Breast lump

Introduction
Symptoms
Causes
Diagnosis
Treatment
Prevention
How should I check my breasts?
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Introduction

Breast lumps are a common condition and have a number of different causes. While most lumps are not breast cancer, any unusual changes to the breasts should be checked by a GP as soon as possible.

The breast

The female breast is a complex gland that is made up of several different types of tissue. Each breast contains milk glands and milk ducts for transporting milk. These structures can increase or decrease in both size and number as and when they are needed.

For example, during pregnancy the milk ducts in the breasts will grow and the breasts will get larger. During breastfeeding, the breasts may change size several times throughout the day as milk is produced and the baby feeds.

The breast is also made up of:

fibrous connective tissue
fatty tissue
nerves
blood vessels
lymph nodes (small oval-shaped glands that remove unwanted bacteria and particles from the body)

Each type of tissue and structure within the breast reacts differently to changes in the hormone levels in the body. Hormones are chemicals that can affect both the sensitivity and texture of the breast.

How common are breast lumps?

Breast lumps are quite common. Every year in the UK, about 3 in every 100 women visit their GP regarding a problem with their breasts. Most breast lumps, about 9 out of 10, are benign (non-cancerous).

There are several types of benign breast lump (see Breast lump - causes). They can vary in appearance or texture depending on the type. Most breast lumps are caused by hormonal changes that occur at different times in a woman’s life, such as during the menstrual cycle when a woman gets her monthly period.

Outlook

Most benign breast lumps will not require any treatment. However, it is very important that you visit your GP as soon as possible if you notice any changes to your breasts.

If your breasts are painful, medication can help ease the pain. In some cases, surgery may be required to remove a large growth, although this is not usually necessary.

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Symptoms

Depending on the underlying cause, the way breast lumps look or feel can vary. Some breast lumps may also cause other symptoms.

Types of breast lumps

Common types of breast lumps include:

fibroadenosis
fibroadenoma
breast cysts
breast abscesses

These types of breast lumps and their symptoms are explained below.

Fibroadenosis

Fibrocystic breast disease, also known as fibroadenosis, is a term used to describe a group of benign (non-cancerous) conditions that affect the breast. The symptoms of fibroadenosis include:

breast pain (mastalgia)
breast enlargement
lumpiness of the breast (nodularity), particularly just before or during a period

Fibroadenosis can develop in one or both breasts, or can affect just part of one breast. The symptoms can also vary significantly between women, with some women finding them slightly annoying and others finding them very painful. The pain and lumpiness will usually disappear after your period.

The cause of fibroadenosis is not well understood. However, it may be the result of the breast tissue responding abnormally to hormonal changes that occur with the menstrual cycle.

Fibroadenoma

A fibroadenoma is a smooth, well-rounded solid lump (tumour) that sometimes develops outside the milk ducts. Milk ducts are the tiny tubes in the breast that carry milk.

Fibroadenomas are made up of fibrous and glandular tissue, which has a rubber-like texture and moves easily when touched.

A fibroadenoma will sometimes disappear, but it can remain and grow larger, particularly during pregnancy.

Breast cyst

A breast cyst is a fluid-filled sac that develops within the breast tissue and may feel like a soft grape. Breast cysts are very common and normal. Cysts form as a natural part of the ageing of breast tissue and are most commonly found in women aged 35-50 years.

Cysts vary in size. Some can be very tiny, while others can grow up to several centimetres in diameter. Single or multiple cysts can occur in one or both breasts.

Cysts often do not cause any symptoms, although some women may experience pain, particularly if the cyst increases in size during the menstrual cycle. They do not significantly increase the risk of breast cancer developing.

Breast abscesses

A breast abscess is a painful collection of pus that forms under the skin of the breast. It can also cause:

a high temperature (fever) of 38°C (100.4°F) or above
inflammation (redness and swelling)

See the A-Z topic about Breast abscess for more information about this condition.

Is a breast lump serious?

While you should always see your GP about any changes to your breasts, benign (non-cancerous) breast lumps:

should not increase your risk of developing breast cancer in the future
will not turn into breast cancer

Some breast lumps, such as breast abscesses, can be painful and others, such as fibroadenomas, may feel quite large. However, most breast lumps do not require any treatment.

When to see your GP

You should see your GP if you notice any changes to your breasts such as:

a lump or area of thickened tissue in either breast
discharge from either of your nipples (which may be streaked with blood)
a lump or swelling in either of your armpits
a change in the size or shape of one or both of your breasts
dimpling on the skin of your breasts
a rash on or around your nipple
a change in your nipple’s appearance, for example, if it becomes sunken into your breast
pain in either of your breasts or armpits that is not related to your period

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Causes

There are several different causes of benign (non-cancerous) lumps and breast pain, including the following:

mastitis (inflammation of the breast): this can be either breastfeeding mastitis or non-breastfeeding mastitis
nipple discharge (galactorrhoea)
dilated milk ducts: milk ducts are the tiny tubes in your breast that carry milk
trauma to the breast due to injury
scarring of the breast from past surgical procedures
fibrocystic breast disease (fibroadenosis): a benign growth in the breast that causes lumpiness and tenderness, and is most common in pre-menopausal women (women who are still having periods)
a fibroadenoma: a small tumour (growth) in the breast that is more common in young women, such as those in their twenties
a cyst (fluid-filled lump): these are most common in pre-menopausal women and those who take hormone replacement therapy
fat necrosis: a hard, irregular lump that is often caused by trauma or bruising to the breast, for example, following breast-reduction surgery
a lipoma: a fatty growth that causes a lump
a breast abscess: a painful collection of pus under the skin
an intraductal papilloma: a benign growth in a milk duct, which may also cause nipple discharge
a haematoma (blood clot)

Breast pain can also sometimes be caused by your menstrual cycle. This is known as cyclical breast pain. Breast pain that is not associated with your menstrual cycle is sometimes referred to as non-cyclical breast pain.

Hormones

Hormonal changes are the most common cause of benign breast lumps. Hormones are chemicals that are produced by the body and have a wide range of effects. Sometimes changes in the levels of hormones in your body can cause your breasts to feel lumpy or swollen.

Hormonal changes can occur:

in teenagers
during the monthly menstrual cycle
during the menopause, which is when a woman’s periods stop
if you take the oral contraceptive pill, which contains artificial versions of female hormones
if you take HRT, which is treatment that is used to replace the female hormones that a woman’s body is no longer producing because of the menopause

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Diagnosis

It is important to be aware of what your breasts normally look and feel like so that you can quickly pick up any changes which may occur.

If you find a lump on your breast or any change in its appearance, feel or shape, inform your GP as soon as possible.

Your GP may ask you a number of questions, including:

when you first noticed the lump
whether you have any other symptoms, such as pain or a discharge from your nipple
whether your symptoms change with your menstrual cycle
whether you have ever injured your breast
whether you have any risk factors for breast cancer, such as a close family member who has previously had breast cancer
what medications you are currently taking
whether you are currently breastfeeding or whether you have done so in the past

Your GP will carry out a physical examination of both of your breasts, including the lump, and may refer you for further tests. Some of the tests that you may have are explained below.

Mammogram

A mammogram is a simple procedure that uses X-rays to create an image of the inside of your breasts.

A mammogram can help identify early changes in your breast tissue. Younger women usually have denser breasts than older women, which makes changes more difficult to identify. Therefore, mammograms are not as effective in women who are under 35 years of age. If you are under 35, your GP may suggest that you have a breast ultrasound instead (see below).

If you need to have a mammogram, a radiographer (an X-ray specialist) will position one of your breasts on a flat X-ray plate. A second X-ray plate will press down on your breast from above, so that it is temporarily flattened between the two plates. An X-ray will then be taken, which will produce a clear image of the inside of your breast.

After the first X-ray has been taken, the same procedure will be carried out on your other breast.

A mammogram only takes a few minutes to carry out. You may find it a bit uncomfortable or even slightly painful. After the procedure is complete, the mammogram (the image of your breast) will be examined for anything unusual.

Ultrasound

If you are under 35 years of age, a breast ultrasound may be recommended because your breast tissue may be too dense for a mammogram. Your doctor may also suggest that you have a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. An ultrasound probe or sensor will be placed over your breasts to create an image on a television screen. The image will highlight any lumps or abnormalities that may be present in your breasts.

See the A-Z topic about Ultrasound scans for more information about this procedure.

Biopsy

You may need to have a breast biopsy if the cause of your breast lump cannot be diagnosed using a mammogram or ultrasound. A biopsy is a procedure that involves removing a tissue sample from the lump for further testing.

During a biopsy, a fine needle will be inserted into the lump in your breast so that a sample of tissue can be removed. The sample will then be examined under a microscope to confirm the diagnosis.

See the A-Z topic about Biopsy for more information about this procedure.

Ductogram

A ductogram is sometimes used to investigate nipple discharge. Dye is injected into the milk ducts, which are the tiny tubes that carry milk, to ensure that they are clearly visible when an image is taken using a mammogram (see above).

A ductogram can be used to help diagnose a problem with your ducts, although most specialist breast units do not use this test.

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Treatment

In most cases, a benign (non-cancerous) breast lump does not need any treatment unless the lump is particularly large or painful. After diagnosing the cause (see Breast lump - causes), your GP will advise you about any treatment that is necessary. If treatment is not necessary, you may be asked to return if you notice any further changes to your breasts.

Breast pain

You should visit your GP as soon as possible if you experience breast pain. They will be able to carry out a physical examination and, if necessary, refer you for further tests.

See the A-Z topic about Cyclical breast pain for more information about treating breast pain that is related to your menstrual cycle.

If your breast pain is not related to your menstrual cycle, you can ease the pain by:

wearing a well-fitting bra to support your breasts
using simple painkillers, such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs)

When using painkillers you should always check the instructions on the packet or the patient information leaflet to make sure the medication is suitable for you and to find out the correct dose.

Danazol

Danazol is a medication that can be used to treat the pain that is associated with benign fibrocystic breast disease (fibroadenosis), if other treatments have been unsuccessful.

Danazol is only available on prescription and usually comes as a capsule to be swallowed. It is not suitable for pregnant or breastfeeding women and can cause some side effects such as:

feeling sick
dizziness
a rash
weight gain

Other treatment methods

Some experts have suggested that breast pain may be improved by reducing your intake of:

caffeine, which is found in tea, coffee and cola
saturated fat, which is found in butter, crisps and fried food

However, the benefits of making these dietary changes have not been proven.

Surgery

If a lump in your breast has been diagnosed as benign it will not usually need to be removed. However, if a lump is large, growing or is causing other symptoms, you may need to have surgery. For example, you may need surgery if you have:

Fat necrosis, which causes a hard irregular lump that may be removed if it continues to get bigger.
Intraductal papilloma, which is a benign growth in a milk duct (the tube that carries milk). The affected ducts may be removed if they continue to cause nipple discharge or inflammation.

Fibroadenomas

Some women decide to have a fibroadenoma (tumour) surgically removed, particularly if it is large. The surgical procedure to remove a lump in your breast is called a lumpectomy and may be carried out under general anaesthetic. This is painkilling medication that makes you unconscious.

An alternative method to remove a fibroadenoma is to destroy it with a laser (a high-energy light beam). The procedure is carried out under local anaesthetic, which means you will be awake. The laser is inside a fibre which is inserted through a needle and positioned inside the lump. Waves of light are then passed through the fibre to destroy the lump.

The safety and effectiveness of using lasers to treat breast lumps is still uncertain, and one study reported that most women found it painful. The National Institute for Health and Clinical Excellence (NICE) has stated that laser therapy for fibroadenomas should only be carried out within specialist breast services and with proper monitoring.

Breast cysts

A small needle and syringe is sometimes used to draw out the fluid from breast cysts. This is called aspiration. After the cyst has been drained the lump usually disappears. The fluid may be sent to the laboratory for examination under the microscope.

Sometimes, breast cysts that have been drained can refill, or you may develop a new cyst somewhere else. You should always visit your GP if you notice any changes to your breasts, such as a cyst refilling. The cyst can be drained again, but if it keeps refilling you may need to have surgery to remove it.

Breast abscesses

A breast abscess is a painful collection of pus that can be treated by making an incision (cut) into the abscess and draining out the pus.

See the A-Z topic about Breast abscess - treatment for more information.

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Prevention

Most breast lumps cannot be prevented because they are caused by hormonal changes that you have no control over. However, it is very important that you identify a breast lump as soon as it develops and get it checked by your GP to rule our breast cancer.

Be breast aware

The Welsh Government recommends that women should be ‘breast aware’ and encourages them to check their breasts regularly. Breast aware means being familiar with your breasts and what is normal for them so you can recognise any changes easily and quickly.

If you notice a lump on your breast you should have it checked by your GP as soon as possible.

Be breast aware

You should be aware of how your breasts normally look and feel at different times. You will then be able to notice any changes in the shape or texture of your breasts, or whether you develop any signs or symptoms, such as a lump. The advice below may help you to become ‘breast aware’.

You can feel your breasts while lying down in bed or in the bath or shower using a soapy hand. Using body lotion can help. It is important to feel the whole breast, including the armpit.
You can look at your breasts in the mirror. Move your arms above your head, onto your hips or by your sides so you can see your breasts from every angle, including the underside.
As older women are at greater risk of developing breast cancer, it is very important to be aware of any unusual changes after the menopause (when your periods stop).
Breasts may change with age and life events, such as pregnancy, breastfeeding, during your periods and after the menopause. This is why it is important to know what is normal for you so you will recognise any changes.

Screening

Regular breast screening is also very important because it will help detect any small changes before you have other signs or symptoms. Screening is a way of identifying people who may have an increased risk of developing a certain condition.

For breast cancer, screening is carried out using mammograms. This is a procedure that uses X-rays to produce an image of the inside of your breasts. See Breast lumps - diagnosis for more information about mammograms.

The NHS Breast Screening Programme provides free breast screening every three years for all women in the UK who are 50 years of age or over.

NHS breast screening is not usually available for younger women (those under 35 years of age) because mammograms are not as effective for this age group. Breast cancer also tends to be uncommon in young women.

You should speak to your GP if you are below the screening age and you are concerned about changes in your breasts or you have a family history of breast cancer.

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How should I check my breasts?

The most important thing is to know how your breasts normally look and feel. Check your breasts regularly, so you can spot any changes quickly. A lump can be an early sign of breast cancer.

There’s no set way to check your breasts. And you don’t need to check them at the same time each month.

Be breast aware

Every woman's breasts are different, and many women have one breast bigger than the other.

Get used to how your breasts feel at different times of the month. Remember this can change during your menstrual cycle.

For a few days before your period, the milk-producing tissue in your breast is active. Some women find this makes their breasts tender and lumpy.

After the menopause, this tissue is no longer active, and normal breasts feel soft, less firm and not lumpy.

How they look

Look at your breasts to see if their size, outline or shape has changed, particularly when you move your arms or lift your breasts. Check to see if one breast has got larger or its position is lower.

Look out for any dimpling or puckering of your skin.

How they feel

Check each breast and armpit. You may find it easiest to do this in the shower or bath, by running a soapy hand over each breast and up under each arm. Feel for any lumps, thickening or bumpy areas that are different from the same area on your other side.

If you have any new discomfort or pain in one breast that doesn’t go away, this also counts as a change.

Your nipples

Check your nipples, and look for:

changes in shape or position, for example, if your nipple turns in or points differently,
new discharge that’s not milky,
bleeding or moist red areas that don’t heal easily, or
a rash on or around your nipple.

Always see your GP

Breast changes can happen for many reasons, and most of them aren’t serious. Many women have breast lumps, and 9 out of 10 are not cancerous (benign).

However, if you find changes in your breast that aren’t normal for you, it’s best to be on the safe side. Always visit your GP as soon as possible. If there is a breast cancer present, the sooner it’s diagnosed, the better the chance of successful treatment.

50 or over?

If you’re 50 or over, you should have a regular mammogram (an X-ray that detects early breast changes):

Women aged 50-70 are invited for breast screening appointments every three years.
Women over 70 are encouraged to request screening from their local screening unit every three years.

Your family history

Women with a family history of breast cancer may be at increased risk themselves. For example, if your mother or sister has had breast cancer. Your GP can give you more information and tell you whether you should be monitored more frequently.

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