to get better on their own in a few days or weeks. If they do not improve, your doctor may have to drain the blood.
• Lipoma -- a collection of fatty tissue
• Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.

Home Care

See your health care provider if you have any new lumps or breast changes. Ask about your risk factors for breast cancer, and screening and prevention for breast cancer.

Call your health care provider if

Call your doctor if:

• The skin on your breast appears dimpled or wrinkled (like the peel of an orange)
• You find a new breast lump during your monthly self-exam
• You have bruising on your breast, but did not experience any injury
• You have nipple discharge, especially if it is bloody or pinkish (blood-tinged)
• Your nipple is inverted (turned inward) but normally is not inverted

Also call if:

• You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination
• You are a woman over age 40 and have not had a mammogram in the past year

What to expect at your health care provider's office

Your doctor will get a complete history from you, asking about factors that may increase your risk of breast cancer. The health care provider will perform a thorough breast examination. If you don't know how to perform a breast self-examination, ask your health care provider to teach you the proper method.

You may be asked medical history questions such as:

• When and how did you first notice the lump?
• Do you have other symptoms such as pain, nipple discharge, or fever?
• Where is the lump located?
• Do you do breast self-exams, and is this lump a recent change?
• Have you had any type of injury to your breast?
• Are you taking any hormones, medications, or supplements?

Steps your health care provider may take next include:

• Order a mammogram to look for cancer, or a breast ultrasound to see if the lump is solid or a cyst
• Use a needle to draw fluid out of a cyst, which will be examined under a microscope to look for cancer cells
• Order a breast biopsy
• Study any nipple discharge under a microscope

How a breast lump is treated depends on the cause.

• Solid breast lumps are often removed with surgery.
• Cysts can be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears after it is drained, you do not need further treatment. If the lump does not disappear or comes back, it is usually removed with surgery.
• Breast infections are treated with antibiotics.
• If you are diagnosed with breast cancer, you will discuss your options carefully and thoroughly with your doctor.

References

Warner E. Clinical practice. Breast-cancer screening. N Engl J Med. 2011;365:1025-1032.

Cuzick J, DeCensi A, Arun B, Brown PH, Castiglione M, Dunn B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12:496-503.

Heisey RE, McCready DR. Office management of a palpable breast lump with aspiration. CMAJ. 2010;182:693-696.

Reviewed By

Review Date: 11/16/2011

Dan Sacks, MD, FACOG. Obstetrics & Gynecology in Private Practice, West Palm Beach, FL. Review provided by Verimed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.