Suspicious breast lumps

Overview

A breast lump is a growth of tissue that forms in the breast. Most breast lumps are not irregular or cancerous. But it's key to have your healthcare professional check them promptly.

Symptoms

Breast tissue typically might feel lumpy or ropy. You also may have breast tenderness that comes and goes with your menstrual period.

If you have a health problem that affects your breasts, you might notice changes in how your breasts usually feel. These changes can include:

• A round, smooth and firm breast lump.
• A lump that feels firm and moves easily under the skin.
• A hard breast lump with irregular edges.
• An area of skin that has changed color.
• Skin dimpling like an orange.
• New changes in breast size or shape.
• Fluid leaking from the nipple.

When to see a doctor

Make an appointment to have a breast lump checked, especially if:

• The lump is new and feels firm or fixed.
• The lump doesn't go away after 4 to 6 weeks. Or it has changed in size or in how it feels.
• You notice skin changes on your breast such as a change in skin color, crusting, dimpling or puckering.
• Fluid comes out of the nipple suddenly on more than one occasion. The fluid might be bloody.
• The nipple recently turned inward.
• There is a new lump in your armpit, or a lump in your armpit seems to be getting bigger.

Causes

Breast lumps can be caused by:

• Breast cysts. These fluid-filled sacs inside the breast are round, smooth and firm. A breast cyst can range in size from a few millimeters to as large as an orange. The tissue around it may be tender. A breast cyst may appear before your period and get smaller, larger or go away afterward. Breast cysts tend to come on quickly around the time of the menstrual cycle.
• Fibrocystic breast changes. With these changes, you may feel general fullness in your breasts. Some areas may be lumpy or ropelike. Your breasts may feel tender. It's common to have fibrocystic breast changes related to the menstrual cycle. The symptoms tend to get better after you have your period.
• Fibroadenomas. These solid breast tumors aren't cancer. They're smooth, and they move easily under the skin when touched. A fibroadenoma may get smaller over time or it may grow larger. Factors that may be linked with fibroadenoma growth include being pregnant, using hormone therapy such as birth control pills or having a period.
• Injury or post-surgery. A serious injury to breast tissue or a complication after breast surgery can create a breast lump. This is called fat necrosis.
• Infections. A collection of infected fluid called an abscess in breast tissue also can cause a breast lump. The lump often is linked with breast pain, redness in that area and swelling of the skin.
• Intraductal papilloma. This is a skin tag-like growth in a milk duct. It can cause the nipple to leak clear or bloody fluid. It's usually not painful. This growth can be seen on a breast ultrasound of the area under the nipple.
• Lipoma. This type of lump can feel soft. It involves fatty breast tissue. It's often harmless.
• Breast cancer. A breast lump that's painless, hard, has irregular edges and is different from the breast tissue around it might be breast cancer. The skin covering the lump may thicken, change color or look red. There also may be skin changes such as dimpled or pitted areas that look like the skin of an orange. Your breast size and shape may change. You may notice fluid leaking from the nipple, or the nipple may turn inward. The lymph nodes under the arm or near the collarbone might be swollen.

See your healthcare professional to learn what kinds of tests you might need and which type of breast lump you have.

Risk factors

Risk factors for breast lumps caused by conditions that are not cancer include the following:

• Age. Some conditions that cause breast lumps are more common in the 30s and 40s. These include fibrocystic changes and fibroadenomas.
• Menstrual periods. Before or during your period, you may feel a breast lump due to extra fluid in the breasts.
• Pregnancy. Your breasts may feel lumpy during pregnancy. That's because the glands that make milk grow in number and get larger.
• Premenopause. As you get closer to menopause, hormone changes might make your breasts feel lumpier and tender.

Some risk factors for breast cancer are within your control to change. These include:

• Alcohol. The more alcohol you drink, the higher the risk of breast cancer.
• Overweight or obesity. The risk of breast cancer rises if you're overweight or obese after menopause.
• A lack of exercise. If you don't get physical activity, it may make you more likely to get breast cancer.
• Not giving birth. The risk of breast cancer is slightly higher in people who haven't had children or who didn't have children until after age 30.
• Not breastfeeding. The risk of breast cancer may be slightly higher in people who don't breastfeed their babies.
• Hormonal birth control. Birth control methods that use hormones to prevent pregnancy may slightly raise breast cancer risk. These include birth control pills, shots and intrauterine devices.
• Hormone therapy. Long-term use of estrogen combined with progesterone can raise the risk of breast cancer.

Other risk factors for cancerous breast lumps can't be controlled. These include:

• Being born female. Women are much more likely than men to get breast cancer.
• Aging. The risk of breast cancer rises with age. Most often, tests find breast cancer in people 55 and older.
• Gene changes. Some types of breast cancer are caused by genes changes passed from parents to children, also called inherited gene changes. A change in the BRCA1 or BRCA2 gene is the most common cause of inherited breast cancer.
• Family history of breast cancer. You're more likely to get breast cancer if a close relative such as a parent or sibling also had the disease.
• Dense breasts. This means your breasts have more glandular and fibrous tissue, and less fatty tissue. People with dense breast tissue have a higher risk of breast cancer than those whose breast density is average.
• Early menstrual periods or later menopause. Starting your period at an early age, especially before 12, is linked with a slightly higher breast cancer risk. Going through menopause after 55 also is tied to a slightly higher risk of breast cancer.
• Certain breast conditions that aren't cancer. Some benign breast conditions that cause lumps can make breast cancer more likely later on. These conditions include atypical ductal hyperplasia and atypical lobular hyperplasia, which involve too much cell growth in certain breast cells. Another condition called lobular carcinoma in situ (LCIS) happens when cells grow in glands that make breast milk. LCIS also can raise the risk for breast cancer.

Complications

Some conditions that cause breast lumps may lead to other health concerns, also called complications. The complications depend on the type of breast lump that you have. For example, without treatment, some breast infections can cause pockets of pus to form in the breast.

Other breast conditions that are not cancer still can raise the risk of breast cancer later on. These include conditions that can cause lumps, such as atypical ductal hyperplasia, atypical lobular hyperplasia and lobular carcinoma in situ. If you have a breast condition that raises the risk of cancer, it doesn't mean that you'll definitely get breast cancer. Ask your healthcare professional what the risk means for you and whether you can make lifestyle changes to lower it.

Some breast lumps don't cause complications. For example, small cysts and simple fibroadenomas sometimes go away on their own over time.

Prevention

There's no clear way to prevent many breast lumps. Breast lumps that are not cancer often are linked with natural changes in the body, such as hormonal changes over time.

But some risk factors for cancerous breast lumps are within your power to change. Take the following steps to lower your chances of breast cancer:

• Drink less alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Eat a balanced diet. Fill your plate with lean proteins, whole grains, and fruits and vegetables. Eat less sugary, salty and processed foods.
• Exercise. The American Cancer Society recommends that adults aim to get 150 to 300 minutes of moderate-intensity exercise a week. Or you can try to do 75 to 150 minutes of vigorous activity a week. If you're not active now, ask your healthcare professional to help you get started.

Diagnosis

Diagnosis of a breast lump involves getting an exam and possibly tests to find out the cause of the lump. During the physical exam, your healthcare professional checks your breasts, chest wall, underarms and neck. You're checked while you're sitting upright and again while lying on your back.

You'll likely need one or more imaging tests to check for changes in the breasts. These include:

• Diagnostic mammogram. This is an X-ray of your breasts. During a mammogram, your breasts are compressed between two firm surfaces. Then an X-ray takes black-and-white images. When your healthcare professional orders a diagnostic mammogram, this tells the radiologist who reviews your images that you have a new breast concern. A diagnostic mammogram is different from a screening mammogram, which looks for breast cancer before a person has symptoms.
• Focused or directed ultrasound. This test uses sound waves to make images of the inside of your breasts. The sound waves come from a wand-like instrument called a transducer that is moved over your breasts. Your healthcare professional tells the radiologist about the area of concern on the breast.
• Magnetic resonance imagining (MRI). This exam is done less often than mammogram and ultrasound. An MRI uses a magnetic field and radio waves to see inside your breasts. During an MRI, you lie in a large, tube-shaped machine that scans your body and makes images. Sometimes, the breast MRI may be done even if the diagnostic mammogram and ultrasound look regular. For example, MRI may be used if your breasts are very dense, and your healthcare professional has concerns about the clinical exam of your breasts.

If these tests show that your lump is not cancer, you might need follow-up appointments. That way, your healthcare professional can check to see if the lump grows, changes or goes away.

If imaging tests don't help diagnose the lump, your healthcare professional might take a sample of cells for lab testing. This is called a biopsy. There are various types of biopsies. Your healthcare professional recommends the one that is right for you. Breast biopsies include:

• Fine-needle aspiration. A small amount of breast tissue or fluid is removed with a thin needle. This procedure can be used to check a complex cyst or to drain fluid from a painful cyst.
• Core needle biopsy. A healthcare professional called a radiologist may do this procedure. A radiologist finds and treats health problems using medical imaging tests. With core needle biopsy, ultrasound is used to guide a needle into the breast lump and take a sample to check. Often, a tiny clip that you can't see or feel also is placed into the biopsied area. It serves as a marker that lets healthcare professionals find the area again during future checkups.
• Stereotactic biopsy. For this procedure, you lie face down on a padded table. One of your breasts is placed in a hole in the table. Breast X-rays provide a 3D view of the breast to help guide a needle to the lump to collect a tissue sample. You may need this procedure if a suspicious area shows up on a mammogram, but the area can't be found with ultrasound. A tiny clip often is placed at the time of the biopsy and serves as a marker for future appointments.
• Surgical biopsy. This procedure removes the entire breast lump. It's also called a lumpectomy or wide local excision. You receive medicine to keep you from feeling pain. You also may be given medicine that makes you sleep during the procedure.

Whichever type of biopsy you have, your healthcare professional sends the tissue samples to a lab to be checked by a pathologist. That's a doctor who studies diseases and the changes they cause in body tissues.

Treatment

Treatment for a breast lump depends on its cause. Your healthcare professional helps you choose the treatment that's right for you. Causes of breast lumps and their treatment options include:

• Fibrocystic breasts. If you have fibrocystic breasts, your healthcare professional may suggest pain medicines that you can buy without a prescription. These include nonsteroidal anti-inflammatory medicine. Or you may need prescription hormone therapy, such as birth control pills.

• Breast cysts. Some breast cysts go away without any treatment. If the cyst is painful, you may need fine-needle aspiration. This procedure drains the fluid out of the cyst with a needle. This can ease the pain.

  If you have painful breast cysts that last a while and keep coming back, your healthcare professional may suggest surgery to remove the painful breast tissue. But most often, painful, recurring breast cysts go away around the time of menopause. That's when hormone changes happen less often.

• Fibroadenomas. A fibroadenoma might go away without treatment after a few months. You'll have regular ultrasound exams of your breast tissue to check the size of the fibroadenoma and how it looks. Ultrasound exams also can check whether the lump stays the same size or grows. If it grows or looks unusual during an ultrasound, you may need a biopsy. Depending on lab findings, your healthcare professional may suggest surgery to remove the fibroadenoma.
• Infections. Medicines called antibiotics cure most breast infections caused by germs called bacteria. But you may need a procedure known as an incision and drainage if a pocket of pus called an abscess forms and does not get better with antibiotics.
• Lipoma. Most often, a lipoma in the breast doesn't need to be treated. But if a lipoma causes painful symptoms, it can be removed with surgery or a procedure called liposuction that removes fat cells.
• Intraductal papilloma. These may not need treatment. But sometimes, intraductal papillomas and the part of the duct they are in are removed with surgery.
• Breast cancer. Treatment for breast cancer depends on the type of cancer and whether it has spread. Your healthcare professional may suggest treatments such as surgery, chemotherapy, hormone therapy such as anti-estrogen medicines or radiation therapy. Or you might be able to join a clinical trial that tests new treatments.