Breast Lumps in Women
The discovery of a lump in a woman’s breast will usually create a lot of anxiety. She will probably have found it herself and with the high public awareness of breast cancer, will want reassurance or rapid action. A careful examination of both breasts and associated lymph nodes is mandatory
Differential diagnosis
Common Diagnoses
- Carcinoma
- Cyst
- Abscess
- Fibroadenoma
- Fibrous Dysplasia
Occasional Diagnoses
- Duct Ectasia
- Fat Necrosis
- Lipoma
- Paget’s Disease of the Nipple
- Galactocoele
- Multiple Cysts
- Spurious Lump (e.g. Palpable Underlying Rib)
Rare Diagnoses
- Tuberculosis
- Sarcoma
- Lymphoma
- Phyllodes Tumour (Benign)
- Mondor’s Disease (Thrombophlebitis)
Ready reckoner
Key distinguishing features of the most common diagnoses
| Cancer | Cyst | Abscess | Fibroadenoma | Fibrous Dysplasia | |
|---|---|---|---|---|---|
| Changes with Periods | No | Possible | No | No | Yes |
| Discharge | Possible | No | Possible | No | Possible |
| Painful | Possible | Possible | Yes | No | Possible |
| Bilateral | Possible | Possible | No | Possible | Yes |
| Highly Mobile | Possible | No | No | Yes | No |
Possible investigations
- There are generally no investigations that are appropriate in general practice. Specialist investigation may include aspiration, mammography, ultrasound (for example, to distinguish a solid from a cystic lump), biopsy and, when appropriate, cancer staging
Top Tips
- Do not be tempted to investigate a lump yourself with imaging. If you are concerned enough to do this then the patient should have a full specialist assessment
- Current guidance advises that patients aged under 30 with an explained breast lump require non-urgent referral – unless, of course, there are other pointers for cancer such as concerning nipple changes, in which case the referral should be urgent.
- It is quite common for women to think they can feel a lump while the doctor has difficulty in detecting a discrete lesion. Re-examine after the patient’s next period – but then make a firm management decision. If in doubt, refer rather than delay further as the woman will understandably be very anxious.
- In the very elderly, breast carcinoma may run a relatively benign course, responding very well to tamoxifen alone. In certain cases it might be worth discussing the situation with your local specialist, as GP treatment will provoke far less anxiety.
Red Flags
- Skin dimpling, local flattening of the breast and nipple alteration indicate cancer until proved otherwise.
- Even if the diagnosis is likely to be a fibroadenoma – as in a young woman with a highly mobile lump – refer, as unpleasant surprises do occur.
- In any patient aged 30 or over with an unexplained breast lump, refer urgently.
- A mass appearing after trauma may be fat necrosis – but recheck after a few weeks and refer if not resolved.