A breast lump is swelling, growth or a lump in the breast. They can occur in both men and women, and are commonly 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 most often worse right before your menstrual period, and then improve after your period starts.
Fibroadenomas are noncancerous lumps that feel rubbery. They move easily inside the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years and are most often not tender. Except in rare cases, they do not become cancerous later. A health care provider can feel during an exam whether a lump is a fibroadenoma. A biopsy will be needed to diagnose a fibroadenoma.
Cysts are fluid-filled sacs. These can sometimes be tender, often just before your menstrual period.
Your provider will get a complete history from you. You will be asked about your factors that may increase the risk of breast cancer. The provider will perform a thorough breast exam. They may order a mammogram to look for cancer, or a breast ultrasound to see if the lump is solid or a cyst. If the lump is a cyst, they may use a needle to draw fluid, which will be examined under a microscope to look for cancer cells. A breast biopsy may be ordered for diagnosis if the lump is solid.
A cyst is a fluid filled sac within the breast and typically feels like a smooth lump under the skin. Women may have a single cyst, or multiple cysts. On a physical exam, it may be difficult to distinguish a cyst from a solid mass, although cysts have a characteristic appearance on ultrasound. Typically a mammogram is performed along with the breast ultrasound.
Once the cyst has been confirmed on ultrasound, the treatment is based on the appearance and symptoms caused by it. If the cyst is painful, aspiration is often performed in the office. A needle is advanced through the skin and the cyst is drained. Aspiration is normally performed with ultrasound guidance. If the cyst recurs, has bloody contents, or is complex, surgical excision with a breast biopsy may be necessary.
Cysts that are simple and not causing pain are frequently observed with physical exam. Follow up imaging may also be ordered in certain instances.
Discharge from the nipple may be noted by a woman when she changes clothes, often with dried fluid inside of her bra. This is usually spontaneous discharge, occurring without compression of the breast. Alternately, nipple discharge may be found on self-breast examination or during a breast exam performed by a health care provider. Nipple discharge is caused by a benign (non-cancerous) condition in the majority of cases.
Common causes of nipple discharge include:
- Duct ectasia
- Hormonal changes
The first step in the diagnosis of nipple discharge is a history and physical exam. Lab tests may have been ordered by your primary care provider. Next, your provider will order or ensure you have had recent imaging of the breasts. This usually consists of a mammogram and/or breast ultrasound. The radiologist then takes xrays to look for abnormalities in the duct illuminated with contrast dye. If an abnormality is found on imaging studies, a percutaneous (through the skin) needle biopsy is performed.
If a specific abnormality is discovered on imaging studies, treatment is based on the biopsy results. This may involve a breast biopsy or lumpectomy. If no abnormality is seen on the radiographic studies, a duct excision may be recommended. Removing the duct or ducts causing the discharge is both therapeutic and diagnostic.
Breast cancer is cancer that starts in the tissues of the breast. There are two main types of breast cancer, ductal carcinoma and lobular carcinoma. Ductal carcinoma is the most common, and starts in the tubes (ducts) that carry milk from the breast to the nipple. Lobular carcinoma starts in parts of the breast called lobules, which produce milk. In rare cases, breast cancer can start on other areas of the breast. There are many cancer risk factors that can increase chances to develop breast cancer. Some lifestyle factors such as drinking alcohol can be controlled, while others such as family history, you cannot. Understanding your risk factors can help you prevent breast cancer.
Click here for a list of risk factors and tips that can help reduce your risk for breast cancer
Early breast cancer often does not cause symptoms. This is why regular mammograms are so important, because it can help find cancers early.
As the cancer grows, symptoms may include a breast lump or lump in the armpit, change in the size, shape or fell of the breast or nipple, or fluid discharge from the nipple.
Tests used to diagnose and monitor people with breast cancer may include:
- Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram
- Breast ultrasound to show whether the lump is solid or fluid-filled
- Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open
- CT scan to check if the cancer has spread outside the breast
- Mammography to screen for breast cancer or help identify the breast lump
- PET scan to check if the cancer has spread
- Sentinel lymph node biopsy to check if the cancer has spread to the lymph nodes
Treatment for breast cancer is personalized for each patient, and is based on a variety of factors, including the type and stage of the breast cancer, whether the cancer is sensitive to certain hormones and if the cancer overproduces the HER2/neu protein. Women typically receive a combination of treatments from a multidisciplinary team, which may include surgery to remove the cancerous tissue, hormone therapy, chemotherapy or radiation therapy to destroy cancer cells.