Benign Breast Lumps

Breast changes are common. Women experience various kinds of breast lumps and other breast changes. These changes include those that normally occur during the menstrual cycle, during pregnancy, and with aging, as well as several types of breast lumps and other changes. Most breast lumps and other changes are not cancer. Among breast conditions for which biopsies are often done, the results show that some 80 percent are not cancer. But only a doctor can tell for sure whether a condition is malignant (cancer) or benign (not cancer).

Each breast has 15 to 20 sections, called lobes, each with many smaller lobules. The lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of the dark area of skin called the areola. Fat fills the spaces between lobules and ducts. There are no muscles in the breasts, but muscles lie under each breast and cover the ribs. These normal structures inside the breasts can sometimes make them feel lumpy. Such lumpiness may be especially noticeable in women who are thin or who have small breasts.

From the time a girl begins to menstruate, her breasts undergo regular changes each month. Many women experience swelling, tenderness, and pain before and sometimes during their periods. At the same time, one or more lumps or a feeling of increased lumpiness may develop because of extra fluid collecting in the breast tissue. These lumps normally go away by the end of a woman's period. Eventually, about half of all women will experience symptoms such as lumps, pain, or nipple discharge. Generally, these symptoms disappear with menopause.

Some studies show that the chances of developing benign breast changes are higher for women who have never had children, have irregular menstrual cycles, or have a family history of breast cancer. Benign breast changes are less common among women who take birth control pills or who are overweight. Because they usually involve the glandular tissues of the breast, benign breast conditions are more of a problem for women of child-bearing age, whose breasts are more glandular.

There are several types of benign breast changes and conditions. Some benign breast conditions cause a discharge from the nipple. Since the breast is a gland, secretions from the nipple of a mature woman are not unusual, nor even necessarily a sign of disease. For example, small amounts of discharge commonly occur in women taking birth control pills or certain other medications, including sedatives and tranquilizers. Discharge may be clear or milky.

Any discharge should be mentioned to the doctor. If the discharge is being caused by a disease, the disease is more likely to be benign than cancerous. The doctor will take a sample of the discharge and send it to a laboratory to be analyzed. Benign sticky discharges are treated chiefly by keeping the nipple clean. A discharge caused by infection may require antibiotics.

Generalized breast lumpiness is one common type of benign breast change. Benign breast conditions also include several types of distinct, solitary (single) lumps. Such lumps, which can appear at any time, may be large or small, soft or rubbery, fluid-filled or solid.

Generalized breast lumpiness is known by several names, including fibrocystic changes, fibrocystic disease, and benign breast disease. Such lumpiness, which is sometimes described as "ropy" or "granular," can often be felt in the area around the nipple and areola and in the upper outer part of the breast. During pregnancy, the milk-producing glands become swollen and the breasts may feel lumpier than usual. It can be difficult for a woman to examine her breasts when she is pregnant, but she should continue to do so; although very uncommon, breast cancer has been diagnosed during pregnancy. Lumpiness may become more obvious as a woman approaches middle age and the milk-producing glandular tissue of her breasts increasingly gives way to soft, fatty tissue. Unless a woman is taking replacement hormones, this type of lumpiness generally disappears after menopause.

Cysts are fluid-filled sacs. They occur most often in women 35 to 50 years of age, and cysts often enlarge and become tender and painful just before a woman's menstrual period. Cysts are usually found in both breasts. Some cysts are so small they cannot be felt; rarely, they may be several inches across. Cysts show up clearly on ultrasound, an exam using sound waves to produce a picture of tissues inside the breast. Cysts are usually handled by observation or by withdrawing fluid with a needle. This procedure is called a fine-needle aspiration.

Fibroadenomas are benign tumors made up of both structural (fibro) and glandular (adenoma) tissues. Usually, these solid, round lumps are painless and most often found by women themselves. Fibroadenomas feel rubbery and can be moved around easily. They are the most common type of tumors in women in their late teens and early twenties, and they occur twice as often in African-American women as they do in other American women. Although fibroadenomas do not become malignant, they can enlarge with pregnancy and breast-feeding. Fibroadenomas have a typically benign appearance on mammography (breast x-rays), and they can sometimes be diagnosed with fine-needle aspiration. Most surgeons believe that it is a good idea to remove fibroadenomas to make certain they are benign.

Fat necrosis refers to painless, round, firm lumps formed by damaged and disintegrating fatty tissue. This condition typically occurs in obese women with very large breasts. Fat necrosis often develops in response to a bruise or blow to the breast, even though a woman may not remember having been injured. Sometimes, the skin around the lumps looks red or bruised. Because fat necrosis can easily be mistaken for cancer, lumps are surgically removed so the tissue can be checked under a microscope.

Sclerosing adenosis is a benign condition involving the excessive growth of tissues in the breast's lobules. It frequently causes breast pain. Usually the changes are microscopic. However, adenosis can produce lumps, and it can show up on mammography, often as calcifications, small deposits of calcium in tissue. Because adenosis is often difficult to distinguish from cancer, doctors usually perform a surgical biopsy to diagnose and treat this condition.

Intraductal papilloma is a small wartlike growth that projects into breast ducts near the nipple. Solitary intraductal papillomas usually affect women nearing menopause. As any slight bump or bruise around the nipple can cause the papilloma to bleed, this condition is a common source of bloody or sticky discharge from the nipple. If the discharge becomes bothersome, the diseased duct can be removed surgically without damaging the appearance of the breast. Multiple intraductal papillomas, in contrast, are more common in younger women. They often occur in both breasts and are more likely to be associated with
a lump than with nipple discharge. Multiple intraductal papillomas, or any papillomas associated with a lump, need to be removed.

Some benign breast conditions are characterized by infection and/or inflammation. Mastitis, sometimes called postpartum mastitis, is an infection most often seen in women who are breast-feeding. A duct may become blocked, causing milk to pool and allowing for infection by bacteria and inflammation. The breast appears red and feels warm, tender, and lumpy. In its early stages, mastitis can by cured by antibiotics. If a pus-containing abcess forms, it may need to be drained or surgically removed.

Mammary duct ectasia is a disease of women nearing menopause. Ducts beneath the nipple become inflamed and can become clogged. Mammary duct ectasia can be painful, and it can produce a thick and sticky discharge that is gray to green in color. Treatment consists of warm compresses, antibiotics, and, if necessary, surgery to remove the duct.

Studies show that certain very specific types of microscopic changes put a woman at higher risk for breast cancer. These changes feature excessive cell growth, or hyperplasia. It is important to understand, however, that most benign breast changes and conditions do not increase a woman's risk of getting cancer.

Approximately 70 percent of the women who have a biopsy showing a benign condition have no evidence of hyperplasia and are at little or no increased risk of developing breast cancer. About 25 percent of benign breast biopsies show signs of hyperplasia, including conditions such as intraductal papilloma and sclerosing adenosis. In these cases, the risk of developing breast cancer is slightly increased. The remaining 5 percent of benign breast biopsies reveal both excessive cell growth (hyperplasia) and cells that are abnormal (atypia). A diagnosis of atypical hyperplasia, as it is called, moderately increases breast cancer risk.

This fact sheet provides important information about benign breast lumps and other benign breast changes. Only a doctor can determine the nature of any breast lump or change. It is important for all women with breast lumps or changes to consult with a doctor.

SOURCE: NCI Fact Sheets: Cancer Facts

also see -> All About Breast Lumps

Elsewhere on the Web:

Benign Breast Lumps - Information from WebMD
Benign Breast Conditions
Common Benign Lumps