Breast Mass Resident Survival Guide: Difference between revisions

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__NOTOC__
{{WikiDoc CMG}}; {{AE}} {{Aisha}}
==Overview==
==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.  
A [[breast mass]] <ref name="pmid21250122">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Perry MC |title= |journal= |volume= |issue= |pages= |date= |pmid=21250122 |doi= |url=}}</ref>is described as a mass that develops in the breast tissue. The breast consists of many different types of tissue, like mammillary glands, and mammillary ducts, and tubes. Additionally, fibrous tissue, fatty tissue, nerves, blood vessels, and lymph nodes also form important constituents of the breast. As a result, the breast mass differs widely in sizes and textures, and symptoms like pain, tenderness, or discharge <ref name="pmid21250127">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Barry M |title= |journal= |volume= |issue= |pages= |date= |pmid=21250127 |doi= |url=}}</ref>. They can be large or small and may either feel hard or spongy. Most of the breast masses are discovered incidentally, either by women on self-breast examination <ref name="pmid27536182">{{cite journal |vauthors=Provencher L, Hogue JC, Desbiens C, Poirier B, Poirier E, Boudreau D, Joyal M, Diorio C, Duchesne N, Chiquette J |title=Is clinical breast examination important for breast cancer detection? |journal=Curr Oncol |volume=23 |issue=4 |pages=e332–9 |date=August 2016 |pmid=27536182 |pmc=4974039 |doi=10.3747/co.23.2881 |url=}}</ref>, physical examination by the practitioner <ref name="pmid29083747">{{cite journal |vauthors=Henderson JA, Duffee D, Ferguson T |title= |journal= |volume= |issue= |pages= |date= |pmid=29083747 |doi= |url=}}</ref>, or if an imaging study was done for some other diagnosis. Sometimes, the diagnosis is made while the annual mammography is done to detect possible suspicious lesions. Women of the reproductive age group are more prone to develop breast lumps or masses. Breast masses can be physiological like adenosis or pathological like malignancy or cancer. Occasionally, breast masses can be associated with hormonal changes<ref name="pmid12927032">{{cite journal |vauthors=Travis RC, Key TJ |title=Oestrogen exposure and breast cancer risk |journal=Breast Cancer Res. |volume=5 |issue=5 |pages=239–47 |date=2003 |pmid=12927032 |pmc=314432 |doi=10.1186/bcr628 |url=}}</ref>, which have a waxing and waning course. Breast masses, although uncommon, can occur in men <ref name="pmid29558507">{{cite journal |vauthors=Yuan WH, Li AF, Chou YH, Hsu HC, Chen YY |title=Clinical and ultrasonographic features of male breast tumors: A retrospective analysis |journal=PLoS ONE |volume=13 |issue=3 |pages=e0194651 |date=2018 |pmid=29558507 |pmc=5860767 |doi=10.1371/journal.pone.0194651 |url=}}</ref>. Most of the breast masses are benign. Imaging studies like mammograms, ultrasound <ref name="pmid25241817">{{cite journal |vauthors=Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI, Norlia A, Zulfiqar MA |title=The comparative accuracy of ultrasound and mammography in the detection of breast cancer |journal=Med. J. Malaysia |volume=69 |issue=2 |pages=79–85 |date=April 2014 |pmid=25241817 |doi= |url=}}</ref>, Magnetic Resonance Imaging, Fine Needle Aspiration Cytology, and Biopsy are used for confirming the diagnosis. If the diagnosis of cancer is confirmed, modalities like lumpectomy, mastectomy, chemotherapy, or radiation are used to treat that.


==Causes==
==Causes==
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*'''Breast cancer'''
*'''Breast cancer'''
**Breast cancer <ref name="pmid28969709">{{cite journal |vauthors=Akram M, Iqbal M, Daniyal M, Khan AU |title=Awareness and current knowledge of breast cancer |journal=Biol. Res. |volume=50 |issue=1 |pages=33 |date=October 2017 |pmid=28969709 |pmc=5625777 |doi=10.1186/s40659-017-0140-9 |url=}}</ref>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, cases have been seen in men also. Often it presents as a mass or lump in the breast which can also have associated symptoms like discharge, discoloration, pain, itching, induration, and lymph engorgement. Breast cancer can be either ductal when it involves the mamillary ducts, or lobular when it starts in the glands. It is the most prevalent cancer in females and the second most common cause of death. Several factors like increasing age, high hormone levels, economic status, and ethnic groups have a modifying effect on the incidence of breast cancer <ref name="pmid19119554">{{cite journal |vauthors=Steiner E, Klubert D, Knutson D |title=Assessing breast cancer risk in women |journal=Am Fam Physician |volume=78 |issue=12 |pages=1361–6 |date=December 2008 |pmid=19119554 |doi= |url=}}</ref>.
*[[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]]. It is the most prevalent cancer in females and the second most common cause of death. Several factors, like increasing age, high hormone levels, economic status, and ethnic groups, affect breast cancer incidence.
**Breast cancer can present as a lump or mass in the breast or area of the armpit, thickening or dimpling of the skin, redness of skin irritation around the nipple, any abnormal discharge, abnormality in the shape and size of the breast, or subjective symptoms like pain and traction.
*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.
**The risk of breast cancer increases with increasing age; and most of the cases are often seen after the age of 50 years. Certain genetic mutations like BRCA1 and BRCA2, also predispose to the occurrence of breast cancer <ref name="pmid30258937">{{cite journal |vauthors=Feng Y, Spezia M, Huang S, Yuan C, Zeng Z, Zhang L, Ji X, Liu W, Huang B, Luo W, Liu B, Lei Y, Du S, Vuppalapati A, Luu HH, Haydon RC, He TC, Ren G |title=Breast cancer development and progression: Risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis |journal=Genes Dis |volume=5 |issue=2 |pages=77–106 |date=June 2018 |pmid=30258937 |pmc=6147049 |doi=10.1016/j.gendis.2018.05.001 |url=}}</ref>. Furthermore, early menarche and late menopause also increase the risk, due to prolonged exposure to hormones. Moreover, dense breast tissue, due to more connective tissue, has increased chances of breast cancer, also making it hard to diagnose. 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, also increase the chances of breast cancer. Any radiation treatment in the past, also makes breast cancer more common <ref name="pmid28316699">{{cite journal |vauthors=Ataollahi MR, Sharifi J, Paknahad MR, Paknahad A |title=Breast cancer and associated factors: a review |journal=J Med Life |volume=8 |issue=Spec Iss 4 |pages=6–11 |date=2015 |pmid=28316699 |pmc=5319297 |doi= |url=}}</ref>.
*The risk of breast cancer increases with increasing age, as most cases are diagnosed after 50 years. Mutations, like [[BRCA1]] and [[BRCA2]], also significantly increase the risk of breast cancer. 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. Any [[Radiation treatments|radiation treatment]] in the past is also a breast cancer risk.


===Common Causes===
===Common Causes===
*'''Breast cysts'''
*'''Breast cysts'''
**These are the fluid-filled, sacs in the breast tissue. They can be either round or oval-shaped and of varied sizes. In the majority of cases, they are palpable as a smooth, round, movable mass, which can present with symptoms like pain and tenderness. Mostly seen in women in their reproductive years, like in the 30s and 40s. The size of the cyst can vary intermittently based on hormonal influences, like menstruation and pregnancy. The cysts can be simple, which are just comprised of fluid, or complex, which have a combination of both fluid and solid components. The exact diagnosis can be confirmed by biopsy.
**These are the fluid-filled sacs in the breast tissue. 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. The size of the cyst can vary intermittently based on hormonal influences, like menstruation and pregnancy. The cysts can be simple, consisting of fluid, or complex, with both fluid and solid components. The exact diagnosis is confirmed by [[biopsy]].
*'''Adenosis'''
*'''Adenosis'''
**Adenosis is basically a nonmalignant breast condition, which is categorized by enlargement and increase in the number of the milk-producing glands. These are more predominant in women with underlying fibrosis and cysts. A biopsy is needed for definitive diagnosis.
**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'''
*'''Galactocele'''
**Galactoceles are benign breast lesions, which are predominantly seen in lactating women. The leading factor 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.
**[[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'''
**Fat necrosis is a benign non-cancerous condition affecting the breast, which occurs after damage or injury to the fatty tissue of the breast <ref name="pmid31194348">{{cite journal |vauthors=Genova R, Garza RF |title= |journal= |volume= |issue= |pages= |date= |pmid=31194348 |doi= |url=}}</ref>. Moreover, it can be a side effect of breast surgery or any radiation therapy. it usually causes a firm mass or lump in the breast <ref name="pmid7716309">{{cite journal |vauthors=Pignatelli V, Basolo F, Bagnolesi A, Cartei F, Grassi L, Savino A, Lischi DM |title=[Hematoma and fat necrosis of the breast: mammographic and echographic features] |language=Italian |journal=Radiol Med |volume=89 |issue=1-2 |pages=36–41 |date=1995 |pmid=7716309 |doi= |url=}}</ref>. Although it is mostly painless, occasionally it can be tender with symptoms like tenderness, or discoloration.
**[[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 <ref name="pmid30570966">{{cite journal |vauthors=Ajmal M, Van Fossen K |title= |journal= |volume= |issue= |pages= |date= |pmid=30570966 |doi= |url=}}</ref> <ref name="pmid26366109">{{cite journal |vauthors=Lee M, Soltanian HT |title=Breast fibroadenomas in adolescents: current perspectives |journal=Adolesc Health Med Ther |volume=6 |issue= |pages=159–63 |date=2015 |pmid=26366109 |pmc=4562655 |doi=10.2147/AHMT.S55833 |url=}}</ref>. These lesions are more common in the women in the age group of the 20s and 30s and often show a regressing pattern after menopause. The biopsy is needed for a definitive diagnosis.
**[[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 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 mammillary ducts of the breast. They comprise of 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 the diagnosis, which can be often confirmed by biopsy.
**[[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'''
*'''Lipoma'''
**A lipoma is a benign lesion or tumor which is 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. On palpation, they are freely mobile, soft, smooth, and pliable and generally do not cause any other symptoms like pain.
**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'''
**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.
**[[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.}}
==Diagnosis==
{{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/start |summary=Breast Mass}}
{{familytree | | | | | | | |,|-|-|-|^|-|-|-|-|-|.| | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | A01 |A01=Palpable breast mass}}  
{{familytree | | | | | | B01 | | | | | | | | | | B02 | | |B01= '''Greater than 30 years''' |B02= '''Less than 30 years'''}}
{{familytree | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | | | | |!| | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | |B01| | | | | | | | | | | | | | | | | | | | | | | B02 | | |B01=Ultrasound(age<30) / Mammogram(age>30)|B02=Fine-needle aspiration}}
{{familytree | | | | | | C01 | | | | | | | | | | | |!| |C01= '''Mammogram'''}}
{{familytree | | | | | |,|-|-|-|+|-|-|-|.| | | | | | | | | | | | | | | | | | | | |!| |}}
{{familytree | |,|-|-|-|-|^|-|-|.| | | | | | | | | |!| }}
{{familytree | | | | |E01| |E02| |E03| | | | | | | | | | | | | | | | | | | |!| |E01=Not visualized|E02=Simple cyst|E03=Complex cyst or solid mass|}}
{{familytree | D02| | | | | | D01 | | | | | | | | |!| |D01= '''Mass present''' |D02= '''Mass not present'''}}
{{familytree | | | | | |!| | | |!| | | |!| | | | | | | | | | | | | | | | | | | | |!| | }}
{{familytree | |!| | | | | | | |!| | | | | | | | | |!| | | }}
{{familytree | | | | F01 | | | F02 | | | F03 | | | | | | | | | | | | | | | | | | |!| |F01=Mammography and fine-needle aspiration or core-needle biopsy|F02=Aspirate, then repeat clinical breast exam in 4-6 weeeks|F03=Mammography and fine-needle aspiration or core-needle biopsy}}
{{familytree | |!| |,|-|-|-|v|-|^|-|.| | | | | | | |!| | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | }}
{{familytree | |!| |!| | | |!| | | |!| | | | | | | |!| | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | }}
{{familytree | |!| |!| | | |!| | | |!| | | | | | | |!| | | }}
{{familytree | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|.| | }}
{{familytree | |!| E01 | | | E02| | E03 |-|-|-|-|-| E04 | | |E01= '''MALIGNANT'''|E02= '''BENIGN'''|E03= '''INDETERMINATE'''|E04= '''ULTRASOUND'''}}
{{familytree | | | | | |F01| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |F02| | | | | | | | |F01=Cyst|F02=Solid mass|}}
{{familytree | |!| |!| | | |!| | | | | | | | | | | |!| | | | }}
{{familytree | | |,|-|-|-|^|-|-|.| | | |,|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|v|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|.| |}}
{{familytree | |!| |!| | | |!| | | | | | | | | | | |!| | | | | }}
{{familytree | |G01 | | | | |G02 | |G03| | | | | |G04| | | | | |G05| | | | | | | | | | | | | | | |G06| | | |G01=Residual mass or bloody fluid|G02=No residual mass|G03=Malignant|G04=Atypical/Suspicious|G05=Benign|G06=Non-diagnostic|}}
{{familytree | |!| |!| | | F01 | | | | | | | |,|-|-|^|-|.| | |F01='''END WORK UP''' }}
{{familytree | | |!| | | | | | |!| | | |!| | | | | | | |!| | | | | | | |!| | | | | | | | | | | | | | | | | |!| }}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | |!| | | | }}
{{familytree | |H01| | | | |H02 | |H03| | | | | |H04| | | | | |H05| | | | | | | | | | | | | | | |H06| | | |H01=Patient ≥ 40 years of age?|H02=Repeat clinical breast exam in 4-6 weeeks|H03=Definitive treatment|H04=Core-needle biopsy or excisional biopsy and/or refer|H05=Mammography|H06=Patient ≥ 40 years of age?|}}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | |!| | | | }}
{{familytree |,|-|^|-|.| | | | | | | | | | | | | | | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | |,|-|-|-|-|^|-|-|.| }}
{{familytree | |!| |!| | | | | | | | | | | | G01 | | | G02 | |G02='''MASS PRESENT'''|G01= '''MASS NOT PRESENT'''}}
{{familytree |I01| |I02 | | | | | | | | | | | | | | | | | | |I03| | | |I04| | | | | | | |I05 | | | | | |I06| | | | | |I01=Yes|I02=No|I03=Positive|I04=Negative|I05=Yes|I06=No|}}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | | | | | |}}
{{familytree |!| | | |!| | | | | | | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | | |!| | | | | | | |!| }}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | | | | | }}
{{familytree |J01| |J02| | | | | | | | | | | | | | | | | | |J03| | | |J04 | | | | | | | |J05| | | | | |J06| | |J01=Mammography or core-needle biopsy|J02=Ultrasonography or core-needle biopsy|J03=Ultrasonography or core-needle biopsy|J04=Repeat clinical breast exam in 4-6 weeeks|J05=Mammography or core-needle biopsy|J06=Ultrasonography or core-needle biopsy|}}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | | | | |}}
{{familytree | |!| |!| | | | | | | | | | | | |!| | | | | | | |}}
{{familytree | |!|-|!|-|-|-|-|-|-|-|-|-|-|-| H01 | | | | | | | |H01= '''BIOPSY'''}}
{{familytree/end}}
{{familytree/end}}


==Treatment==


*Treatment of a breast mass is dependent on the outcome of the diagnostic workup.


==Do's==


*Perform a complete clinical history and review of [[Risk factor|risk factors]] for every patient presenting with a breast mass.
*Perform diagnostic evaluation with radiographic imaging ([[ultrasound]]/[[mammography]]), and in some cases, breast [[biopsy]].
*If a [[biopsy]] is benign, clinical evaluation with imaging should be revisited every 6 months for a period of two years.


==Dont's==


 
*Do not dismiss a breast mass without a diagnostic workup regardless of size.


<references />
<references />

Latest revision as of 17:28, 12 January 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

A breast mass is a mass that develops in the breast tissue. The breast consists of many different tissue types, i.e., mammary glands, 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 breast ultrasound or 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 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 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. It is the most prevalent cancer in females and the second most common cause of death. Several factors, like increasing age, high hormone levels, economic status, and ethnic groups, affect breast cancer incidence.
  • 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.
  • The risk of breast cancer increases with increasing age, as most cases are diagnosed after 50 years. Mutations, like BRCA1 and BRCA2, also significantly increase the risk of breast cancer. 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. Any radiation treatment in the past is also a breast cancer risk.

Common Causes

  • Breast cysts
    • These are the fluid-filled sacs in the breast tissue. 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. The size of the cyst can vary intermittently based on hormonal influences, like menstruation and pregnancy. The cysts can be simple, consisting of fluid, or complex, with both fluid and solid components. 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
    • 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 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
    • 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.


Diagnosis

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Palpable breast mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ultrasound(age<30) / Mammogram(age>30)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fine-needle aspiration
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Not visualized
 
Simple cyst
 
Complex cyst or solid mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mammography and fine-needle aspiration or core-needle biopsy
 
 
Aspirate, then repeat clinical breast exam in 4-6 weeeks
 
 
Mammography and fine-needle aspiration or core-needle biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cyst
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solid mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Residual mass or bloody fluid
 
 
 
 
No residual mass
 
Malignant
 
 
 
 
 
Atypical/Suspicious
 
 
 
 
 
Benign
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-diagnostic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient ≥ 40 years of age?
 
 
 
 
Repeat clinical breast exam in 4-6 weeeks
 
Definitive treatment
 
 
 
 
 
Core-needle biopsy or excisional biopsy and/or refer
 
 
 
 
 
Mammography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient ≥ 40 years of age?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive
 
 
 
Negative
 
 
 
 
 
 
 
Yes
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mammography or core-needle biopsy
 
Ultrasonography or core-needle biopsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ultrasonography or core-needle biopsy
 
 
 
Repeat clinical breast exam in 4-6 weeeks
 
 
 
 
 
 
 
Mammography or core-needle biopsy
 
 
 
 
 
Ultrasonography or core-needle biopsy
 
 

Treatment

  • Treatment of a breast mass is dependent on the outcome of the diagnostic workup.

Do's

  • Perform a complete clinical history and review of risk factors for every patient presenting with a breast mass.
  • Perform diagnostic evaluation with radiographic imaging (ultrasound/mammography), and in some cases, breast biopsy.
  • If a biopsy is benign, clinical evaluation with imaging should be revisited every 6 months for a period of two years.

Dont's

  • Do not dismiss a breast mass without a diagnostic workup regardless of size.


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