View source for Breast Mass Resident Survival Guide

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{{WikiDoc CMG}}; {{AE}} {{Aisha}}

==Overview==
A breast mass is a [[mass]] that develops in the [[Breast|breast tissue]]. The breast consists of many different tissue types, i.e., [[Mammary gland|mammary glands]], [[Duct (anatomy)|mammary ducts]], and tubes. [[Fibrous tissue]], [[adipose tissue]], [[nerves]], [[blood vessels]], and [[lymph nodes]] also form essential [[breast]] components. As a result, breast masses differ widely in sizes, textures, and symptoms (i.e., pain, tenderness, discharge). Breast masses can be benign or malignant and is often an [[incidental finding]]. A [[Ultrasound|breast ultrasound]] or [[Mammography|mammogram]] can diagnose suspicious lesions. Women of reproductive age are more prone to develop breast lumps or masses. Occasionally, breast masses may be associated with hormonal changes (i.e., [[Fibrocystic Disease of the Breast|fibrocystic changes]]), which have a waxing and waning course. Breast masses, although uncommon, can occur in men. If a cancer diagnosis is confirmed, modalities like [[lumpectomy]], [[mastectomy]], [[chemotherapy]], or [[Radiation|radiation therapy]] are treatment options. 

==Causes==
===Life Threatening Causes===

*'''Breast cancer'''
*[[Breast cancer]] is a type of [[cancer]] that originates in the breast tissue and occurs when the breast tissue starts growing at an uncontrollable rate. Although it is predominantly present in females, It also occurs in men. [[Breast cancer]] can be either ductal when it involves the mammary ducts or [[lobular]] when it starts in the [[glands]]<ref name="urlWhat Is Breast Cancer? | Breast Cancer Definition">{{cite web |url=https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html |title=What Is Breast Cancer? &#124; Breast Cancer Definition |format= |work= |accessdate=}}</ref>. It is the most prevalent cancer in females and the second most common cause of death<ref name="urlEpidemiology of breast cancer: retrospective study in the Central African Republic | BMC Public Health | Full Text">{{cite web |url=https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3863-6#:~:text=The%20breast%20cancer%20prevalence%20was,is%20more%20than%2048%20months. |title=Epidemiology of breast cancer: retrospective study in the Central African Republic &#124; BMC Public Health &#124; Full Text |format= |work= |accessdate=}}</ref>. Several factors, like increasing age, high hormone levels, economic status, and ethnic groups, affect breast cancer incidence<ref name="urlWhat Are the Risk Factors for Breast Cancer? | CDC">{{cite web |url=https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm |title=What Are the Risk Factors for Breast Cancer? &#124; CDC |format= |work= |accessdate=}}</ref>.
*Breast cancer can present as a mass or lump in the breast and can have associated symptoms like discharge, discoloration, pain, itching, induration, and lymph engorgement. Dimpling the skin, abnormality in the shape and size of the breast, or subjective symptoms like pain and traction may also be present<ref name="urlWhat Are the Symptoms of Breast Cancer? | CDC">{{cite web |url=https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm |title=What Are the Symptoms of Breast Cancer? &#124; CDC |format= |work= |accessdate=}}</ref>.
*The risk of breast cancer increases with increasing age, as most cases are diagnosed after 50 years<ref name="urlWhat Are the Risk Factors for Breast Cancer? | CDC">{{cite web |url=https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm |title=What Are the Risk Factors for Breast Cancer? &#124; CDC |format= |work= |accessdate=}}</ref><ref name="pmid24114568">{{cite journal |vauthors=DeSantis C, Ma J, Bryan L, Jemal A |title=Breast cancer statistics, 2013 |journal=CA Cancer J Clin |volume=64 |issue=1 |pages=52–62 |date=2014 |pmid=24114568 |doi=10.3322/caac.21203 |url=}}</ref>. Mutations, like BRCA1 and BRCA2, also significantly increase the risk of breast cancer<ref name="pmid25224030">{{cite journal |vauthors=Mersch J, Jackson MA, Park M, Nebgen D, Peterson SK, Singletary C, Arun BK, Litton JK |title=Cancers associated with BRCA1 and BRCA2 mutations other than breast and ovarian |journal=Cancer |volume=121 |issue=2 |pages=269–75 |date=January 2015 |pmid=25224030 |pmc=4293332 |doi=10.1002/cncr.29041 |url=}}</ref>. Furthermore, early [[menarche]] and late [[menopause]] also increase the risk due to prolonged exposure to hormones. Women with a history of breast cancer have an increased risk of future recurrences of the same. Also, a history of breast cancer in mother, sister, or any first-degree relative or [[breast]] or [[ovarian cancer]] in other relatives increases breast cancer chances<ref name="pmid28578505">{{cite journal |vauthors=Brewer HR, Jones ME, Schoemaker MJ, Ashworth A, Swerdlow AJ |title=Family history and risk of breast cancer: an analysis accounting for family structure |journal=Breast Cancer Res Treat |volume=165 |issue=1 |pages=193–200 |date=August 2017 |pmid=28578505 |pmc=5511313 |doi=10.1007/s10549-017-4325-2 |url=}}</ref>. Any [[Radiation treatments|radiation treatment]] in the past is also a breast cancer risk<ref name="pmid30573632">{{cite journal |vauthors=Opstal-van Winden AWJ, de Haan HG, Hauptmann M, Schmidt MK, Broeks A, Russell NS, Janus CPM, Krol ADG, van der Baan FH, De Bruin ML, van Eggermond AM, Dennis J, Anton-Culver H, Haiman CA, Sawyer EJ, Cox A, Devilee P, Hooning MJ, Peto J, Couch FJ, Pharoah P, Orr N, Easton DF, Aleman BMP, Strong LC, Bhatia S, Cooke R, Robison LL, Swerdlow AJ, van Leeuwen FE |title=Genetic susceptibility to radiation-induced breast cancer after Hodgkin lymphoma |journal=Blood |volume=133 |issue=10 |pages=1130–1139 |date=March 2019 |pmid=30573632 |pmc=6405334 |doi=10.1182/blood-2018-07-862607 |url=}}</ref>.

===Common Causes===

*'''Breast cysts'''
**These are the fluid-filled sacs in the breast tissue<ref name="pmid2696224">{{cite journal |vauthors=Hughes LE, Bundred NJ |title=Breast macrocysts |journal=World J Surg |volume=13 |issue=6 |pages=711–4 |date=1989 |pmid=2696224 |doi=10.1007/BF01658419 |url=}}</ref>. They can be either round or oval-shaped and vary in size. In most cases, they are palpable, smooth, round, movable masses, and present with symptoms like pain and tenderness. They are mostly seen in women of reproductive age i.e 30s and 40s but can also be found in men<ref name="pmid31404321">{{cite journal |vauthors=Azimi N, Azar A, Khan A, DeBenedectis CM |title=Benign Breast Cyst in a Young Male |journal=Cureus |volume=11 |issue=6 |pages=e4814 |date=June 2019 |pmid=31404321 |pmc=6682391 |doi=10.7759/cureus.4814 |url=}}</ref>. The size of the cyst can vary intermittently based on hormonal influences, like menstruation and pregnancy. The cysts can be simple<ref name="pmid10541113">{{cite journal |vauthors=Venta LA, Kim JP, Pelloski CE, Morrow M |title=Management of complex breast cysts |journal=AJR Am J Roentgenol |volume=173 |issue=5 |pages=1331–6 |date=November 1999 |pmid=10541113 |doi=10.2214/ajr.173.5.10541113 |url=}}</ref>, consisting of fluid, or complex, with both fluid and solid components<ref name="pmid16398815">{{cite journal |vauthors=Houssami N, Irwig L, Ung O |title=Review of complex breast cysts: implications for cancer detection and clinical practice |journal=ANZ J Surg |volume=75 |issue=12 |pages=1080–5 |date=December 2005 |pmid=16398815 |doi=10.1111/j.1445-2197.2005.03608.x |url=}}</ref>. The exact diagnosis is confirmed by biopsy.
*'''Adenosis'''
**Adenosis is a nonmalignant breast condition categorized by enlargement and an increase in the milk-producing glands. These are more predominant in women with underlying fibrosis and cysts. A [[biopsy]] is needed for definitive diagnosis.
*'''Galactocele'''
**[[Galactoceles]] are benign breast lesions, predominantly seen in lactating women. The leading cause of [[galactocele]] is the cessation of breastfeeding, which leads to retention of milk in the ducts and stagnation, which causes pouches to form known as [[galactoceles]]. Usually, it presents as a painless mass or lump in the breast. On palpation, they feel like simple cysts, but instead of fluid, they contain milk. Although they are [[symptomatic]], they are not dangerous.
*'''Fat Necrosis'''
**[[Fat necrosis]] is a benign non-cancerous condition affecting the breast, which occurs after damage or injury to the breast's fatty tissue mostly due to trauma. It can be a side effect of breast surgery or any radiation therapy. It usually causes a firm mass or lump in the breast. Although it is mostly asymptomatic, occasionally it can present with [[tenderness]], or discoloration.
*'''Fibroadenoma'''
**[[Fibroadenoma|Fibroadenomas]] are known as benign, non-malignant breast masses, which are made up of a combination of both glandular and stromal connective tissue. These lesions are more common in the women between the ages of 20 and 30, and often show a regressing pattern after menopause. A biopsy is needed for a definitive diagnosis.
*'''Intraductal papilloma'''
**[[Intraductal papilloma|Intra-ductal papillomas]] are non-cancerous tumors that grow inside the breast's mammillary ducts. They comprise glandular tissue, fibrous tissue, and various blood vessels. These can be either solitary or multiple papillomas. The solitary papillomas are single tumors growing in the larger mammillary ducts close to the nipple. They present with a nipple discharge, which can be clear or bloody. The multiple papillomas are present in breast tissue, which is farther away from the nipple. Ductograms, ultrasound, and mammograms are used for diagnosis, which can be often confirmed by biopsy.
*'''Lipoma'''
**A lipoma is a benign lesion or tumor composed of adipose tissue, enclosed within a thin fibrous capsule. Although they can occur at any age, they are more common after the age of 40. They are freely mobile, soft, smooth, and pliable on palpation and generally do not cause any other symptoms like pain.
*'''Mastitis'''
**Mastitis is defined as the inflammation or swelling in the breast tissue, preceded by an infection. The infection is caused by either an obstructed or clogged milk duct, which does not drain the milk completely, leading to stagnation and bacterial colonization. Sometimes, cracks or breaks in the skin surrounding the nipple can also lead to bacterial infection. Mostly it affects breastfeeding women, and the involvement is unilateral. The affected part is swollen, engorged, painful, and warm to the touch. Also, constitutional symptoms like fever, headache, and fatigue can be seen. Treatment involves mainly milk expression to avoid stagnation of milk in the ducts and glands and antibiotics.

==Management==

{{familytree/start |summary=Breast mass.}}
{{familytree | | | | | | | | A01 | | |A01= '''Breast Mass''' <ref name="pmid28790593">{{cite journal |vauthors=Kumar A, Vohra LS, Bhargava S, Reddy PS |title=INVESTIGATION OF BREAST LUMPS: AN EVALUATION |journal=Med J Armed Forces India |volume=55 |issue=4 |pages=299–302 |date=October 1999 |pmid=28790593 |pmc=5531917 |doi=10.1016/S0377-1237(17)30353-2 |url=}}</ref>}} 
{{familytree | | | | | | | |,|-|-|-|^|-|-|-|-|-|.| | }}
{{familytree | | | | | | B01 | | | | | | | | | | B02 | | |B01= '''Greater than 30 years''' |B02= '''Less than 30 years'''}}
{{familytree | | | | | | |!| | | | | | | | | | | | |!| }}
{{familytree | | | | | | C01 | | | | | | | | | | | |!| |C01= '''Mammogram'''}}
{{familytree | |,|-|-|-|-|^|-|-|.| | | | | | | | | |!| }}
{{familytree | D02| | | | | | D01 | | | | | | | | |!| |D01= '''Mass present''' |D02= '''Mass not present'''}}
{{familytree | |!| | | | | | | |!| | | | | | | | | |!| | | }}
{{familytree | |!| |,|-|-|-|v|-|^|-|.| | | | | | | |!| | | }}
{{familytree | |!| |!| | | |!| | | |!| | | | | | | |!| | | }}
{{familytree | |!| |!| | | |!| | | |!| | | | | | | |!| | | }}
{{familytree | |!| E01 | | | E02| | E03 |-|-|-|-|-| E04 | | |E01= '''MALIGNANT'''|E02= '''BENIGN'''|E03= '''INDETERMINATE'''|E04= '''ULTRASOUND'''}}
{{familytree | |!| |!| | | |!| | | | | | | | | | | |!| | | | }}
{{familytree | |!| |!| | | |!| | | | | | | | | | | |!| | | | | }}
{{familytree | |!| |!| | | F01 | | | | | | | |,|-|-|^|-|-|.| |F01='''END WORK UP''' }}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | | |!| | | | }}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | | |!| | | | }}
{{familytree | |!| |!| | | | | | | | | | | | G01 | | | | G02 | |G02='''MASS PRESENT'''|G01= '''MASS NOT PRESENT'''}}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | | |!| | | |}}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | |,|-|^|-|.| }}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | |!| | | |!| |}}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | |!| | | H01 | | |H01= '''SIMPLE CYST'''}}
{{familytree | |!|-|!|-|-|-|-|-|-|-|-|-|-|-| I01 |-| I02 | | | | | | |I01= '''BIOPSY''' |I02= '''SOLID CYST''' }}
{{familytree/end}}








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