Breast tissue normally might feel lumpy or ropy and you may have tenderness that comes and goes with your menstrual period.
If you have an underlying breast condition, you might notice changes in how your breasts normally feel, such as:
- A round, smooth and firm breast lump
- A large, solid-feeling lump that moves easily under your skin
- A hard, irregular-shaped breast lump
- Skin redness or dimpling like an orange
- Changes in breast size or shape
- Fluid leaking from your nipple
If you find a breast lump that feels round, smooth and firm, it could be a cyst — a dilated milk duct filled with fluid. A breast cyst can be large or small, and the surrounding breast tissue may be tender. A breast cyst may appear before your menstrual period and get smaller or disappear afterward.Fibrocystic breast changes.
With fibrocystic breast changes, you may feel fullness in your breasts with areas of lumpiness or ridgelike areas. Your breasts may feel tender. Many women experience fibrocystic breast changes related to their menstrual cycles that tend to improve after the menstrual cycle.
Fibroadenomas are solid, noncancerous breast tumors that are smooth and move easily under your skin when touched. A fibroadenoma may grow larger. Factors that may be associated with fibroadenoma growth include being pregnant, using hormone therapy or menstruation.Injuries and infections.
A severe injury to your breast tissue or nearby nerves can create a breast lump. Doctors describe this condition as fat necrosis. A collection of infected fluid (abscess) in breast tissue also can cause a breast lump, one that's often associated with localized breast pain and inflammation of the skin.Breast cancer.
A breast lump that's painless, hard, irregularly shaped and different from surrounding breast tissue might be breast cancer. Skin covering the lump may look red, dimpled or pitted like the skin of an orange. Your breast size and shape may change, or you may notice discharge from the nipple.
Only by seeing your doctor for evaluation can you be certain of what kinds of tests you might need and which type of breast lump you have.
Cyclic breast pain appears to have a strong link to hormones and your menstrual cycle. Cyclic breast pain often decreases or disappears with pregnancy or menopause.Breast structure:
Noncyclic breast pain often results from changes that occur in the milk ducts or milk glands. This can result in the development of breast cysts. Breast trauma, prior breast surgery or other factors localized to the breast can lead to breast pain. Breast pain may also start outside the breast — in the chest wall, muscles, joints or heart, for example — and radiate to the breast.Fatty acid imbalance:
An imbalance of fatty acids within the cells may affect the sensitivity of breast tissue to circulating hormones.Medication use:
Certain hormonal medications, including some infertility treatments and oral birth control pills, may be associated with breast pain. Also, breast tenderness is a possible side effect of estrogen and progesterone hormone therapies that are used after menopause. Breast pain may be associated with certain antidepressants, including selective serotonin reuptake inhibitor (SSRI) antidepressants.Breast size:
Women with large breasts may have noncyclic breast pain related to the size of their breasts. Neck, shoulder and back pain may accompany breast pain due to large breasts.Breast surgery:
Breast pain associated with breast surgery and scar formation can sometimes stay safter incisions have healed.
- Birth control pills
- Breast cancer
- Ductal carcinoma in situ (DCIS)
- Endocrine disorders
- Excessive breast stimulation
- Fibrocystic breasts (lumpy or rope-like breast tissue)
- Injury or trauma to the breast
- Intraductal papilloma (a benign, wartlike growth in a milk duct)
- Mammary duct ectasia
- Mastitis (an infection in breast tissue that most commonly affects women who are breast-feeding)
- Medication use
- Menstrual cycle hormone changes
- Paget's disease of the breast
- Periductal mastitis
- Pregnancy and breast-feeding
When to consult your doctor
Being familiar with how your breasts normally feel makes it easier to detect when there's a change in your breasts.
Consult your doctor if:
- You find a new breast lump or thickening that feels different from the surrounding tissue
- You notice a change in the size, shape or appearance of your breast
- Breast pain doesn't go away after your next period
- You notice skin changes on your breast, such as itchiness, redness, scaling, dimpling or puckering
- You have a newly inverted nipple
- You notice spontaneous nipple discharge
What to expect during a clinical breast exam
Evaluation of a breast lump typically begins with a clinical breast exam. During this exam, your doctor will likely:
- Ask about symptoms and your risk factors for breast cancer or benign breast conditions
- Examine your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities
- Examine the skin on your breasts
- Check for nipple problems, such as inversion or discharge
If your doctor confirms that you have a breast lump or other area of concern, you'll likely need testing.
Procedures to evaluate a breast lump
This specialized breast X-ray helps your doctor investigate suspicious breast changes. It takes X-ray pictures from several angles.Breast ultrasound.
Sound waves create images of the inside of your breast on a monitor. Ultrasound imaging is helpful for determining whether a breast lump is solid or filled with fluid.Breast MRI.
An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast.Breast biopsy
You might have a tissue sample removed and examined under a microscope (biopsy). Ultrasound or mammography might help guide the needle, and a local anesthetic might be used. Breast biopsy options include:
- Fine-needle aspiration biopsy.
With a thin needle attached to a syringe, cells and fluid are removed from the suspicious area.
- Core needle biopsy.
A larger needle with a special tip is used to remove a sample of breast tissue.
- Stereotactic biopsy.
Mammography produces images of the area in question from several different angles (stereo images). Your doctor then removes a sample of breast tissue with a needle.
- Vacuum-assisted biopsy.
A probe connected to a vacuum device removes a small sample of breast tissue.
After a biopsy, the tissue sample is sent to a lab for analysis. Your doctor will let you know when to expect the test results and will discuss them with you when they're available.
- If the breast lump isn't cancerous, your doctor will decide if you need short-term monitoring with clinical breast exams or repeat breast imaging. You may be asked to return in two to three months to see if there have been changes in your breast. Consult your doctor if you notice changes in the lump or develop new areas of concern.
- If the diagnosis is in question — the clinical breast exam and the mammogram show areas of suspicion, for example, but the biopsy reveals benign tissue — you'll need Surgical excisional biopsy.
- If the breast lump is cancerous, you'll work with your doctor to create a treatment plan. The stage and type of breast cancer will influence your treatment options.
Breast Cancer Risk factors
Simply being a woman is the main risk factor for developing breast cancer.
Although women have many more breast cells than men, the main reason they develop more breast cancer is because their breast cells are constantly exposed to the growth-promoting effects of the female hormones estrogen and progesterone.
Men can develop breast cancer, but this disease is about 100 times more common among women than men.
Your risk of developing breast cancer increases as you get older. About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 out of 3 invasive breast cancers are found in women age 55 or older.
About 5% to 10% of breast cancer cases are thought to be hereditary, resulting directly from gene defects (called mutations) inherited from a parent.
The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes.
Breast cancer risk is higher among women whose close blood relatives have this disease.
Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk.
Having 2 first-degree relatives increases her risk about 3-fold.
White women are slightly more likely to develop breast cancer than are African women.
African women are more likely to die of this cancer. At least part of this seems to be because African women tend to have more aggressive tumors, although why this is the case is not known.
Women with denser breast tissue have more glandular tissue and less fatty tissue, and have a higher risk of breast cancer.
Unfortunately, dense breast tissue can also make it harder for doctors to spot problems on mammograms.
Women diagnosed with certain benign breast conditions may have an increased risk of breast cancer.
Some of these conditions are more closely linked to breast cancer risk than others.
Lobular carcinoma in situ:
Women with lobular carcinoma in situ (LCIS) have a 7- to 11-fold increased risk of developing cancer in either breast.
Women who have had more menstrual cycles because they started menstruating at an early age (before age 12) and/or went through menopause at a later age (after age 55) have a slightly higher risk of breast cancer.
This may be related to a higher lifetime exposure to the hormones estrogen and progesterone.
Women who, as children or young adults, had radiation therapy to the chest area as treatment for another cancer (such as Hodgkin disease or non-Hodgkin lymphoma) are at significantly increased risk for breast cancer.
This varies with the patient's age when they had radiation.
Breast cancer prevention
The more alcohol you drink, the greater your risk of developing breast cancer.Don't smoke.
Evidence suggests a link between smoking and breast cancer risk, particularly in premenopausal women.Control your weight.
Being overweight or obese increases the risk of breast cancer. This is especially true if obesity occurs later in life, particularly after menopause.Be physically active.
Physical activity can help you maintain a healthy weight, which helps prevent breast cancer.Breast-feed.
Breast-feeding might play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect.Limit dose and duration of hormone therapy.
Combination hormone therapy for more than three to five years increases the risk of breast cancer.Avoid exposure to radiation and environmental pollution.
Medical-imaging methods. Reduce your exposure by having such tests only when absolutely necessary.
There's some evidence that hormonal contraception, which includes birth control pills and IUDs that release hormones, increases the risk of breast cancer. But the risk is considered very small, and it decreases after you stop using hormonal contraceptives.
Discuss your contraceptive options with your doctor. Also consider the benefits of hormonal contraception, such as controlling menstrual bleeding, preventing an unwanted pregnancy, and reducing the risk of other cancers, including endometrial cancer and ovarian cancer.
Be vigilant about breast cancer detection. If you notice any changes in your breasts, such as a new lump or skin changes, consult your doctor. Also, ask your doctor when to begin mammograms and other screenings based on your personal history.
Breast Cancer Screening Guidelines
Mammograms play a central part in the early detection of breast cancer because they can detect changes in the breast that may be early signs of cancer, but are too small or subtle to be felt.
The use of digital mammography has greatly enhanced the ability to detect breast cancers at earlier stages and are a must for women with dense breast tissue. Remember that an annual mammogram is one of your best defences against breast cancer.
- Women with an average risk of breast cancer - most women - should begin yearly mammograms at age 45.
- Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
- At age 55, women should have mammograms every other year - though women who want to keep having yearly mammograms should be able to do so.
- Regular mammograms should continue for as long as a woman is in good health.
- These guidelines are for women at average risk for breast cancer. Women at high risk -- because of family history, a breast condition, or another reason -- need to begin screening earlier and/or more often. Talk to your medical provider to be sure.
Treatment for breast cancer
Treatment for breast cancer is unique to each patient and may include one or more of the following:Surgery
- Anti-Estrogen Therapies
- Anti-HER2 therapies