Lumps in the breasts

Alternative names:

breast mass; fibroadenoma

Definition:

A disorder in which palpable lump(s) are felt in the tissue of one or both breasts. Such breast lumps may be either benign (non-cancerous) or malignant (cancerous).

Causes, incidence, and risk factors:

There are many causes for lumps in the breast including normal physiologic findings. Some lumps are age dependent. Both male and female newborn infants have lumps of enlarged breast tissue beneath the nipple which have been stimulated by maternal hormones. These disappear within a few months of birth.

Beginning as early as 8 years old, girls may develop tender lumps beneath one or both nipples (frequently only one). These lumps are breast buds and are one of the earlier signs of the beginning of puberty. Boys at mid-puberty (usually around 14 or 15 years old) may develop tender lumps beneath one or both nipples, also in response to hormonal changes of puberty. These tend to disappear over a period of 6 months to 1 year. It is also important to remember that hormonal changes just prior to menstruation may cause a lumpy or granular feeling to the breast tissue.

All lumps in the adolescent and adult female breast are not cancer although the discovery of a lump brings that scenario immediately to mind. It is important to remember that 80 to 85% of all breast lumps are benign, especially in women less than 40 to 50 years old. Benign causes include fibrocystic breast changes, fibroadenoma, fat necrosis (damage to some of the fat tissue within the breast), and breast abscess.

Fibrocystic breast disease
(The term "condition" is preferred to "disease" by many providers since it occurs so frequently in the normal population.) The cause is not completely understood but is believed to be associated with ovarian hormones since the condition usually subsides with menopause. The incidence is estimated at over 60% of all women. It is common in women 30 to 50 years old and is rare in postmenopausal women. The incidence is lower in women taking oral contraceptives (birth control pills). Risk factors may include heredity and diet (excessive dietary fat, caffeine intake).

Fibroadenoma
The cause is not known; however, some research suggests that increased fat consumption may play a role. The highest incidence is in women from the teen years into the 20s. Fibroadenomas rarely develop after the age of 30. Single or multiple fibroadenomas may develop in one or both breasts.

Fat necrosis
Trauma is presumed to be the cause. Bruising is occasionally noted near the lump. The area may or may not be tender. The mass may be associated with skin or nipple retraction. A fat necrosis mass cannot be distinguished from breast cancer without biopsy.

Breast abscess
In breastfeeding women, a local breast infection introduced through the nipple may wall off into an abscess. Young to middle-aged women who are not breastfeeding rarely develop subareolar abscesses (located beneath the areola, which is the darker area around the nipple). Potential abscesses in breast tissue other than the subareolar area are excessively rare in nonbreastfeeding women and should be surgically removed and biopsied.

Breast cancer
Breast cancer may occur in men and women, but it is much more common in women. The cause is unknown; however, a number of predisposing factors have been identified. Recent statistics say that one in 8 or 9 American women will develop breast cancer at some point in her life. Risk increases exponentially after the age of 30. The average age of women diagnosed with breast cancer is 60 years old. In general, the rate of breast cancer is lower in underdeveloped countries and higher in more affluent countries (with the exception of Japan where the rate is quite low). In the U.S., Caucasians (especially those of northern European descent) have a higher incidence compared to non-whites. However, the incidence in blacks is increasing particularly in women less than 60 years old.

Other risk factors include: family history of breast cancer, particularly in mother or siblings; past medical history of breast, ovarian, uterine, or colon cancer; menstrual history consistent with early menarche (start of menstruation before age 12) or late menopause (after the age of 50); no pregnancies or first pregnancy after the age of 40; and radiation exposure. Postmenopausal estrogen therapy and oral contraceptive use are considered possible risk factors, but the majority of recent studies do not indicate such risk.