Introduction
A breast lump can be alarming. But not every lump means cancer. This article guides you through the types, causes, diagnosis, and next steps for any breast lump—whether you're a young woman, an elderly patient, or somewhere in between.
What is a Breast Lump?
- Definition: palpable mass in breast
- Common symptom in both benign and malignant conditions
- Often localized, may or may not be painful
- Bilateral vs unilateral involvement
Age-Based Classification of Breast Lumps
In Young Women (<35 years)
- Fibroadenoma (most common)
- Localized fibrocystic disease
- Cysts (rarely carcinoma)
In Older Women (>50 years)
- Carcinoma (most common)
- Cysts
- Fibroadenoma (less common)
Solid vs Cystic Breast Lumps
Cysts
- Fibrocystic disease: irregular, often tender
- Galactocele: postpartum, milky contents, tender
Solid Lumps
Benign:
- Fibroadenoma: mobile, regular, well-defined
- Lipoma: soft, mobile
- Fat necrosis: irregular, skin changes
- Cystosarcoma phyllodes (rare, <1% of tumors)
- Carcinoma: irregular, hard, tethered, possible skin ulceration or ‘peau d’orange’
Key Features to Differentiate Benign vs Malignant Lump
- Pain: usually benign
- Tethering: often malignant
- Surface: smooth vs irregular
- Mobility: mobile (benign) vs fixed (malignant)
- Multiple lesions: more likely benign
- Skin/nipple changes: red flag for malignancy
Related topic: Breast Pain – When to Worry
Differential Diagnosis Based on Presentation
Swelling of the Whole Breast
- Pregnancy, lactation
- Puberty (in males too – gynecomastia)
- Drug-induced hypertrophy
Localized Lump
- Fibroadenoma
- Cyst
- Abscess (mastitis)
- Carcinoma
Breast Abscess or Infection
- Mastitis (red, painful, tender)
- Tuberculous abscess (chronic sinus)
Behind the Breast
- Rib abnormalities
- Chondroma, costochondritis
Triple Assessment Approach to Diagnosis
1. Clinical Examination
- Size, location, mobility, tenderness
- Skin and nipple inspection
- Axillary and supraclavicular nodes
2. Imaging
- Ultrasound: better for young women with dense breasts
- Mammography: better for older women, screens for carcinoma
3. FNAC (Fine Needle Aspiration Cytology)
Differentiates C1–C5:- C1: Inadequate
- C2: Benign
- C3/4: Suspicious
- C5: Malignant
Interpretation of FNAC and Decision Tree
FNAC = C5 (Carcinoma)
- Immediate treatment planning
FNAC = C3/4 (Equivocal)
- Excision biopsy or repeat triple assessment
FNAC = C2 (Benign)
- If non-suspicious: observe
- If suspicious clinically/radiologically: excision biopsy
Special Cases
Fibroadenoma:- <35 years and unconcerned → 6-month review
- 35 or concerned → biopsy
Helpful read: Neck Lump Signs
Special Conditions
Fibroadenoma
- Young women
- Painless, mobile
- Monitored unless >35 or enlarging
Carcinoma of Breast
- Common after age 50
- Hard, irregular, fixed lump
- May involve nipple discharge, skin changes
Cystosarcoma Phyllodes
- Rare, large tumor
- Requires excision
Red Flags for Cancer
- Hard, irregular, immobile mass
- Skin dimpling or nipple retraction
- Discharge (especially bloody)
- Peau d’orange appearance
- Axillary lymphadenopathy
Treatment Overview
Benign Lumps
- Observation
- Excision if symptomatic or diagnostic uncertainty
Breast Abscess
- Antibiotics + drainage
- Avoid delay during lactation
Breast Cancer
Triple assessment followed by:- Surgery (lumpectomy or mastectomy)
- Chemotherapy/radiation
- Hormonal therapy if receptor positive
FAQs About Breast Lumps
Are all breast lumps cancerous?
No. Most lumps in young women are benign. Evaluation is still essential.
Is a painful breast lump dangerous?
Usually not. Pain is more common in infections or cysts.
How is a breast lump diagnosed?
Triple assessment: Clinical exam, imaging, and FNAC or biopsy.
Can a breast lump go away on its own?
Yes, benign cysts may resolve. Persistent or enlarging lumps need investigation.
What does a cancerous breast lump feel like?
Hard, irregular, non-tender, fixed, possibly associated with skin changes.
Conclusion
A breast lump may be benign or malignant—but early evaluation is key. Whether you're a young woman with a fibroadenoma or over 50 with suspicious features, understanding the signs, tests, and treatment options can save lives.
