COMMON CAUSES OF BREAST LUMPS
Physiological (normal) swelling and tenderness
This is also known as fibrocystic change or fibroadenosis. Your breasts change throughout your menstrual cycle each month because of your hormones. At least half of all women who have periods will have some pain, tenderness and lumpiness in their breasts at some time in the month. This is usually most obvious in the week before your period. It quickly goes when your period starts. It is more common in women aged 30-50.
Fibroadenoma
This is a benign (non-cancerous) breast lump that usually occurs in women under the age of 40. They occur as a result of excess growth of the glands and connective tissue in the breasts. They usually feel like round, firm, and rubbery lumps. They usually move slightly under the skin when they are pressed. They are not usually painful.
Sometimes they can disappear of their own accord or they can be removed. They tend to go after the menopause.
Breast cysts
A cyst is a fluid-filled lump. Cysts are more common in women approaching menopause, although they can occur at any age. They are usually oval or round lumps that are smooth and firm. They tend to move slightly when pressed. It is common for them to appear within two weeks prior to your period and then resolve soon after the period.
Treatment of breast cysts typically involves draining the fluid in them by using a thin needle inserted into your breast by the doctor. After draining, about 3 in 10 cysts will refill with fluid, but can be drained again.
Infection
A lump caused by infection is fairly common in women who are breast-feeding. The ducts that carry the breast milk can become blocked. Bacteria, or germs, can enter through cracks in the nipple. This can lead to the development of an abscess in the breast. Warm compresses, paracetamol and/or antibiotics may be needed. Infection can also cause lumps in women who are not breast-feeding.
Fat necrosis
Injury or trauma to the fatty tissue in your breast can cause a lump. These lumps usually heal and go away of their own accord. However, if they persist then they can be removed.
Lipoma
A lipoma is a fatty growth that develops within the fatty tissue of your breast. It is non-cancerous and usually does not need any treatment. However, they can be removed if they are large or causing any symptoms.
Breast cancer
The vast majority of breast lumps are not caused by breast cancer. However, breast cancers are a cause of lumps in the breasts. There are separate leaflets called Breast cancer and Breast cancer - hereditary factors
HOW ARE BREAST LUMPS EVALUATED
Physical Examination
A manual examination of the breast is an important screening method for detecting cancer and is the first step in the evaluation of a breast lump. Unfortunately, the manual examination of the breast is not perfect. However, if a mass can be felt manually, it is important to estimate the location of the mass so that the mammogram and/or other diagnostic examinations can focus on the particular area. A doctor also inspects any suspicious skin changes that may be a sign of breast cancer. Since the manual examination can miss breast cancer, mammography is also important as a screening tool.
Mammogram
Women with a breast lump need to have a mammogram of both breasts. A mammogram is estimated to be able to detect about 90% of breast cancers. This means that about 10% of breast cancers are missed by mammography. Therefore, if a woman or her physician feels a lump and the mammogram is normal, further studies or biopsies are carried out to rule out cancer. Sometimes, a certain pattern of calcium deposits appears on the mammogram that makes the doctor suspicious of cancer. In these cases, it is often recommended that a biopsy be taken that is guided by mammogram images to be sure the correct area is sampled.
Ultrasound
Ultrasound is useful in the evaluation of breast lumps. It can distinguish between a cyst (such as a benign cyst, which is filled with fluid) and a solid lump (which may or may not be cancerous). The first step in the evaluation of a breast lump is to determine whether it is a cyst or solid mass, and this is what an ultrasound can do best. Especially in young women, in whom a benign cyst may be suspected, if the woman's ultrasound confirms a typical cyst, she may not require any procedures or biopsies. If it is unclear on the ultrasound whether the lump is completely a cyst, a further evaluation is usually recommended.
MRI
Magnetic resonance imaging (MRI) is becoming more widely used in the evaluation of breast lumps because it is particularly sensitive to small abnormalities in breast tissue. MRI is a special radiology technique designed to image internal structures of the body using magnetism, radio waves, and a computer to produce the images of body structures. Cancers require a greater blood supply than non-cancerous growths, and the images obtained from an MRI may help determine whether a particular area is cancerous because the MRI shows greater contrast in those areas with an increased blood supply. In most cases, MRI is performed if results of mammography and ultrasound evaluations are not conclusive.
MRI also has limitations. For example, MRI cannot detect the presence of calcium deposits, which can be identified by mammography and may be a sign of cancer
HOW CAN A WOMAN BE CERTAIN A LUMP IS NOT BREAST CANCER?
The only one way to be certain that a lump is not cancerous is to have a tissue sampling (biopsy). There are several ways to do the biopsy.
Types of biopsy studies inlcude:
Fine needle aspiration (FNA)
Needle core biopsy
Excisional biopsy
Fine needle aspiration is similar to a blood test in that a needle is inserted and fluid is withdrawn. The fluid and cells are examined by a pathologist for signs of abnormal or cancerous cells.
For some, a needle core biopsy may be performed. In this procedure, a hollow needle is inserted into the suspicious area, and a core of tissue is removed via the needle.
To determine the correct location to sample by either method, the lump can either be felt, or if it cannot be felt, the FNA or core biopsy may be done during an ultrasound or mammogram. FNA of a benign cyst may remove the fluid contents of the cyst and cause the mass to disappear or markedly decrease in size.
If no fluid can be aspirated, and the mass is solid, then a direct tissue sampling must be performed. Tissue sampling using either a core biopsy or an excisional biopsy (removal of all or a portion of the abnormal area in a surgical procedure) is the best method of making an accurate diagnosis. An excisional biopsy is done in the operating room using either local or general anesthesia.
HOW CAN BREAST LUMP BE TREATED?
A breast infection (mastitis) in a breastfeeding woman is treated with warm compresses and antibiotics.
A convenient and effective way of applying heat treatment is to wet some washcloths and put them in the microwave briefly to warm them.
Hot showers are also helpful.
During heat treatment, the infected area can be massaged.
After heat treatment, which helps open up the milk ducts, either nursing the baby or using a breast pump can help relieve the swelling and pain. Contrary to common myth, nursing the baby or using a breast pump is a critical part of the treatment because it helps decrease the chance of the infection progressing.
If the area actually looks red or fails to get better with heat, massage, and nursing, a doctor should be consulted for consideration of antibiotics, because mastitis can progress quickly and develop into a severe infection. Whether a woman is pregnant or not, she needs to see a doctor if the area does not return completely to normal with treatment in order to rule out more unusual types of infections. Cellulitis needs to be treated with antibiotics and frequent follow-ups with the doctor.
An abscess of the breast often needs to be drained by a doctor because antibiotics alone cannot adequately treat an abscess.
Fibroadenomas are usually removed because they are difficult to distinguish from cancer until they are removed.
Breast pain (mastodynia) is a common problem. As long as no mass can be felt by the doctor or patient, and no breast lump is seen on a mammogram or ultrasound, breast pain is often concluded to be a normal condition. It is often thought that this pain is caused by natural hormonal fluctuations. If the discomfort is particularly acute and interferes excessively with a woman's life, oral contraceptives or other medications can be helpful, especially if the pain is worse around the time of the menstrual cycles.
Fibrocystic changes do not require medication or surgery. Often, a baseline mammogram is done. Then, no further treatment is needed unless a new lump arises, in which case an evaluation with a mammogram and possibly ultrasound is necessary.
Breast cancer requires urgent treatment. Treatment depends on the type of cancer detected, its size, and its location
