Understanding Benign Breast Disease

"I’ve found a lump in my breast."

Don’t panic. Eighty percent of all breast lumps are benign (non-cancerous). Benign breast lumps are usually moveable and smooth, and can often be found in both breasts. There are several common causes of benign breast lumps:

• Benign breast changes
• Breast infection or injury
• Medications that may cause lumps or breast pain

Breast tissue changes during a woman’s entire life. Breast tissue is particularly sensitive to estrogen and progesterone hormone levels that often fluctuate during the menstrual cycle.

• Fibrocystic changes
  Changes in hormone balances during normal, monthly menstrual cycles can create, for some women, symptomatic breast changes that are referred to as fibrocystic changes. These often are described as benign, tiny, fluid-filled sacs that may feel like lumps. Tenderness and lump size commonly increase the week before the menstrual period and lessen a week after. The lumps may be hard or rubbery and can appear as a single breast lump that may be large or small. Fibrocystic changes also can appear as thickening of the breast tissue. Fibrocystic changes can occur in one or both breasts and are the most common cause of benign breast lumps in women age 35 to 50. It is relatively uncommon for postmenopausal women to have symptomatic breast changes because of a lack of hormone stimulation of breast tissue.
• Simple cysts
  Simple cysts are benign fluid-filled sacs that usually occur in both breasts. They can be single or multiple and can vary in size. Tenderness and lump size often change with the woman’s menstrual cycle.
• Fibroadenomas
  Fibroadenomas are the most common benign tumors found in the female breast. Fibroadenomas are solid, round, rubbery lumps that move freely in the breast when pushed. They form as the result of excess formation of lobules (milk-producing glands) and stroma (connective tissue in the breast). Fibroadenomas are usually painless. They occur most often between the ages of 20 and 30 and are more common in African-American women.
• Intraductal papillomas
  These are small, wart-like growths in the lining of the mammary duct near the nipple. They usually affect women 40 to 50 years of age and can produce bleeding from the nipple or nipple discharge.
• Traumatic fat necrosis
  This condition occurs when there is trauma (sudden injury) to the breast. This causes fat to form in lumps. The lumps are usually round, firm, hard, single, and painless.

Can men have breast lumps?
Yes, men can have tender breast enlargement, often with a lump beneath the nipple. Sometimes this is in one breast, often in both. This benign finding is called gynecomastia. Gynecomastia also can occur after taking certain types of medications.

Can a breast lump indicate an infection?
Possibly. Sometimes breast infections are first noticed as a painful lump, with or without redness. Mastitis is an infection that often occurs in women who are breastfeeding. Mastitis is caused by bacteria that enter the mammary ducts through the nipple. Localized pockets of infection will appear as tender, warm lumps in the breast.

Breast self-exam
By performing monthly breast self-exams, you can become familiar with the normal monthly changes in your breasts. Breast self-examination should be performed at the same time each month, 3 to 5 days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.

What should I do if I find a lump?
See your physician if you discover any new breast changes, changes that persist after your menstrual cycle, or changes that concern you. Conditions that should be checked by a physician include:

• An area that is distinctly different from any other area on either breast
• A lump or thickening in or near the breast, or in the underarm that persists through the menstrual cycle
• A change in the size, shape or contour of the breast
• A mass or lump that may feel as small as a pea
• A marble-like area under the skin
• A change in the feel or appearance of the skin on the breast or nipple [dimpled, puckered, scaly or inflamed (red, warm or swollen)]
• Bloody or clear fluid discharge from the nipples
• Redness of the skin on the breast or nipple

• A detailed health history will be taken.
• A thorough breast exam will be performed. Your health care provider will feel for lumps or other changes in the breast tissue.
• If there is a nipple discharge, a sample will be collected and examined under a microscope to detect the presence of cancer cells.
• Breast imaging (mammogram or ultrasound) will be performed if your previous studies are not current. Ultrasound helps determine if the lump is a solid mass or filled with fluid.

Other diagnostic tests may be needed, such as:

• Fine needle aspiration (FNA): This is a non-surgical form of breast biopsy in which a small needle is used to withdraw a sample of cells from the breast lump. If the lump is a cyst (fluid-filled sac), removal of the fluid will cause the cyst to collapse. If the lump is solid, cells can be smeared onto slides for examination in the laboratory.
• Core biopsy: This is similar to FNA, but a larger needle is used because actual breast tissue is removed, rather than a sampling of cells. A sample of the lump is removed, but the whole lump is not removed. The types of core biopsies include ultrasound-guided core biopsy and stereotactic biopsy.
• Ultrasound-guided core biopsy: This is a tissue sampling technique that does not require surgery. A biopsy needle is placed into the breast tissue. Ultrasound helps confirm the needle placement using sound waves reflected off breast tissue so the exact location of breast tissue is biopsied. The type of echo varies with each type of tissue. Ultrasound can distinguish many benign lesions, such as fluid-filled cysts, from solid lesions. Tissue samples are then taken through the needle.
• Stereotactic biopsy: A biopsy needle is placed into the breast tissue. Computerized mammographic pictures help confirm the needle placement using digital imaging so the exact location of breast tissue is biopsied. Tissue samples are then taken through the needle
• Open excisional biopsy: This is the surgical removal of the entire mass. The tissue is then studied under a microscope. If a rim of normal breast tissue is taken all the way around a lump (lumpectomy), biopsy can also serve as part of breast cancer treatment.

Cells or tissue that are removed are given to a pathologist, a physician who specializes in diagnosing abnormal tissue changes.

You may return to the physician for another evaluation in a few weeks.

How are benign breast conditions treated?
Fibrocystic breast changes do not require treatment. Your physician may recommend therapies that can help relieve monthly tenderness.

Simple cysts can be treated through fine needle aspiration, which may take place during the evaluation. After fluid is drawn from the cyst, it collapses.

Fibroadenomas and intraductal papillomas can be removed surgically.

Mastitis can be treated with warm compresses. Sometimes an antibiotic medication may be prescribed.

• Perform monthly breast self-examination beginning at age 20
• Have a baseline mammogram at age 35
• Have screening mammograms every year starting at age 40
• Have breast examinations by your health care provider (physician or nurse) every 3 years starting at age 20 and every year starting at age 40
• Keep track of your family health history
• Have a risk assessment performed to determine if you are at high risk