Breast Lumps: Should I Worry?

What are breast lumps?

Breast lumps are masses that develop in the breast. There are some women that can feel small lumps in both breasts. If these lumps are felt throughout both breasts, this is most likely normal breast tissue. Some women experience painful lump in the breast as they go through their menstrual cycle. These lumps form due to extra fluid in the breast, but they eventually subside.

However, you may feel lumps that are large or hard compared to the rest of the breast. Although most lumps are non-cancerous (also called benign masses), they can be a source of worry and anxiety for most women. While breast lumps occur more commonly among women, some men may also experience this condition.

What are the symptoms of breast lumps?

Some of the changes that you may notice include:

• A round, smooth, firm breast lump
• A large, solid-feeling lump that moves easily under your skin
• A hard, irregular-shaped breast lump
• Skin redness or dimpling like an orange
• Changes in breast size or shape
• Fluid leaking from your nipple

Common breast lump causes

Fibroadenomas

A fibroadenoma is a benign (non-cancerous) breast tumour that is firm, smooth, rounded, and moves easily under your skin when touched. Fibroadenomas commonly occur in women in their reproductive years, however the exact cause of these tumours is not known.

Fibrocystic changes

Fibrocystic breast changes feel like fullness in your breasts with areas of lumpiness. Your breasts may also feel tender. These changes are usually related to your menstrual cycles and tend to improve after the menstrual cycle.

Simple cysts

Simple cysts are fluid-filled sacs that usually affect both breasts. They can vary in size, which often changes with your menstrual cycle. These cysts can be treated with fine needle aspiration or they can also go away on their own.

Intraductal papilloma

An intraductal papilloma is a small, wart-like growth in the lining of the mammary duct near the nipple. This usually affects women between the ages of 30 and 50 years and can cause bleeding from the nipple.

Traumatic fat necrosis

Traumatic fat necrosis happens when there is an injury to the breast. This causes fat to form in lumps that are generally round, firm, hard and painless. They usually form one at a time.

When should I be concerned with breast lumps?

Most women worry that their breast lumps are a sign of cancer. Among women aged 40 and younger, 80 – 85% of these breast lumps are not cancerous.

It is important to recognise that breast lumps that could potentially be cancerous so that early treatment could be instituted. Some warning signs of breast cancer include:

• Change in the size or shape of the breast
• Dimpling, redness or scaling of the overlying skin in the breast
• Lumps in the armpit
• Lumps that continue to grow larger
• Lumps that persist even after menstruation
• Nipple discharge
• Pulling in, or inversion of the nipple
• Swelling of a portion of the breast

Breast lump diagnosis

When you consult a doctor for a breast lump, the doctor will first obtain your medical history and perform a thorough physical examination. The doctor may also request for any of the following tests:

• Mammogram – A mammogram uses X-rays to examine the breasts for signs of cancer
• Breast ultrasound – Breast ultrasound uses sound waves to evaluate breast lumps
• Breast magnetic resonance imaging (MRI) – MRI uses magnetic fields and can produce very detailed images of the breast
• Biopsy – A biopsy involves removing a portion of the lump or the entire lump to determine if it is cancerous

Different types of cancerous breast lumps

Cancerous breast lumps can be classified in many ways. The most common classification is based on the specific cell that is affected in the breast.

• Ductal carcinomas. Ductal carcinomas are the most common type of breast cancer. These tumours originate from the milk duct.
• Lobular carcinomas. The second most common type are the lobular carcinomas. These tumours originate from the milk-producing glands (called the lobules) of the breast.
• Angiosarcoma. Angiosarcoma is a rare type of breast cancer. This tumour originates from cells that line the blood vessels or lymph vessels of the breast.
• Paget's disease. Paget's disease of the nipple is also rare. It originates from the breast ducts, but spreads to the skin of the nipple or the skin surrounding the nipple.
• Phyllodes tumours. Phyllodes tumours are rare breast tumours that originate from the connective tissue of the breast. Although majority of Phyllodes tumours are benign, 10% are cancerous.

Breast cancers can also be classified based on whether they have spread.

• In situ breast cancer. In situ breast cancer refers to tumours that have not yet spread into the surrounding breast tissue.
• Invasive breast cancers. These are tumours that have already invaded or infiltrated the surrounding breast tissue.

What are the treatment options for cancerous breast lumps?

The treatment options for cancerous breast lumps depends on the type of breast cancer and the extent of spread of the cancer. The available treatment options include:

• Lumpectomy – A lumpectomy involves the removal of only a portion of the breast.
• Mastectomy – A mastectomy involves the removal of the entire breast.
• Quadrantectomy – Quadrantectomy, also called partial mastectomy, involves the removal of one quarter of the breast and some surrounding muscles.
• Drug therapy – There are various drugs currently in use for breast cancer. These drugs include chemotherapy, hormone therapy, and targeted drug therapy.
• Radiation – Radiation therapy involves using high levels of radiation to kill cancer cells.

Can breast lumps recur?

Breast lumps can recur months or years after treatment. If you had breast surgery, you may feel lumps that are caused by scar tissue. However, a recurring lump can also be due to recurrence of breast cancer. Cancerous breast lumps may recur in the original site or in a different area of the breast.

When to see a doctor for breast lump?

It is best to consult a doctor if you experience any of the following:

• Breast lump with any warning sign of breast cancer
• Breast lump that recurs after treatment
• Breast lump in individuals with family history of breast cancer or in individuals greater than 40 years old

A general surgeon can evaluate your breast lump and give your advice if further tests are needed.