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Not every lump in the breast is malignant (cancer); in fact, most are benign (not cancer). Breast lumps may prove to be cysts or fibrous tumors caused by hormones, age or other factors. However, even tumors that are not cancerous must sometimes be removed, either because of their size or position in the breast or simply to be sure they don’t lead to cancer.
Possible Breast Cancer
The following scenarios do not necessarily mean you have breast cancer, but any of them should be examined without delay:
- A lump in your breast
- Thickening, dimpling or pitting/indentation (retraction) of the skin of the breast
- Nipple discharge that is either clear yellow or bloody
- Retraction or inversion of the nipples that is new
- Asymmetric appearance of the breast
- Redness of the breast
- Change in the appearance of the breast and/or nipple
Non-Cancerous Breast Problems
Common types of non-cancerous breast problems include cysts, lumps and thickening; breast pain; discharge from the nipple; and breast infection.
Lumps and Thickenings
If you are still having periods (menstrual cycles) and you have had lumps that come and go with your period, wait one cycle. If the lump is still present after one cycle, call your doctor. If you find a breast lump or thickening and you do not have periods, call your doctor to be examined.
Treatment: First, your doctor will perform an examination of both breasts. The result of this exam may assure your doctor that further testing is not needed. Should more testing be necessary, you may need diagnostic tests such as mammography, ultrasonography, needle aspiration studies (cytology), or a biopsy (histology). If a biopsy is necessary, it may be performed in one of several ways: office core or fine needle aspiration biopsy, stereotactic biopsy, ultrasound-guided core needle biopsy, or surgical excisional biopsy. Depending on the procedure, these are performed either in the office/radiology department or in the operating room under local anesthesia, with or without intravenous sedation, and usually on an outpatient basis.
Breast infections are relatively uncommon. Pain can be generalized (the whole breast hurts or throbs) or localized (the breast hurts in one area). Generalized breast pain, called "mastitis," can be associated with breast-feeding, pregnancy, or cancer treatment. Localized breast infection can be associated with an abscess, cellulitis (a non-contagious infection of the connective tissue beneath the skin), folliculitis (contagious inflammation or infection of one or more hair follicles of the skin), or other skin or soft tissue damage. Breast infections, like other infections, can become serious and create fever or systemic illness (affecting the whole body). It is very important that a breast infection be evaluated and treated in a timely fashion.
Treatment: Breast infections often require treatment with antibiotics. Additional measures such as heat, pain relievers, and surgical incision and drainage may also be required.
Nipple discharge can be associated with hormonal or normal aging changes (ductal ectasia). Nipple discharge that occurs rarely and in tiny drops, or during breast self-examination or other breast manipulation, is common. However, when nipple discharge occurs on its own or you notice staining of your bra or nightclothes, you should consult a physician. Similarly, bloody discharge, spontaneous clear or yellow discharge, or persistent one-sided discharge should be brought to the immediate attention of a health practitioner. Discharge that is slightly milky and coming from both breasts could be the result of pregnancy or certain supplemental hormones and medications. All nipple discharge should be evaluated.
Treatment: Complaints of nipple discharge are evaluated by a clinical breast exam and appropriate imaging studies. If nipple discharge is found on examination, the physician will try to localize the area from which the discharge originates, determine whether there is blood in the fluid, and consider testing the fluid for cytology (analysis of the cells in the nipple fluid) and/or culture (analysis for any bacteria that may be present).
Breast pain may occur at almost any age and can have any number of causes. The pain can be one-sided or on both sides, constant or intermittent, frequent or occasional. Sharp, dull, aching and/or sticking sensations are all possible. Some common reasons for breast pain are hormonal changes associated with menstruation, pregnancy, peri-menopause and/or menopause, and muscular straining of the chest wall, upper back, and shoulder muscles. Fortunately, breast pain is rarely a sign of cancer.
Treatment: A thorough examination of the breasts, lymph nodes, and muscles of the chest and shoulders through a diagnostic test such as mammography, sonography, or needle aspiration of cysts may be considered. Other considerations that may be discussed include the amount of caffeine intake, medications, hormones, diuretics, birth control, the type of support bra, and daily activities.
Guidelines for Obtaining Mammograms
All women should have an initial mammogram at age 40 and annually thereafter. Women at an increased risk because of family or personal history should consider beginning screening before 40 and/or obtaining a mammogram every year, subject to the recommendation of their physician. Click here to view comprehensive mammogram screening guidelines from the American Cancer Society.