Breast Lumps

A normal breast

This diagram shows a normal breast. The breast is connected to muscles on the wall of your chest. It is made up of fatty tissue. Within the fatty tissue are lobules or 'milk-forming' glands. Milk drains from these glands into breast ducts during breast feeding. Milk then leaves the ducts through your nipple if you breastfeed a baby.

The glands and ducts can decrease or increase in number and size depending on when they are needed.

Breast lumps can involve any of these different tissues, or components, that make up your breast.

Common causes of breast lumps

Physiological (normal) swelling and tenderness

This is also known as fibrocystic change or fibroadenosis. Your breasts change throughout your menstrual cycle each month because of your hormones. At least half of all women who have periods will have some pain, tenderness and nodularity (lumpiness) in their breasts at some time in the month. This is usually most obvious in the week before your period. It quickly goes when your period starts. It is more common in women aged 30-50.

Fibroadenoma

This is a benign (non-cancerous) breast lump that usually occurs in women under the age of 40. Sometimes they can disappear of their own accord. They also tend to go after the menopause.

Cysts

A cyst is a fluid-filled lump. Breast cysts usually occur in women who have not gone through the menopause. The cyst may go away completely with aspiration. This is where a needle is used to drain the fluid from the cyst. Sometimes cysts can recur.

Infection

A lump caused by infection is common in women who are breast feeding. The ducts that carry the breast milk can become blocked. Bacteria, or germs, can enter through cracks in the nipple. This can lead to the development of an abscess in the breast. Warm compresses, paracetamol and/or antibiotics may be needed. Infection can also cause lumps in women who are not breast feeding.

Fat necrosis

Injury or trauma to the fatty tissue in your breast can cause a lump. These lumps usually heal and go away of their own accord.

Lipoma

This is a fatty growth that develops within the fatty tissue of your breast. It is non-cancerous and usually does not need any treatment.

Breast cancer

Most women discover that they have breast cancer after noticing a lump in the breast. There are separate leaflets on 'Breast Cancer' and 'Breast Cancer - Hereditary Factors'.

What should I do if I find a breast lump?

If you find a lump in one of your breasts, you should make an appointment with your GP as soon as possible. When you see your GP, they may start by asking you some questions. It is a good idea to think about these questions before your appointment. Questions may include:

• When did you notice the lump?
• Do you have any breast pain?
• Do you have any nipple discharge?
• When was your last period (if you still have them)?
• Are you taking an hormonal medication such as the contraceptive pill or hormone replacement therapy?
• Have you had breast lumps before?
• Do you have any history in your family of breast problems?

Breast examination

Your doctor may then suggest that they examine your breasts. A male doctor should always suggest that a chaperone is present during the examination. You may be asked to remove your top and bra by the doctor. They may want to examine your breasts with your arms in the air and then by your sides. They may also want to examine your breasts when you are sitting and then lying down. They may also want to examine underneath your arms to feel for any enlarged lymph glands. Your doctor may ask you to point out the lump to them. If you have had any nipple discharge, your doctor may ask you to demonstrate this yourself by asking you to squeeze your nipple.

What happens next?

This will depend on what your doctor finds when they examine you. If you are young, have not gone through the menopause, and have only just noticed the lump, your doctor may suggest that you return for another examination after your next period.

If the doctor is uncertain as to the cause of the lump, or if you have a family history of breast problems that they are worried about, they may suggest that they refer you to a specialist breast clinic. Here you will see a doctor who has special expertise in dealing with breast problems.

You can usually expect an appointment at the clinic within a few weeks. However, waiting times can vary depending on how busy the clinic is and how urgent your GP feels the problem is. The aim is that any woman with suspected breast cancer is seen in a specialist breast clinic within two weeks. If your doctor feels that you are more likely to have one of the benign (non-cancerous) causes of a breast lump, it may take longer than two weeks for you to be seen. Your GP will follow local guidelines when referring you to a breast clinic. Even if you are referred urgently, you should remember that your lump may still turn out to be benign. The majority of people referred to a breast clinic do not have breast cancer.

What to expect if you are referred to a breast clinic

Usually there is a specialist breast nurse who works in a breast clinic. They may be present during your appointment with the doctor and are usually available for any questions afterwards. In some breast clinics, the specialist nurse runs the clinic and you may only see them.

In most clinics you will first be asked about your symptoms. You may be given an information sheet to fill out. This may include some of the questions that are listed above. After this, the breast specialist doctor or nurse will examine your breasts in a similar way as happened when you saw your GP. They may then suggest that you have some further tests. These can include a mammogram and/or an ultrasound scan of your breast (see below). Sometimes investigations are carried out on the same day that you attend the clinic. Sometimes you may be given an appointment to come back for a test. For further details of these tests, see below.

The breast specialist may also suggest that they take a 'sample' or biopsy of the lump. There are two common ways of doing this, either by fine needle aspiration or a core biopsy (details below). They are both straightforward procedures. Sometimes ultrasound scanning is done to 'guide' the procedure. The specialist uses the scan to identify exactly where the lump is so that they can take the sample. The sample may be taken on the same day in the breast clinic or you may be given an appointment to come back for the procedure. This depends on the clinic you attend.

What is a mammogram?

A mammogram is essentially an x-ray of your breasts. A radiographer (someone trained in taking x-rays) will ask you to remove your top and bra. The mammogram is generally done with you standing up. Each breast is compressed between two x-ray plates. This may feel a little uncomfortable but the discomfort should only last for a few minutes. Two images of each breast are taken in different positions.

What is an ultrasound scan of the breast?

An ultrasound scan of the breast uses the same technique as an ultrasound scan that women have when they are pregnant. Again, you will be asked to remove your top and bra. Some gel will be spread onto your breast. The ultrasonographer will then move the scanning probe over the surface of your breast. High-frequency sound waves allow them to produce an image of your breast that they can look at. They should be able to see any lumps in your breast.

You may have both an ultrasound scan and a mammogram. Women under the age of 35 may only have an ultrasound scan. This is because it is difficult to get a good picture of younger women's breasts using a mammogram.

What is fine needle aspiration?

Fine needle aspiration cytology (FNAC) is when a small, fine needle with a syringe connected to it is used to take a sample of breast cells from the lump. This sample is then sent to the laboratory and is examined under a microscope. It is usually a quick procedure and may be a little uncomfortable. Local anaesthetic is not usually used as this would mean using two needles (a needle to give the local anaesthetic first) instead of just one. Your breast may feel a little sore for a short period afterwards.

It may take one to two weeks for the results, or sometimes longer depending on the clinic. You will generally be given another appointment to come back for the results. The results can show if the lump is cancerous or non-cancerous. Sometimes not enough cells are present in the sample to give a definite answer. In this case you may need further tests.

What is a core biopsy?

For a core biopsy, a larger needle is used to take a sample of tissue from your breast lump. You will usually be given a local anaesthetic to numb the area before the biopsy is taken. More than one biopsy may be taken. The tissue that is taken is sent to the laboratory and is examined under a microscope.

You may need to wear a dressing on the area afterwards and your breast may feel a little sore. Painkillers usually help the soreness. It may take one to two weeks for the results, or sometimes longer depending on the clinic. You will generally be given another appointment to come back for the results. Again, the results can show if the lump is cancerous or non-cancerous.

Other advice

If you do have to go back to a breast clinic to get your results, it may be a good idea to take a partner, relative or friend with you. In this way you will have someone present to give you support if you need it. However, remember that for many women who have mammography, ultrasound, fine needle aspiration and/or a core biopsy, the results do not show that they have cancer. They may have one of the benign breast problems that are discussed above.

You should also remember that even if your tests do come back as benign, or non-cancerous, you should still continue to be vigilant and 'breast aware'. You should regularly check your breasts for anything that is not normal for you. You should see your GP if you are worried about any new breast pain, lumps or nipple discharge.

Breast cancer screening

If you are between 50 and 70 years old, you will be called for regular breast cancer screening using mammography. You should continue to attend this. You will automatically be sent an appointment for a mammogram every three years.

If you are over 70 years, it is advised that you continue to have a mammogram every three years. You will not get a routine appointment sent to you, but you should contact your local breast screening clinic to arrange this every three years.

Further help and information

Breast Cancer Care

Support for women with breast cancer or breast health concerns.
5-13 Great Suffolk Street, London SE1 0NS
Main switchboard: 0845 092 0800 Helpline: 0808 800 6000 (textphone 0808 800 6001)
Between 9am and 5pm, Mon-Fri, or 9am-2pm on Saturdays.
Web: www.breastcancercare.org.uk
The website includes an 'Ask the Nurse' email service

NHS Breast Screening Programme

Web: www.cancerscreening.nhs.uk/breastscreen/