Breast lump

Originally Published: December 1, 1994 - Last Updated / Reviewed On: October 21, 2014
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Dear Alice,

My doctor found a lump in my breast recently. She told me not to worry, but have it checked out soon, by another doctor. She said that it did not feel cancerous, but may be a cyst or fibroadenoma. Can you tell me about what these are exactly, and does this mean a greater chance for breast cancer later in life? What should I expect? Thanks for your help.

—Concerned

Dear Concerned,

Finding a breast lump may be a worrisome experience, but rest assured not all lumps are cancerous. In fact, eighty percent of all breast lumps are benign. Fibrocystic changes occur in one to three quarters of all women, usually because of hormonal changes that occur throughout a woman’s monthly menstrual cycle. Injuries, infections, and medicines may also cause benign breast lumps to form. Although most lumps are harmless, studies show breast cancer risk increases significantly with age after a woman turns 40. Even if you’re under 40, your doctor’s recommendation to obtain a second opinion is a great idea, because lumps and bumps can be erroneously diagnosed as harmless.

A benign cyst is the most common type of breast lump. As hormone levels oscillate throughout ovulation, breast cells may retain fluid, thereby forming cysts. If a woman examines her breasts during various phases of her menstrual cycle, she may find a series of cysts in one or both breasts – especially in the areas near the underarms. Benign cysts have the following characteristics:

  • Their size and number may fluctuate throughout the menstrual cycle.
  • They might be present from a woman’s very first period or develop much later on in life.
  • They’re most common in women nearing menopause.

Cysts usually resolve with time. If they don’t, however, a health care provider may drain cyst fluid using a fine needle. For recurrent cysts, other options, such as surgery, are considered. The presence of multiple cysts in the breast makes examination and differentiation between normal and abnormal lumps more difficult, so women with multiple cysts may seek the assistance of a medical provider for breast examinations.

A fibroadenomais the second most common type of breast lump. Fibroadenomas have the following characteristics:

  • They’re fibrous, painless, firm, round, mobile, and are usually about one inch in diameter.
  • They’re solitary and do not form in clusters.
  • They occur most often in women under the age of 30.
  • They’re more common among black women.
  • They do not resolve over time and may continue to grow, especially during adolescence.

Surgical removal of fibroadenomas is generally recommended, though conservative management is appropriate in some cases. If you and your doctor opt for surgical removal, a pathologist will examine the lump to confirm the diagnosis of fibroadenoma and to rule out the possibility of a precancerous breast tumor.

Scientific consensus indicates that benign fibroadenomas and breast cysts are not associated with an increased risk of developing breast cancer. However, studies have demonstrated an association between increased breast cancer risk and multiple breast biopsies.

To effectively monitor any changes in your breasts, the American Cancer Society (ACS) recommends that a breast self-examination (BSE) be done at the same time every month, preferably one week after your period ends when your breasts are not swollen or tender. For instructions on how to perform a BSE, check out the ACS website. Alternatively, the U.S. Preventive Services Task Force (USPSTF)  posits that BSEs and clinical breast examinations  may not be effective in locating precancerous or cancerous breast lumps. Further, the USPSTF reports that the benefits of these screening methods do not currently outweigh the risks. According to USPSTF, screening for breast lumps should be an individualized process. When in doubt, consult with your health care provider regarding which screening methods make the most sense for you.

If you are concerned about any changes in your breasts, it’s best to talk with your primary care provider about your personal risk for breast cancer as well as the many ways of screening for breast lumps. Columbia students can make an appointment with Medical Services (Morningside) or Student Health Services (CUMC). Your provider can make necessary referrals, offer support, and hopefully put your breast concerns at ease.

Alice