Breast lump
Alternative names:
lump in the breast
Definition:
A localized swelling, protuberance,
or bump in the breast.
Considerations:
A lump in the breast has different significance at different
ages and for different sexes. Since some lumps and some changes
are considered normal, understanding the structure of the
breast and how it functions may help eliminate some concerns.
The first lump to concern parents is often the lump found
beneath the nipple of the newborn infant. This is true breast
tissue that is enlarged in response to circulating maternal
estrogens and will decrease over subsequent months as maternal
estrogen effects decrease. The breast
enlargement may be found in both male and female infants
and is not only normal, but expected. The size of the breast
is used in evaluating how close to term the newborn infant
is.
The next most worrisome lump is that found in girls, often
as young as 6 years old. A "breast bud" generally heralds
the onset of puberty. They most often are discovered around
9 years of age. Often only one breast is involved or if both
are involved, one side is larger than the other. The breast
may be tender to pressure. This is the normal development
of puberty and should not cause the parents or child any distress.
A major source of concern is tender breast enlargement with
a lump beneath the nipple found in adolescent boys. The enlargement
may be small or fairly significant. This is called gynecomastia
and is common in boys during mid-puberty. It is a response
to changing hormones and resolves over a period of months.
Significant enlargement may be psychologically stressful for
the individual. Treatment consists of reassurance and time.
Only rarely is surgery necessary because of persistence of
the gynecomastia or severe psychological trauma.
The last cause of concern is finding a lump in the mature
female breast. Every lump in a mature woman's breast should
be checked out by the health care provider. Although most
are not dangerous (less than one-fourth of all breast lumps
are found to be cancerous), early diagnosis and treatment
of breast cancer greatly
improves the chance of a good outcome. Fortunately, more women
are learning how to perform a breast
self-exam and lumps are being found and diagnosed earlier.
Some of the causes of lumps in a mature woman's breast are
discussed below.
Benign fibrocystic changes,
which can occur in one or both breasts, are frequently noted.
Benign lumps are usually rounded with smooth borders, either
rubbery or slightly fluctuant (able to be dented or changed
in shape), and not anchored. There is often an associated
nipple discharge that
occurs only after manipulation of the nipple. The discharge
is milky looking, and often can be expressed from both breasts.
A fibroadenoma, which
is a benign tumor that
can be felt very easily, is the most common tumor found in
female breasts. They occur most often among women who are
in their reproductive years. They are not tender and they
do not usually become malignant. Most of the time there is
only one lump, however, there are cases that involve multiple
lumps and in a few of these cases, lumps are found in both
breasts. A physician can usually diagnose a fibroadenoma by
palpating (feeling) the breast. Although fibroadenomas are
usually harmless, surgical removal is still recommended. There
are two main reasons for this recommendation. Unless the tumor
is removed and studied under a microscope, there is no way
to guarantee that it is not cancerous, and although the lump
does not involve the breast tissue, it may grow large and
cause the breast to be malformed.
Fibrocystic disease, which is characterized by a number of
small cysts (fluid filled
sacs surrounded by fiberous tissue), is also common and occurs
most frequently during the reproductive years. Usually, both
breasts are involved. Tendernous is frequently associated,
especially just before the menstrual period begins. Needle
aspiration (withdrawal
of fluid from the cyst(s))
is used to diagnose and treat this disease and can be performed
in the doctors office. If the fluid that is withdrawn is brownish
or yellowish and contains no blood, and the lumps disappear
after the procedure is completed, no further study is necessary.
An intraductal papilloma
is a small growth inside a duct of the breast. It is harmless
and frequently cannot be felt. In some cases the only symptom
is a watery, pink discharge from the nipple. Since a watery
or bloody discharge can be associated with cancer
(very rarely), a microscopic examination of the fluid, and
usually a mammogram are
recommended to rule out the possibility. Surgical removal
is recommended.
On occasion, an injury to the breast will cause a hematoma.
This is characterized by a bruised area on the skin with an
associated lump underneath. This lump is a blood
clot formed by the collection of blood in the traumatized
area. The area may swell and be tender, but should slowly
return to normal. This may take a few days or a few weeks,
depending on the injury. If the blood clot is not being reabsorbed
(if you don't notice improvement) and a lump or fluid-filled
sac is forming, surgery may be indicated to remove the lump
or drain the fluid.
Regarding breast cancer:
While less than 20% of breast nodules are life threatening,
the clinical signs of breast cancer are not easily distinguished
from those of benign breast
disease.
Breast cancer is a leading cause of death among women but
can occur occasionally in men, with signs and symptoms similar
to those found in women. Therefore, breast lumps in both women
and men should always be evaluated by a health care provider.
Most of the associated risk factors for breast cancer cannot
be controlled. However secondary prevention--early detection
and appropriate treatment early in the disease process--may
be accomplished through routine breast
self-examination and screening mammography
after age 40.
The great majority of all breast cancers are discovered by
women themselves. This is done by careful breast self-examination
that takes some practice. The American Cancer Society distributes
booklets demonstrating the proper technique (see cancer
- support group).
Potentially malignant breast lumps (cancer) may be accompanied
by spontaneous nipple discharge from a single duct in one
breast. However, discharge only occurs with about 4% of breast
cancers.
As a rule, first mammograms should begin between age 35 and
40, then repeated every 2 years between ages 40 and 50, and
annually thereafter. Studies are currently underway that may
change these recommendations.
A good breast self-examination technique, regular medical
evaluations, and mammography provide the best chance of finding
a breast malignancy early
enough in the disease to cure it.
Staging is a means to categorize the severity of a tumor.
The clinical stage of breast cancer is the best indication
of the likely outcome. Five-year survival rates (the number
of people who live for at least 5 years after diagnosis) for
people with breast cancer who receive appropriate treatment
are approximately:
- 85% for stage 1
- 66% for stage 2
- 41% for stage 3
- 10% for stage 4
When the lymph nodes in the armpit (axillary nodes) are involved,
the survival rate drops to approximately 40 to 50% at 5 years,
and probably less than 25% at 10 years depending on the number
of nodes involved.
Common causes:
Note: There are other causes of a breast lump. This list
is not all-inclusive, and the causes are not presented in
order of likelihood. The causes of this symptom can include
unlikely diseases and medications. Furthermore, the causes
may vary based on age and gender of the affected person, as
well as on the specific characteristics of the symptom such
as location, quality, time course, aggravating factors, relieving
factors, and associated complaints.
Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
editorial
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