The discovery of a breast lump—whether by chance, during a routine breast self-exam, or during a clinical breast exam—can be stressful for a woman. Because a lump can be a symptom of breast cancer, all persistent breast lumps should be evaluated by a physician. However, the majority of breast lumps (approximately 80%) are due to non-cancerous causes.

Main Menu:

• What Should a Woman Do If She Finds a Breast Lump?
• What Signs Suggest a Lump is Likely to Be Cancerous?
• How Are Breast Lumps Evaluated By Physicians?
• Breast Lumps During Pregnancy
• Additional Resources and References

What Should a Woman Do If She Finds a Breast Lump?

First, it is important for all women to practice monthly breast-self exams beginning at age 20. These self-exams allow women to become familiar with how their breasts look and feel so they can more readily detect any changes that may occur. Many women naturally have some lumpiness and asymmetry (differences between the right and left breast). The key to the breast self-exam is to learn to find changes in the breast(s) that persist over time. If a new lump is found and does not disappear after the menstrual cycle, then it should be reported to a physician for clinical evaluation.

All persistent breast lumps should be evaluated by a physician. Practicing monthly breast self-exams helps women get to know their breasts and more easily detect changes.

  Click here to learn more about breast self-exam.

What Signs Suggest a Lump is Likely to Be Cancerous?

It is not possible for a woman or a physician to know for certain whether a breast lump indicates breast cancer until imaging exams (such as mammography and ultrasound) and/or biopsy are performed. A breast biopsy involves taking a sample of breast tissue and examining it under a microscope to determine whether it contains cancer cells. However, there are certain characteristics associated with lumps that can suggest whether they are more likely to be cancer or benign (non-cancerous).

Signs that suggest a lump is more likely to be cancerous:

• The lump is firm and hard
• The lump is not discrete; it is not easily distinguishable
• The lump is fixed in the breast; it does not move
• There is only one lump
• There is not an identical lump in the opposite breast
• The skin of breast is dimpled
• The lump is accompanied by bloody nipple discharge

Signs that suggest a lump is less likely to be cancerous:

• The lump is soft
• The lump is discrete; it is easily distinguishable
• The lump moves in the breast
• There are multiple breast lumps
• There is an identical lump in the opposite breast
• The lump disappears after the menstrual cycle

While the above signs can help suggest whether a lump is more likely or less likely to be cancerous, having one or more of these characteristics does not guarantee or eliminate the possibility of having breast cancer. These characteristics merely provide clues for the physician when evaluating a lump. Some breast cancers can have characteristics found in the "less likely to be cancerous" category. Therefore, all persistent breast lumps need to be presented to a physician.

Fibrocystic breasts: Fibrocystic breast condition is a common, non-cancerous condition that affects more than 50% of women at some point in their lives. In fact, the condition is so common that many physicians refrain from using the term "fibrocystic" and simply tell their patients that their breasts are lumpier than average but are still normal.

The most common signs of fibrocystic breasts include: lumpiness, tenderness, cysts, areas of thickening, fibrosis, and breast pain. Having fibrocystic breasts, in and of itself, is not a risk factor for breast cancer. However, fibrocystic breast condition can sometimes make it more difficult to detect a hidden breast cancer with standard examination and imaging techniques. Therefore, it is important that women with fibrocystic breasts practice monthly breast self-exams, receive regular clinical breast exams, and have yearly screening mammograms (the latter beginning at age 40).

The degree to which women experience symptoms of fibrocystic breast condition varies considerably. Some women with fibrocystic breasts have only mild breast pain and may not be able to feel any breast lumps when performing breast self-exams. Other women with fibrocystic breasts may experience more severe breast pain or tenderness and may feel multiple lumps in their breasts. Most fibrocystic breast lumps are found in the upper, outer quadrant of the breasts (near the armpit), although these lumps can occur anywhere in the breasts. Fibrocystic breast lumps tend to be smooth, rounded, and mobile (not attached to other breast tissue), though some fibrocystic tissue may have a thickened, irregular feel. The lumps or irregularities associated with fibrocystic breasts are often tender to touch and may increase or decrease in size during the menstrual cycle.

  Click here to learn more about fibrocystic breasts.

How Are Breast Lumps Evaluated By Physicians?

Whether a breast lump is first detected by a physician during a clinical breast exam or by the woman herself, the process of evaluation usually begins with a detailed patient history. The physician will ask the patient specific questions about the lump and her medical history to help identify the cause of the lump. Sample questions may include:

• How long have you had the lump?
• Does the lump change in size with your menstrual cycle?
• How long has it been since your last menstrual period?
• Have you recently been pregnant or are you breast-feeding?
• Have you experienced discharge from the nipple?
• Do you use hormone replacement therapy?
• Have you experienced any recent trauma to the breast?
• Have you had any previous breast biopsies? If yes, what were the diagnoses?
• Do you have a history of cancer?
• Do you have a history of other medical conditions?
• Have you had a mammogram or other breast imaging test before?

These questions can provide important information as to what is causing the lump. For example, a woman who has recently been pregnant and who is breast-feeding may have a galactocele (milk-filled cyst). A woman who is taking hormone replacement therapy (HRT) may have more nodules in her breast due to the therapy. Trauma to the breast may cause a hematoma (a blood-filled packet), fat necrosis (swelling of fatty breast tissue), or a ruptured cyst (fluid-filled packet).

Learning the patient’s family and personal medical history can also be helpful. A family history of breast cancer can increase a woman’s chances of developing breast cancer herself. A personal history of non-cancerous conditions such as atypical hyperplasia (an abnormal increase in breast cells) or lobular carcinoma in situ (LCIS) can also increase the risk of breast cancer.

Once a thorough patient history is taken, the physician will perform a thorough clinical breast exam to investigate the lump and other areas of the breast and axilla (armpit). In addition to feeling for breast masses, the physician will check for any skin dimpling, nipple retraction, or other visual changes. The clinical breast exam typically lasts several minutes and the patient will usually need to raise her arms, place her hands on her hips and exert pressure, and lie down during the exam so the breasts can be examined from different angles.

After the clinical breast exam, the evaluation of a breast lump will differ depending on the woman’s age, history, and characteristics of the lump. The following descriptions provide information on how women in different age groups are typically evaluated:

• Women age 30 or older: A diagnostic mammogram is usually ordered. A diagnostic mammogram differs from the routine screening mammogram in that it involves additional x-ray views from different angles and/or special magnification. A diagnostic mammogram is used instead of a screening mammogram when a breast abnormality is present. Depending on the results of the mammogram, additional breast imaging (such as ultrasound) may be ordered. In many cases, further breast imaging will be ordered even if a mammogram does not show a suspicious abnormality. This is because a small percentage of breast cancers can be missed with mammography. Depending on the results of the mammogram and additional imaging tests, a breast biopsy may be performed. A biopsy involves removing a sample of breast tissue and examining it under a microscope to determine whether cancer cells are present. Sometimes, a biopsy (or fine needle aspiration—sampling of a few breast cells) will be performed even if breast imaging tests are normal. This usually happens when the physician suspects that the breast lump is suspicious regardless of the results of the imaging tests.

In approximately 80% of cases, breast lumps are benign (non-cancerous). Benign conditions that can cause breast lumps include:

• Fibrocystic breasts
• Cysts
• Fibroadenomas
• Papillomas
• Phyllodes tumors (usually benign)
• Galactoceles
• Granular cell tumors
• Duct ectasia
• Fat necrosis