Breast lumps and changes

Many breast cancers are found by a woman or her partner. You can help find breast cancer by getting to know your breasts and being aware of any changes that are not normal for you.

Looking at your breasts in the mirror and feeling them while washing or dressing are important as you get older, especially after age 40.

Checking your breasts is recommended for all women, even if they are having mammograms. If breast cancer is found when it is small it is less likely to have spread.

Treating breast cancer before it has spread gives a woman a better chance of successful treatment. There is also a greater chance of breast conserving surgery.

What are breasts made of?

Your breasts are made up of the following:

• milk glands made up of many milk sacs throughout the breast
• milk ducts to carry milk to the nipple
• fibrous tissue which covers and supports the whole breast
• fatty tissue which gives the breast its shape and size.

In the breast, armpit and neck there are collections of lymph nodes. These are small glands, each about the size of a pea, which help your body fight infection. Your chest muscles and ribs lie beneath your breasts.

If you lie on your back and feel your breasts you may be able to feel your ribs, especially if you have small breasts.

You may notice that your breasts are slightly different in shape or size or that one is slightly higher than the other. If your breasts have always been like this, these differences are normal.

Normal breast changes

Periods
Your breasts may increase in size just before your period. Tender lumps may also appear and last until about a week after.

Pregnancy
During pregnancy your breasts get bigger, become firmer and more tender. The area around the nipple usually becomes darker and small bumps may appear.

Menopause
Milk glands get smaller and breast tissue loses strength and stretchiness at menopause. This causes breasts to sag and become softer. Your skin may also wrinkle.

The pill
If you take a contraceptive pill you might notice changes, such as pain, or tenderness, lumps and thickenings.

Breast pain
Causes of breast pain can include cysts, a blocked duct or infection during breast feeding, and tenderness due to your period. Pain isn't usually a sign of breast cancer.

Breast lumpiness
This is very common from the age of 35 to 50 years. The lumpiness or thickening can be in a part of one breast or throughout both breasts. Some lumpy areas come and go over the years. Others are present for days or weeks.

The lumpiness is often more obvious before your period and tends to become less or disappear after menopause.

What if I have breast changes?

If you feel or see something in one breast which seems different from usual, check your other breast. If there is something in the same place in both breasts, your breasts are probably quite normal. If you don't think it's normal, see your doctor.

In some cases your doctor will ask you to return in a few weeks' time, to see if the change is related to your period. It's a good idea to make another appointment while you are at the doctor's surgery.

If the lump or change is still there on your next visit, you should ask to be referred to a hospital clinic or a specialist.

Benign breast lumps

All breast lumps should be checked by a doctor. Most breast lumps which develop before menopause are benign (not cancer) and benign lumps do not change into cancerous lumps.

Some common benign lumps are:

• Lipomas. These are lumps made up of fatty tissue.
• Cysts. These are fluid-filled sacs. You may have a single cyst or a number of different sized cysts. Your doctor may use a needle to remove the fluid.
• Fibroadenomas. These lumps are smooth, hard and movable, rather like a marble dropped into the breast tissue. They are common in women aged 18 to 30.

Breast cancer

Breast cancer usually occurs in women over the age of 40 and becomes more common as women grow older.

The signs of breast cancer are often the same as for benign breast changes. They are:

• a new lump or thickening
• a change in breast shape or size
• puckering or dimpling of the skin
• any change in one nipple, such as:
  - a turned-in nipple
  - a discharge which persists without squeezing
• lumpiness in one breast soon after your period ends
• pain in the breast that is unusual.

These changes may not be cancer. But it's important for all of them to be checked by a doctor.

Checks for cancer

There are several ways your doctor will check a breast lump or other change. The aim of these checks is to make sure you don't have breast cancer.

In some cases your doctor will do these checks and in others you will be referred to a hospital clinic or specialist.

Examination by a doctor

Your doctor will firmly feel both your breasts, your armpits and the nodes in your neck. It will help if you show your doctor exactly where you feel the lump or have noticed a change.

Mammography

Mammography is the use of special x-rays (called mammograms). It helps give a general picture of both breasts and any lumps or changes in them. If there is a lump, mammography on its own usually is not enough to show if it is cancer or not. A sample of the lump will be needed.

Sometimes mammography can find a lump which cannot be felt. However, a lump that can be felt may not always show up on a mammogram.

Sometimes ultrasound is used as well as mammography, particularly in women under 50. It can show whether the lump is solid or fluid-filled.

Fine needle sampling

A fine needle is used to obtain a small sample of the lump or thickening, so that it can be examined under a microscope. This is relatively painless and is usually done in a doctor's surgery or hospital clinic.

If you have a nipple discharge some of this fluid will be smeared onto a slide and sent to a laboratory.

Core (tru-cut) biopsy

A local anaesthetic is given, then a slightly larger needle is used to remove a small core of tissue.

Excision biopsy

This involves partial or total removal of the abnormal area. A local or general anaesthetic is given.

What if cancer is found?

Treatment of breast cancer depends on the type of breast cancer, its size and position, whether it has spread, the woman's age and general health.

There are two main treatment options:

• removal of the lump, usually followed by radiation therapy
• mastectomy or removal of the breast.

Treatment may also include chemotherapy (drugs) and hormones. Some women who have a mastectomy may also have radiation therapy.

Related topics

What is breast cancer? See Breast cancer

How is breast cancer diagnosed? See Breast cancer diagnosis

How is breast cancer treated? See Breast cancer treatment

Who should have a mammogram? See Breast screening: mammograms

What does that term mean? See Cancer glossary

Original material provided by the Cancer Society, 2003. Reviewed by everybody, February 2005.