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What is a 'breast lump'?

A breast lump is any unusual lump or bump on or around your breasts, nipples or towards your armpits. These can be smooth or hard filled with fluid, solid, move around or stay in the same place, painful or painless. You may have more than one, and they may affect either or both breasts.

What can cause a breast lump?

The first thing to know about breast lumps is that they are not always an indication of cancer. In fact, around 90% of breast lumps are benign (non-cancerous) and are usually caused by hormonal changes such as your period or the menopause. It's important not to panic if you do find a lump, although you should get it checked by a doctor as soon as possible. The cause of a lump depends on what type of lump it is.

Non-cancerous causes of breast lumps

Most breast lumps are one of three things:

  • Cysts (fluid sacs that build up in the tissue)

  • Fibroadenomas (growths made up of harder fibrous tissue)

  • Breast abscesses (pus under the skin, normally caused by bacterial infection)


The causes of these common lumps are as listed below:

Cysts

Cysts can be tiny or up to two or three centimetres in size and can occur on one or both breasts. They are more common in women aged 30-60. You may get more than one cyst at a time and they may or may not be painful. They are sacs that fill with fluid, and are thought to be caused by hormones. They're very common around the time of the menopause and in women who are having hormone replacement therapy (HRT).

Fibroadenomas

Fibroadenomas are more solid lumps. They can occur anywhere but often occur around your milk ducts; they sometimes disappear on their own. They are also thought to be caused by hormones; specifically, an unusual response to oestrogen, although this is not 100% certain. They are common among pregnant women, younger women who haven't yet gone through the menopause and women who are having HRT.

Breast abscesses

Breast abscesses are painful lumps caused by a build-up of pus inside your breast. These are generally recognisable because of their other symptoms, which can include a temperature and redness and/or swelling around the lump. Breast abscesses are normally caused by a bacterial infection; bacteria can enter the breast through any cracks, scrapes or damage to the skin of your nipple, which can sometimes happen when you are breastfeeding.

Other common non-cancerous breast lumps and their causes:

  • Lipoma (fatty growth under the skin)

  • Mastitis (inflammation of the breast tissue)

  • Intra-ductal papilloma (a growth in your milk duct)

  • Fat necrosis (a lump caused by bruising or damaging the breast, common after surgery)


Symptoms of breast cancer

Breast cancer can have a number of symptoms – a lump is not the only change that could indicate the presence of breast cancer. Any changes in the outline or shape of the breast, to the look or feel of breast tissue, pain, nipple discharge or bleeding, rash around or on the nipple or change in the position and appearance of the nipple could potentially be an indication of breast cancer. This doesn’t mean that the presence of any of the above symptoms is definitely cancer, but it is important to look for any and all changes.

However, breast lumps can, in some cases, be a symptom of cancer. A lump on or around your breast is more likely to be cancerous if it is firm to the touch and does not move around. Some lumps may disappear after your period or the menopause is over; cancerous lumps will not go away on their own.

How to check for breast lumps and changes

There are several ways to perform a self-exam, or to check your own breasts for lumps. You should begin by being aware of your own breasts: what's normal for you, and what routinely changes during your period – your breasts may become tender and lumpy during your cycle, as milk-producing tissue in your breasts becomes more active around this time. Once you know what is normal for your breasts, you can check for any abnormalities.

To check your breasts in the mirror:

Remove your top and look at your breasts with your arms by your side. It's normal to have one breast slightly larger than the other. Bend forward to let your breasts hang and check for any unusual lumps or symptoms. Lift your hands behind your head and look at your breasts once again. Lift your breasts and feel the area around them, and then check your nipples for any discharge.

To check your breasts in the shower:

Begin by checking the area around your collarbone and just above your breasts. Check your left armpit with your right hand and your right armpit with your left hand. Slide your hands firmly over your breasts – soap is helpful at this point – and check for any changes to the tissue of your breasts. Make sure you have covered both breasts and the areas around them thoroughly.

To check your breasts lying down:

Many women find it easiest to check their breasts while lying comfortably. Once you are lying down, put your right hand behind your head and use your left to firmly check your whole right breast, using circular motions to make sure you have covered the whole area. Check your right armpit with your left hand. Check your nipple by gently squeezing it to make sure there is no discharge.

Repeat the process again for your left breast, with your left hand behind your head.

How often should I check for breast lumps?

You can check your breasts as often as you like. It's very unlikely that lumps, thickening or abnormalities will develop on a day-to-day basis, so there is no need to check every day, or even every week, but checking regularly is recommended.  The most important thing is to be breast aware, i.e to know what is normal for you.

Breast lumps and changes: when to see a doctor

You should see a doctor if you notice any of the following changes:

  • a lump on or around your breast

  • a change in the shape or size of your breast

  • a change in the texture or thickness of the skin of the breast

  • a change in the nipples (such as turning inwards, or inversion)

  • a rash around your nipple or on your breast

  • any discharge from your nipples

  • swelling or lumps in your armpit area

  • any wound/moist area that is not healing


I have a lump in my breast: what next?

The first and foremost thing to do is not to panic. See your doctor immediately if you find any kind of lump, thickening or change in your breast, and he or she will be able to give you a diagnosis. This may not necessarily be anything serious, but he or she will need to examine your breasts, with your permission, in order to tell you what it might be. If your doctor is concerned or cannot tell you what the lump is just by look and touch, you may be sent for further tests, which could include:

  • a mammogram, or X-ray of the breasts

  • an ultrasound scan

  • a biopsy (usually only when the first two methods of diagnosis have failed)


These tests will tell you exactly what the cause of your breast lump/s is, and your doctor will be able to discuss further treatment options with you if necessary.

Breast lumps and pregnancy

Breast cancer is very uncommon during pregnancy. In fact, most lumps found during pregnancy, especially if you are over three months pregnant, are caused by blockages in your milk ducts. Your body is preparing to feed your new baby, and these blockages happen frequently, causing enlargement of the ducts. This may look like small red lumps that feel sore to the touch. They should go away within several days, but if they don't, see your GP.

Sources:

http://www.whattoexpect.com/pregnancy/breast-lump-during-pregnancy

http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/about/finding-breast-cancer-early

http://www.nhs.uk/Conditions/Breast-lump/Pages/Diagnosis.aspx

http://www.nhs.uk/Conditions/Breast-lump/Pages/Causes.aspx

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