Breast Lump - Causes, Types, Symptoms, Evaluation and Treatment

Introduction:

A breast lump is a growth of mass in the breast, which is hard, palpable, and varies in texture when compared to surrounding healthy tissues. Hence, it is possible to locate it by self-examination. Men and women both tend to develop a breast lump, though it is rare in men. Most frequently, breast lump appears in women between the age of 15 and 35. Lumps developing at a younger age often vanish at the end of the menstrual (periods) cycle.

What Are Breast Lumps?

Breast lumps are benign tumors that are not cancerous. Breast tissue naturally has a bumpy texture. Few women have lumpier breasts which are normal. When lumps become harder, slightly different from the rest of the surrounding tissue, it is suggested to undergo examination. Men rarely develop breast lumps. Young boys and girls (till the age of 10) have a small amount of breast tissue that changes at puberty. Due to low levels of female hormones, young boys and men do not develop breast tissue any further.

What Are the Causes of Breast Lumps?

• Prolonged exposure to excess estrogen.

• Early menarche.

• Late pregnancy.

• Hormonal surges.

• Hormone replacement therapy.

• Nulliparity (refers to a condition where a woman had never given birth to a child before).

• Use of oral contraceptives.

• Late menopause.

Males who develop breast lumps may be due to:

• Hormonal treatments.

• Use of testosterone.

• History of orchitis (inflammation of one or more testicles due to bacterial or viral infection).

• Klinefelter syndrome: It is a congenital syndrome that affects X chromosomes in males. The growth of testicles is adversely affected hence resulting in lower testosterone.

How Many Types of Breast Lumps Are There?

1. Fibroadenoma: These are the most common breast lumps occurring in young women. They are benign, which means they rarely tend to develop into cancer. It is often felt like a smooth lump that easily moves under the skin. Fibroadenomas are generally painless but may become painful during the menstrual cycle. There are three types of fibroadenoma:

• Simple adenoma.

• Complex adenoma.

• Giant or juvenile adenoma.

2. Breast Cysts: These are commonly found in the pediatric population. Breast cysts are fluid-filled sacs and are benign. Changes in hormones cause changes in breasts. These are called fibrocystic breast changes. The lumps that develop due to these fibrocystic changes are harder and rubbery. Breast cysts are usually solitary, small, or large.

3. Intraductal Papillomas: Occurs in women between the age of 30 and 50 years.They can cause bleeding from the nipple.

4. Traumatic Fat Necrosis: This happens in women with a history of injury to the breast. These lumps are round and hard when palpated. They are painless and solitary (single).

What Are the Symptoms of a Breast Lump?

• New lump in the breast.

• Change in the size and shape of the breast.

• Flaky skin.

• Irritation of the overlying skin.

• Nipple discharge.

How Are Breast Lumps Diagnosed?

Breast lumps are usually benign. But, to rule out malignancy, a thorough and careful evaluation is necessary. The triple assessment method is used to arrive at a diagnosis. Triple assessment methods include:

• Physical examination.

• Radiological examination.

• Pathological examination.

What to Expect While Evaluating the Lump?

Physical Examination:

It includes a complete examination of both breasts (complete breast examination-CBE), axillae, and regional lymph nodes. Breast lumps are physically and clinically evaluated for any changes in the size of breasts, change in color of overlying skin, or any obvious swelling, inflammation, and rashes. The doctor palpates the lump by asking the patient to raise an arm and assesses superficial, intermediate, and deep tissue planes. The doctor also palpates the neck, above the clavicle region, and axillae to locate any other masses if present. Digital palpation with fingertips is an effective way to detect any masses and if they are benign and malignant to an extent.

Radiological Examination:

1. Mammography: A mammogram uses X-rays of low dosage to examine breasts, which gives out a picture of the insides.

2. Ultrasound: This scan is used to determine if the mass is solid or filled with liquid. Ultrasound uses sound waves to capture pictures of the insides.

3. MRI (Magnetic Resonance Imaging): MRIs are highly sensitive, and they cannot detect lumps smaller than 3 mm. MRIs are potentially useful in patients with silicone breast implants and in patients who cannot rely on diagnosis through ultrasound and mammography, i.e., patients with a history of breast-conserving surgery. MRI has an additional advantage of differentiating benign and malignant lesions.

Imaging reports are analyzed by a standard tool called Breast Imaging Reporting and Data System (BIRADS). This system helps to determine the structure of the mass, presence, and location of the lump, density, calcifications, and any other associated features. This system is graded from one to six.

Pathological Examination:

The pathological examination involves tissue studies. Tissues of the lump are studied under a microscope. Tissue is taken from the mass through “biopsy.” There are different types of biopsies:

1. Fine Needle Aspiration Biopsy: FNA uses a fine needle to aspirate the fluid from the lump, and the tissue sample is studied under a microscope for further assessment.
2. Core Needle Biopsy: This biopsy uses a wider needle to collect the specimen. It is performed under local anesthesia to allow painless procedures for the patient. Core needle biopsy is used to identify the presence of biomarkers. The presence of biomarkers indicates the malignant nature of the lump.
3. Surgical Biopsy: This biopsy is performed to remove larger amounts of tissue. Surgical biopsy is diagnostic and therapeutic. It is considered therapeutic when an entire mass is removed, leaving healthy margins wherein surgery is not required further. A surgical biopsy may be performed under local or general anesthesia.
4. Image-Guided Biopsy: When a needle is inserted into the tumor tissue under the guidance of a Magnetic Resonance Imaging, ultrasound, or mammogram, it is called an image-guided biopsy.

What Is the Treatment for Breast Lump?

1. Surgical Removal: The lump is removed through a surgical procedure known as lumpectomy, also referred to as an excisional biopsy. Depending on the size of the lump, it can be done under local or general anesthesia.
2. Antibiotics: When the lump is infected and painful, the doctor prescribes antibiotics to reduce the infection.
3. Drainage: Fluid-filled lumps are treated by draining the fluid from the mass. Often, following drainage, lumps disappear.
4. Cancerous Lesions: Breast lumps are mostly non-cancerous. When the lumps are diagnosed to be cancerous, mastectomy, chemotherapy, and radiotherapy are used as treatment modalities.

What Is the Prognosis of Breast Lump?

The prognosis of breast lumps is multifactorial. Often breast lumps disappear following drainage and surgical removal. Though it is non-cancerous, post-menopausal women are at high risk for the recurrence of breast lumps.

Conclusion:

Patients with hormonal imbalance must pay regular visits to the doctor. Being aware of any changes happening to the breast helps in the early evaluation of the mass. There is no need to panic. Breast lumps are not life-threatening. Regular health check-ups help in evaluating any changes occurring in the body.