What Are Breast Lumps?

Overview

Have you ever noticed a lump in your breast? A lesion found through self-examination or standard breast cancer screening is a palpable breast mass (a mass that can be felt through touch). Even though eight out of ten breast lumps are benign (not harmful/cancerous), show no symptoms and only a small percentage of them are malignant, early detection and effective care are crucial for recovery. Always have your breast checked by a general physician if you notice a lump there.¹

This article will cover the causes, clinical symptoms, diagnosis, management and treatment of breast lumps.

Causes of breast lumps

Palpable breast lumps can have various causes, including inflammatory, neoplastic, or idiopathic causes, such as breast cysts or abscesses. Benign breast tumours and breast cancer are neoplastic causes of breast lumps. You should remember that not all breast lumps are signs of breast cancer.

• Fibrocystic changes - They are common benign changes seen mostly in premenopausal women, frequently leading to many lumps or cysts. These lumps can be tender and may change in size during the menstrual cycle.²
• Cysts - They are sacs packed with fluid that can form in the breast tissue. Usually benign, they feel like smooth, rounded, moveable bumps. Cysts' size and tenderness might change over time.
• Fibroadenomas - They are benign tumours made of connective (responsible for shape and holding everything in place) and glandular (responsible for milk production) tissue. They typically look like rubbery, smooth, firm, easily movable masses. Women of any age can develop fibroadenomas, although those in their 20s and 30s are more likely to do so. After a woman goes through menopause, they frequently shrink.
• Trauma or injury - A breast injury, such as a bruise or hit, may occasionally lead to a lump formation.
• Infections in the breast tissue, such as mastitis, can result in localised areas of swelling or painful lumps. These are especially common in breastfeeding women. Breast infections are common during breastfeeding and it requires prompt and effective treatment.³ The development of an abscess is a potential complication of mastitis.³
• Breast cancer -  While most breast lumps are benign, breast cancer can also manifest as a lump in the breast. However in this case a lump feels firm, is unevenly shaped, and is fixed (not easily movable).

Signs and symptoms of breast lumps

If you have a health issue that affects your breasts, you may notice differences in how they usually feel. These may include:

• Breast contour, size, or form alterations: Look for changes in the breast's contour, size, or shape. This could involve breast enlargement, bulging, or indentation.
• Changes in the skin of the breast, such as redness, warmth, puckering, dimpling, or the development of an orange peel texture (peau d'orange), should be noted.
• Changes in the nipple: Look for nipple inversion (pushing inward), flattening, or a change in position. Nipple discharge should also be observed, especially if there is any blood. Changes in the nipple area could be due to a genetic abnormality, but when the nipple becomes inverted, it may be a warning sign of malignancy.
• Most breast lumps do not cause discomfort, but some people may experience pain, tenderness, or aching in the breast or the surrounding area.
• Axillary (armpit) lymph node enlargement: Examine the lymph nodes in the armpit for swelling or pain. Some individuals with breast cancer that travels to the lymph nodes may not have any symptoms or structural abnormalities in the breast, but they may feel something strange beneath their arm. This could indicate that cancer from the breast has spread to the axillary lymph nodes in the armpit.
• Persistent breast changes: Any breast alterations that continue after your monthly cycle should be checked by a healthcare practitioner.

Remember that having any of these signs and symptoms is not always a sign of breast cancer. However, if you detect any changes in your breasts, you must get medical attention to identify the cause and receive proper treatment.

Diagnosis

Diagnosis of the breast lump includes a medical history review, physical examination, imaging studies, and biopsy if necessary.¹ 

• The first step is the examination of the patient's symptoms, medical history, and family history of breast cancer.¹ 
• Then a physical examination is performed to check for lumps, changes in shape or texture, and other breast abnormalities. 
• To further analyse the lumps and surrounding breast tissue, imaging procedures such as mammograms, ultrasounds, and, in certain situations, MRIs are used.¹ These tests help determine whether the lump is solid or fluid-filled and provide important information for diagnosis. Mammography is the first-line imaging for women over the age of 35 who have a new breast mass.^1,4 In younger women and men, ultrasound imaging is preferred  over mammography because their breast tissue is denser and contains a lower proportion of fatty tissue.⁴
• A biopsy may be done if a suspicious mass is discovered. Pathologists examine the biopsy sample under a microscope to determine whether the lump is benign or cancerous. Based on the results, other procedures such as genetic testing or more imaging may be required.

Management and treatment for breast lumps

Treatment for a new breast lump is chosen by its cause, the patient's physical health and personal preferences.

Breast cancer treatment options commonly include surgery, chemotherapy, radiation therapy, hormone therapy, and immunotherapy.⁵

Benign breast masses are managed based on their specific causes:

• Breast cysts: Simple cysts generally resolve on their own without the need for medical intervention. However, if the cyst persists or is bothersome, cyst aspiration may be considered, however, recurrence is possible.
• Fibroadenomas: These benign tumours frequently involute (go back to their original state) if left untreated. Surgical consultation may be indicated if they are large, painful, or distressing. Diagnostic confirmation through excision biopsy may be necessary in cases of diagnostic uncertainty.⁶
• Fat necrosis and hematomas usually need pain management and monitoring. If the mass is causing considerable pain or cosmetic concerns, surgical consultation may be considered.⁷
• Breast abscesses: To eliminate the cause of infection, surgical incision(cut made on the skin to perform surgery) and drainage are usually required. Smaller abscesses may be treated with oral antibiotics and needle aspiration, however, bigger or multiloculated abscesses can require intravenous antibiotics (antibiotics administered directly into the vein) and surgical or radiological drainage.⁸
• Gynecomastia: Evaluation focuses on determining the underlying cause, and if no cause is established, referral to endocrinology is indicated.⁹
• Mastitis: The conventional treatment is antibiotic therapy, with the drug chosen based on the causing bacteria and antibiotic resistance profile. Treatment typically lasts 7 to 14 days.¹⁰

FAQs

How can I prevent breast lumps?

While it is impossible to prevent all breast lumps, there are steps you may do to improve breast health. Schedule periodical clinical breast exams with your healthcare professional and perform regular breast self-exams.¹¹ Do regular mammography screenings. Follow a healthy lifestyle, including a well-balanced diet, regular exercise, and moderation in alcohol consumption. Seek genetic counselling and testing if necessary. Breastfeeding, if possible, may provide protective benefits.¹² 

How common are breast lumps?

Breast lumps are relatively common and affect many women at some point in their life. Breast lumps occur at varying rates depending on factors such as age and specific risk factors.

Do breast lumps go away on their own?

Breast lumps occasionally disappear on their own, especially if they are benign. Some solid lumps like fibroadenomas and some fluid-filled cysts may gradually shrink or go away. 

Are breast lumps cancerous?

Breast lumps do not always indicate cancer. In reality, the majority of breast masses are benign (non-cancerous). Various conditions, including fibrocystic alterations, cysts, fibroadenomas, or infections, might result in benign breast lumps. However, it is crucial to remember that some breast lumps can be malignant. 

Who is at risk of breast lumps?

Breast lumps can affect people of any age or gender, but specific factors can make it more likely. People assigned females at birth have a higher chance of developing breast lumps due to hormonal changes. Older individuals are also more likely to have a breast lump. A  family history of breast cancer or specific genetic abnormalities also puts you in the high-risk group. The growth of a breast lump may be influenced by hormonal events such as puberty, pregnancy, and menopause. Use of hormone replacement therapy (HRT) for an extended period may potentially raise the risk. 

When should I see a doctor?

See a doctor, if you observe any new or disturbing changes in your breasts, such as:

• Finding a new lump or a thickening under the arm or in the breast.
• Changes in the breast's size or appearance.
• Nipple discharge, especially if it is bloody and not breast milk.
• Pain or discomfort unrelated to your menstrual cycle
• Skin changes, such as redness or dimpling appear on the breast
• Any other alarming breast symptoms or anomalies.

Summary

Breast lumps are abnormal growths in the breast tissue. They can be benign or malignant. Benign breast lumps are more common and can be caused by several reasons such as fibrocystic changes, cysts, fibroadenomas, or infections. These lumps are usually not life-threatening and do not need treatment. Not all breast lumps are malignant, and many benign lumps are completely harmless. Any new breast lump should be evaluated by a physician. Imaging (mammograms, ultrasounds) and biopsies are performed to assess the nature of the mass and, if necessary, treatment is provided. Early identification and immediate medical intervention are essential for properly managing breast lumps.