Breast lumps: what to do when you find one

Most lumps are benign, and that is not a reason to wait

The majority of breast lumps turn out to be benign: fibroadenomas, cysts, areas of normal but lumpy breast tissue, or changes related to the menstrual cycle.

That statistic is reassuring in general and useless in particular. It tells you what happens to most people. It does not tell you what is happening to you. Reassurance is a finding, something established by assessment, not an assumption you can safely make at home.

What a breast lump can feel like

Breast lumps vary enormously, which is exactly why feel alone cannot settle the question.

A fibroadenoma is often smooth, firm and mobile, frequently described as slipping away from the fingers when pressed.

A cyst can appear quickly, may be tender, and often feels smooth and rounded.

A cancerous lump is more often hard, irregular in outline, and fixed rather than mobile, but not always. Some cancers feel soft, smooth or mobile, and some are not felt as a lump at all.

This is the central point: the characteristics overlap. A surgeon examining a lump is forming an impression, not reaching a diagnosis. The diagnosis comes from imaging and, where needed, tissue.

Does it matter whether it hurts?

Less than people expect. Pain is a poor discriminator in breast disease.

Painful lumps are frequently benign, cysts and cyclical changes are often tender. Painless lumps are not automatically safe. Many breast cancers cause no pain at all in their early stages.

So the absence of pain is not reassurance. It is simply the absence of pain.

When should you see someone?

Arrange an assessment for any of the following:

A new lump that is still present after one full menstrual cycle.

A lump that is getting larger, or changing in character.

Any new lump at all after menopause.

Skin changes, dimpling, puckering, thickening, or an area resembling orange peel.

Nipple changes, a nipple newly turning inwards, or a persistent rash or scaling.

Spontaneous discharge from one nipple, particularly if blood-stained.

A lump in the armpit.

Pain confined to one spot that does not vary with your cycle and does not settle.

What assessment involves

Breast problems are assessed using three strands together, because no single strand is reliable alone. This is called triple assessment.

Clinical examination, your history and a physical examination.

Imaging, ultrasound, mammography, or both. Which is used depends largely on your age. Younger women usually have ultrasound first, because denser breast tissue makes mammograms harder to interpret.

Tissue sampling, a needle biopsy, if examination or imaging raises a question that only tissue can answer.

When all three agree, the answer is reliable. When they disagree, that disagreement is itself important and is investigated rather than explained away.

What happens if it is benign

Most people are told their lump is benign. What follows depends on what it is.

Many benign lumps need nothing beyond knowing what they are. Some are monitored with a repeat scan. Some are removed, because they are large, growing, causing symptoms, or because the diagnosis could not be established confidently any other way.

You should leave the consultation knowing which of these applies to you, and what would prompt you to come back.