Breast lumps

What is a breast lump?

A breast lump may be a non-cancerous (benign) growth (such as cysts) or infection - it is not always a sign of breast cancer. You should make an appointment with your GP as soon as possible if you find a breast lump. They will then decide if you need referral to a specialist breast clinic for further tests.

Breast lump causes

There are many causes of breast lumps. The most common causes are:

• Normal swelling and tenderness during the menstrual cycle.

• Fibroadenoma.

• Breast cysts.

• Infection (for example, an abscess).

• Fat necrosis.

• Lipoma.

• Breast cancer.

Normal (physiological) swelling and tenderness

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.

When this pain and lumpiness cause problems, the condition is known as fibrocystic breast change. Pain and lumps (nodules) may occur which are severe enough to need checking by a doctor. It is more common in women aged 30-50.

Fibroadenoma

This is a non-cancerous (benign) breast lump that usually occurs in women under the age of 40. It is most common in women in their 20s. It is the most common type of benign breast lump.

These lumps 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 sac. 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 to go away (resolve) soon after the period.

Cysts cannot turn into cancer and do not always need treating once the diagnosis has been confirmed. Where treatment is needed, it typically involves draining the fluid from the cyst. This is done by using a thin needle inserted into your breast by the doctor. After draining, some cysts will refill with fluid but can be drained again. Usually this is done by a specialist doctor in a breast clinic.

Infection

A lump caused by infection is fairly common in women who are breastfeeding. The milk ducts can become blocked and germs (bacteria) can enter through cracks in the nipple. This can lead to the development of a collection of pus (an abscess) in the breast. Warm compresses, paracetamol and/or antibiotics may be needed. Infection can also cause lumps in women who are not breastfeeding.

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 over time. 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. These types of lumps are not cancerous and usually doesn't need any treatment. However, it can be removed if it is 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.

See the separate leaflet called Breast Cancer for more details.

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What should I do if I find a breast lump?

If you find a lump in one of your breasts, you should make an appointment with your GP as soon as possible. When you see your GP, they may start by asking you some questions. It is a good idea to think about these questions before your appointment.

Questions may include:

• When did you notice the lump?

• Do you have any breast pain?

• Do you have any nipple discharge?

• When was your last period (if you still have them)?

• Are you taking a hormone medication such as the contraceptive pill or hormone replacement therapy (HRT)?

• Have you had breast lumps before?

• Do you have any history of breast problems in your family?

Breast examination

Your doctor may then suggest that they examine your breasts. A doctor should always offer for a chaperone to be present during the examination. If they do not offer one you can ask for a chaperone to be present if that helps you feel more comfortable.

You will be asked by the doctor to remove your top and bra. They may want to examine your breasts, with your arms in the air and then by your sides. They may also want to examine your breasts when you are sitting and then lying down. They may also want to examine underneath your arms to feel for any enlarged lymph glands. Your doctor may ask you to point out the lump to them. If you have had any nipple discharge, your doctor may ask you to demonstrate this yourself by asking you to squeeze your nipple.

There is more than one right way to examine the breasts and doctors may differ in their approach.

What happens after the breast lump has been examined?

This will depend on what your doctor finds when they examine you. If you are under 30 years old, are still having periods and have only just noticed the lump, your doctor may suggest that you return for another examination after your next period.

In most cases, the doctor will suggest they refer you to a specialist breast clinic. Here you will see a doctor who has special expertise in dealing with breast problems. This is to check that your lump is not cancer. Most breast lumps are NOT cancer but it is important to be certain by doing some tests.

You can usually expect an appointment at the clinic within a short space of time. However, waiting times can vary depending on how busy the clinic is and how urgent your GP feels the problem is. The aim is that any woman with a breast lump should be seen in a specialist breast clinic within two weeks. If your doctor feels that you are more likely to have one of the non-cancerous (benign) causes of a breast lump, it may take longer than two weeks for you to be seen.

What to expect if you are referred to a breast clinic

Usually there is a specialist breast nurse who works in a breast clinic. This nurse may be present during your appointment with the doctor and is usually available for any questions afterwards. In some clinics, the specialist nurse runs the clinic and you may only see the nurse.

In most clinics you will firstly be asked about your symptoms. You may be given an information sheet to fill out. This may include some of the questions that are listed above. After this, the breast specialist doctor or nurse will examine your breasts in a similar way to the examination by your GP. They may then suggest that you have some further tests.

These can include a mammogram or an ultrasound scan of your breast (see below). Often investigations are carried out on the same day that you attend the clinic. Sometimes you may be given an appointment to come back for a test.

The breast specialist may also suggest that they take a sample (biopsy) of the lump. There are two common ways of doing this, either by fine-needle aspiration or a core biopsy:

• Fine-needle aspiration cytology (FNAC) is a procedure where a small, fine needle, with a syringe connected to it, is used to take a sample of breast cells from the lump.

• For a core biopsy, a larger needle is used to take a sample of tissue from your breast lump.

They are both straightforward procedures. Sometimes ultrasound scanning is done to guide the procedure. The specialist uses the scan to identify exactly where the lump is so that they can take the sample. The sample may be taken on the same day in the breast clinic or you may be given an appointment to come back for the procedure.

Other advice

If you do have to go back to a breast clinic to receive your results, it may be a good idea to take a partner, relative or friend with you. In this way you will have someone present to help you remember what has been said and to give you support if you need it. However, remember that for many people who have these tests, the results show that they do NOT have cancer. They may have one of the non-cancerous (benign) breast problems that are discussed above.

You should also remember that even if your tests do come back as benign, you should still continue to be vigilant and be breast-aware. If you feel anything in your breasts that is not normal for you, see your doctor as soon as possible.