Breast Masses (Breast Lumps)

Although breast cancer Breast Cancer Screening and Prevention Breast cancer screening is recommended for all women in the United States, but major medical organizations vary regarding the starting age and frequency of screening (see table ) ( 1, 2). Determining... read more is the most feared cause, most (about 90%) breast masses are nonmalignant. The most common causes include

Fibrocystic changes (previously, fibrocystic disease) is a catchall term that refers to nonproliferative lesions, including breast cysts and nondescript masses (usually in the upper outer part of the breast); these findings may occur in isolation or together. Breasts have a nodular and dense texture and are frequently tender when palpated. The breasts may feel heavy and uncomfortable. Women may feel a burning pain in the breasts. Fibrocystic changes are the cause of the most commonly reported breast symptoms. Symptoms tend to subside after menopause.

Repeated stimulation by estrogen and progesterone may contribute to the development of fibrocystic changes, which are more common among women who had early menarche, who had their first live birth at age > 30, or who are nulliparous. Fibrocystic changes are not associated with increased risk of cancer.

Fibroadenomas are typically smooth, rounded, mobile, painless masses; they may be mistaken for cancer. They usually develop in women during their reproductive years and may decrease in size over time. Juvenile fibroadenoma, a variant, occurs in adolescents, and unlike fibroadenomas in older women, these fibroadenomas continue to grow over time. Simple fibroadenoma does not appear to increase risk of breast cancer; complex fibroadenoma may increase risk slightly.

Breast infections (mastitis Mastitis Mastitis is painful inflammation of the breast, usually accompanied by infection. Fever later in the puerperium is frequently due to mastitis. Staphylococcal species are the most common causes... read more ) cause pain, erythema, and swelling; an abscess can produce a discrete mass. Puerperal mastitis, usually due to Staphylococcus aureus, can cause massive inflammation and severe breast pain, sometimes with an abscess. Infections are extremely rare except during the puerperium (postpartum) or after penetrating trauma. They may occur after breast surgery. If infection occurs under other circumstances, an underlying cancer should be sought promptly. Types of benign nonlactational mastitis are periductal mastitis, idiopathic granulomatous mastitis, and tuberculous mastitis (see Extrapulmonary Tuberculosis Extrapulmonary Tuberculosis (TB) Tuberculosis outside the lung usually results from hematogenous dissemination. Sometimes infection directly extends from an adjacent organ. Symptoms vary by site but generally include fever... read more ); these types occur mainly in young women.

Galactocele is a round, easily movable milk-filled cyst that usually occurs up to 6 to 10 months after lactation stops. Such cysts rarely become infected.

Cancers of various types can manifest as a mass.

Treatment of a breast mass is directed at the cause.

A fibroadenoma is usually removed if it grows or causes symptoms. Fibroadenomas can usually be surgically excised or, if < 3 cm, cryoablated after patients are given a local anesthetic, but fibroadenomas frequently recur. Patients who have fibroadenomas that are not excised should be checked periodically for changes. After patients have had several fibroadenomas established as benign, they may decide against having subsequent ones excised. Because juvenile fibroadenomas tend to grow, they should be removed.

Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and athletic bras (to reduce trauma) can be used to relieve symptoms of fibrocystic changes. Evening primrose oil may be somewhat effective.

A galactocele typically resolves after aspiration.

Breast cancer Breast Cancer Breast cancers are most often epithelial tumors involving the ducts or lobules. Most patients present with an asymptomatic mass discovered during examination or screening mammography. Diagnosis... read more is treated as appropriate.