Breast lumps are very common. It is estimated that every year in developed countries, about 2-3% of all women will visit a doctor regarding a problem with their breasts, with breast lumps being by far the most common presentation. Although in the great majority of cases (90%), breast lumps prove to be benign (non malignant, not cancerous), they may cause major cause of concern for any woman discovering a new breast lump.
Schematic diagram showing a breast lump
There are different types of breast lumps, and these include:
1) Malignant (Cancerous)
a. Breast cancer
2) Non-malignant (Benign, not
cancerous)
All women need to examine their breasts regularly, at least once a month, and ideally at about the same time of their menstrual (period) cycle. In this way women get to know how their breasts feel, and what is normal for them, so any new changes to the breast (such as a new breast lump) will become apparent as soon as possible.
Every new breast lump needs to be fully and appropriately investigated by a doctor who specialises in breast disease. In most developedcountries this is done in a dedicated breast clinic, where you see a general surgeon (usually with breast sub-specialisation) who examines you. He or she will need to examine both of your breasts, as well as both of your axilla (armpits). This is the first part of the so-called Triple Assessment, which also consists of radiological imaging and a biopsy.
Triple Assessment of breast lumps
1) Clinical examination
The doctor will be looking and feeling for any breast lumps, as well as any other skin changes which may provide clues to the underlyingdiagnosis (problem). These include changes of the shape of the nipple (such as nipple flattening or nipple inversion), changes of the skin of the breast (such as Peau d’orange, where the skin looks like the skin of an orange; tethering of the breast skin, where the skin becomes wrinkly over a specific area of the breast), or evidence of breast infection or inflammation, where the breast becomes hot, red and inflamed.
Peau d'orange of the breast skin - a sign of breast oedema, which can be due to an underlying malignancy
Redness and inflammation of the breast, which can be due to infection (mastitis) or malignancy (inflammatory carcinoma)
In the axilla (armits), the doctor will be looking for any enlarged, palpable lymph nodes. These may be enlarged in breast cancer, but there are other benign causes of axillary lymphadenopathy (enlarged armpit lymph nodes), such as an infection of the hand or arm, following a small injury or cut.
Examination of the axillary lymph nodes
If there is suspicion of cancer, or of an alternative diagnosis (such as generalised lymphadenopathy), the doctor may wish to also examine your neck and your groin lymph nodes, as well as your chest and abdomen (tummy).
2) Radiological Imaging
For women over the age of 35 years old, this usually consists of a mammogram of both breasts, together with a focal ultrasound scan (USS) of the area of concern. This area is usually marked by the doctor who examines you, so that the ultrasonographer who performs the USS can find and look at the right spot. If the doctor has identified any other areas in either of your breasts that need further investigations, he or she will usually mark these sites too, so that an USS can be performed for all these areas at the same time.
A digital mammographer
A mammogram being performed
A mammogram (an x-ray of the breast)
A typical ultrasound machine
3) Biopsy
If a solid breast lump is found either on clinical examination and/ or on imaging, then a biopsy should be performed. This can either be anFNAC (Fine Needle Aspiration and Cytology) or a Core biopsy. Areas with abnormal-looking microcalcifications in the mammogram are also biopsied under mammographic guidance. Core biopsies and FNACs can also be performed under ultrsound guidance. In this way, it is ensured that the biopsies have taken samples from the correct area, and are therefore representative.
A core biopsy "gun"
Schematic diagram showing a core biopsy of the breast being performed
Source: NHS Choices
There are different types of breast lumps, and these include:
1) Malignant (Cancerous)
a. Breast cancer
2) Non-malignant (Benign, not
cancerous)
a. Breast cyst
b. Fibroadenoma
c. Breast abscess
d. Fibroadenosis
All women need to examine their breasts regularly, at least once a month, and ideally at about the same time of their menstrual (period) cycle. In this way women get to know how their breasts feel, and what is normal for them, so any new changes to the breast (such as a new breast lump) will become apparent as soon as possible.
Every new breast lump needs to be fully and appropriately investigated by a doctor who specialises in breast disease. In most developedcountries this is done in a dedicated breast clinic, where you see a general surgeon (usually with breast sub-specialisation) who examines you. He or she will need to examine both of your breasts, as well as both of your axilla (armpits). This is the first part of the so-called Triple Assessment, which also consists of radiological imaging and a biopsy.
1) Clinical examination
The doctor will be looking and feeling for any breast lumps, as well as any other skin changes which may provide clues to the underlyingdiagnosis (problem). These include changes of the shape of the nipple (such as nipple flattening or nipple inversion), changes of the skin of the breast (such as Peau d’orange, where the skin looks like the skin of an orange; tethering of the breast skin, where the skin becomes wrinkly over a specific area of the breast), or evidence of breast infection or inflammation, where the breast becomes hot, red and inflamed.
Peau d'orange of the breast skin - a sign of breast oedema, which can be due to an underlying malignancy
In the axilla (armits), the doctor will be looking for any enlarged, palpable lymph nodes. These may be enlarged in breast cancer, but there are other benign causes of axillary lymphadenopathy (enlarged armpit lymph nodes), such as an infection of the hand or arm, following a small injury or cut.
For women over the age of 35 years old, this usually consists of a mammogram of both breasts, together with a focal ultrasound scan (USS) of the area of concern. This area is usually marked by the doctor who examines you, so that the ultrasonographer who performs the USS can find and look at the right spot. If the doctor has identified any other areas in either of your breasts that need further investigations, he or she will usually mark these sites too, so that an USS can be performed for all these areas at the same time.
3) Biopsy
