Definition and Overview

A breast lump is a growth of tissue in the breast that can develop due to infection, trauma, hormonal changes, benign masses, and cancer. An overwhelming number of breast lumps are harmless and do not pose any serious risk to a woman’s health. Most also resolve on their own without treatment.

Breast lumps can vary in appearance and the way they feel. Some present as a swelling that makes the other breast look bigger or fuller than the other while others are accompanied by other breast changes such as pitting of skin, redness, and breast pain.

Although most breast lumps are harmless, women are advised to see a doctor right away if they notice signs of possible breast cancer, which include a breast lump that does not go away within six weeks, fluid or blood seeping out of the nipple, and a nipple that has turned inward.

Diagnostic tests, such as a mammogram, imaging tests, and biopsies are used to determine if the lump is benign or cancerous. Treatment of breast lumps depends on their specific cause.

Causes of Condition

Breast lumps can develop for a wide variety of reasons, including:

  • Injury or trauma to the breast - The breasts have a network of tiny blood vessels that can rupture in case of injury or severe trauma. This can result in localised bleeding that can be felt as a lump. Trauma can also cause damage to the fat cells in the breast tissue that can result in a condition called fat necrosis.

  • Radiation therapy to the chest area

  • Infection, which can lead to the development of fluid-filled sacs in the breast

  • Fibroadenoma, which development is often associated with reproductive hormones. They usually grow in size during pregnancy or when a woman is undergoing hormone therapy. They usually shrink after menopause when hormone levels decrease.

  • Intraductal papilloma - Small, benign tumours that form in the ducts of the breasts. They are common in women ages between 35 and 55.

  • Mastitis - A type of infection that commonly develops when the areola is injured while a woman is breastfeeding. Such injury can create an opening or a gateway for bacteria. Breastfeeding women can also develop a clogged milk duct that can cause the breast milk to build up behind the blockage.

  • Breast cancer - Forms when cancer cells grow out of control and form a tumour.

  • Fibrocystic changes - Fluctuating hormones can sometimes cause fibrocystic changes resulting in breast lumps and pain.

Key Symptoms

Symptoms of breast lumps vary depending on their cause. Generally, however, benign or non-cancerous growths cause temporary symptoms that change with a woman’s menstrual cycle or when there’s change in hormone levels. These include:

  • Breast pain or discomfort

  • Irregular, movable nodules

  • Dense breast tissue

  • Rubber-like texture lumps

  • Round cysts with distinct edges

Malignant breast lumps, on the other hand, cause different signs and symptoms that become apparent when cancer cells begin to form in the breast structure. These symptoms include:

  • A lump that is anchored (not movable) to the deep tissue or skin of the breast

  • An irregularly-shaped lump in the breast or underarm area

  • Red, swollen or scaly breast skin

  • Changes in the shape and size of the affected breast. In many cases, the affected breast looks bigger or fuller than the other.

  • Nipple discharge (fluid or blood)

  • Nipple turning inward

  • Puckering or dimpling of the breast

  • Thickening of the breast

Sometimes, malignant breast lumps can be difficult to distinguish from non-cancerous growths, particularly benign breast cysts and fibroadenomas. For this reason, patients with breast lumps are encouraged to see their doctor right away for diagnosis and prompt treatment, if necessary.

Who to See and Types of Treatments Available

Women with breast lumps can consult a general practitioner (GP), family doctor, or gynaecologist. Such doctors can perform or order the following tests to determine whether the growths are benign or cancerous.

  • Physical examination - During a physical examination, the doctor will determine the location of the abnormal growth and look for any possible signs of breast cancer, including skin changes and nipple discharges.

  • Mammography - The results of the physical examination will determine the need for a mammography. The test uses low-dose x-ray to detect changes in breast tissue, including calcifications and growth of abnormal masses.

  • Ultrasound - This test is often performed to determine whether the lump is a solid mass or cyst.

  • Magnetic resonance imaging - MRI uses a powerful magnetic field to create detailed pictures of the breast structure. It is very helpful in evaluating lumps that cannot be detected by ultrasound or mammography.

  • Biopsy - This test is used to determine whether the lump is malignant or benign. It involves obtaining sample tissue by inserting a special needle in the affected breast. The needle can be guided by x-ray, ultrasound, or MRI.

Treatment of breast lumps can range from simple home remedies to invasive surgeries depending on what causes the condition. Breast infections, for example, are treated with antibiotics and hot compresses. Drainage is also a part of the treatment if the growth has an abscess. In many cases, active surveillance is advised where the patient is monitored and directed to undergo diagnostic tests if they develop new symptoms.

Breast cancer, on the other hand, is often treated with a combination of surgery, chemotherapy, and radiation. Breast cancer patients are treated by a multidisciplinary team of doctors composed of a surgeon, radiation and medical oncologists, nutritionists, and oncology nurses, among others.

Depending on the size and location of the tumour, patients may undergo mastectomy (total removal of the breast) or lumpectomy (breast-conserving surgery). Breast cancer surgery is often followed by radiation or chemotherapy, which goal is to ensure that no cancer cells remain in the body. Patients who have undergone a mastectomy can elect to undergo breast reconstruction procedures.

Breast cancer is the second most common cause of cancer deaths in the United States. However, its mortality rate has been steadily decreasing due to early detection and improvements in cancer treatment.

References:

  • Raftery AT, et al. Breast lumps. In: Churchill’s Pocketbook of Differential Diagnosis. 4th ed. Philadelphia, Pa.: Churchill Livingston Elsevier; 2014. http://www.clinicalkey.com.

  • Fibroadenomas of the breast. American Cancer Society. https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/fibroadenomas-of-the-breast.html.

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