Breast Problems

Topic Overview

Breast lumps or changes are a common health worry for most women. Women may have many kinds of breast lumps and other breast changes throughout their lives, including changes that occur with menstrual periods, pregnancy, and aging. Most breast lumps and breast changes are normal.

See a picture of the breast anatomy.

Common, non-cancerous (benign) breast changes include:

• Sacs filled with fluids (cysts).
• Generalized breast lumpiness.
• Painless, movable, and firm round lumps (fibroadenomas).
• Damaged fatty tissue (fat necrosis).
• Growths inside the ducts (intraductal papillomas).
• Enlargement of lymph nodes in the breast.
• Breast pain (mastalgia).
• Breast infections (mastitis) or abscesses.
• Nipple discharge.
• Inflamed blood vessels (thrombophlebitis).

Breast development is the first sign of puberty in young girls. Usually, breasts begin as small, tender bumps under one or both nipples that will get bigger over the next few years. It is not unusual for one breast to be larger than the other or for one side to develop before the other. A girl may worry that a lump under the nipple is abnormal or a sign of a serious medical problem when it is a part of normal breast development.

In men, enlargement of male breast tissue (gynecomastia) is a non-cancerous breast change. During puberty, young men commonly have smooth, round lumps or "breast buds" under the nipple. These develop because of rapid changes in hormone levels. They are not dangerous and usually disappear in a few months.

Many women with breast pain or breast lumps worry about breast cancer. The incidence of breast cancer has gradually increased during the past 30 years and is the second leading cause of cancer deaths in women. Breast cancer represents approximately 30% of new cancer diagnosed in women. Approximately 1 man gets breast cancer for every 100 cases of breast cancer in women.

The earlier breast cancer is detected, the more easily and successfully it can be treated.

There are 2 methods of early detection:

• Clinical breast examination (CBE). During your routine physical examination, your doctor may do a clinical breast examination. During a CBE, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.
• Mammogram. A mammogram is an X-ray of the breast that can often find tumours that are too small for you or your doctor to feel. Most women should begin having mammograms at the age of 50. If you are younger than age 50 and have risk factors for breast cancer, talk with your doctor about starting screening before age 50.

Breast self-examination (BSE) involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror. Once you know what your breasts normally look and feel like, any new lump or change in appearance should be evaluated by a doctor. Most breast problems or changes are not caused by cancer. However, BSE should not be used in place of clinical breast examination and mammography. Studies have not shown that BSE alone reduces the number of deaths from breast cancer.

One of the biggest risk factors for breast cancer is age. Breast cancer is a common disease in women older than 50. At least 1 out of every 9 women in Canada will develop breast cancer if she lives long enough.

Early breast cancer is often seen on a mammogram before there are any symptoms. The most common symptom of breast cancer is a painless lump. However, sometimes painful lumps are cancerous. Other symptoms of breast cancer include:

• A lump or thickening in the breast or armpit that is new or unusual.
• A change in the size or shape of the breast.
• Skin changes, such as a dimple or pucker in the skin of the breast.
• Discharge or bleeding from the nipple that comes out without squeezing the nipple (spontaneous discharge).
• A change in the nipple.
• Scaling or crusting of the nipple.
• A change in the colour or feel of the skin of the breast or the darker area around the nipple (areola).
• A breast lump in a man.

Treatment of a breast problem depends on the cause of the problem.

Review the Check Your Symptoms section to determine if and when you need to see a doctor.

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Author:	Jan Nissl, RN, BS	Last Updated: December 10, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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