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| | ==[[Breast lumps overview|Overview]]== |
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| ==Epidemiology and Demographics== | | ==[[Breast lumps historical perspective|Historical Perspective]]== |
| * 40% of breast complaints leading to an office visit
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| * 6% of all women ages 40-69 seek advice about breast lumps
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| * Cysts and [[fibroadenoma]]s = most common underlying conditions
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| * 75-80% of breast biposies in the US are for benign lesions
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| * [[Breast cancer]] detected in
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| *:* 4% of women with breast complaints
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| *:* 8% of women with abnormal screening mammograms
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| *:* 2% of women with abnormal findings on screening clinical breast exam
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| == Breast Cancer Risk Factors == | | ==[[Breast lumps classification|Classification]]== |
| === Breast Cancer Risk Factors ===
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| {|
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| |-style="background:silver; color:black"
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| | '''Age (> 70 vs. < 35)''' || '''RR 17.0'''
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| |-style="background:silver; color:black" | |
| | '''Positive Family History''' || '''RR 2.6'''
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| |- style="background:silver; color:black"
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| | '''Early Menarche (< 12 years old)''' || '''RR 1.5'''
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| |-style="background:silver; color:black"
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| | '''Late Menopause (> 55 years old) ''' || '''RR 2.0'''
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| |-style="background:silver; color:black"
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| | '''HRT Use (current)''' || '''RR 1.2-1.4'''
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| |-style="background:silver; color:black"
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| | '''OCP Use (ever)''' || '''RR 1.07-1.2'''
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| |-style="background:silver; color:black"
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| | '''Postmenopausal Body Mass Index (> 30.7)''' || '''RR 1.6'''
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| |}
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| == Pathophysiology & Etiology== | | ==[[Breast lumps pathophysiology|Pathophysiology]]== |
| * '''Cysts'''
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| *:* Common in premenopausal women > 40 years old
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| *:* Less frequent in younger women (10% of breast masses in women < 40 years old)
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| *:* Uncommon in postmenopausal women not on hormone replacement therapy (HRT)
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| *:* Often fluctuate with menstrual cycle
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| *:* Especially common during periods of hormonal irregularity
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| * '''Fibroadenomas'''
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| * '''Prominent Fibrocystic Change''' (without a dominant mass)
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| * '''Fat Necrosis'''
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| * '''Malignancy'''
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| == Diagnosis == | | ==[[Breast lumps causes|Causes]]== |
| * '''''Triple Diagnosis'''''
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| *:* Use of physical examination, mammogram and fine needle aspiration biopsy (FNAB) for diagnosis of palpable lumps
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| *:*:* If all 3 are benign: < 1% incidence of breast cancer
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| *:*:*:* Follow patient with complete breast exam (CBE) every 3-6 months x 1 year to ensure stability
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| *:*:* If all 3 are positive: 99.4% incidence breast cancer
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| *:*:* If any 1 is positive: excisional biopsy recommended
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| == Differential Diagnosis of a Breast Lump== | | ==[[Breast lumps differential diagnosis|Differentiating Breast lumps from other Diseases]]== |
| * [[Breast Abscess]]
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| * [[Breast Cancer]]
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| * [[Carcinoma]]
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| * [[Cyst]]
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| * [[Cystic mastitis]]
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| * [[Cystosarcoma Phylloides]]
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| * Fat necrosis
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| * [[Fibroadenoma]]
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| * Fibrocystic changes
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| * [[Galactocele]]
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| * [[Gynecomastia]]
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| * [[Hematoma]]
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| * [[Intraductal papilloma]]
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| * [[Lipoma]]
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| * [[Lymphoma]]
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| * [[Mammary adenosis]]
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| * [[Mammary duct ectasia]]
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| * Phylloides tumor
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| * [[Prolactinoma]]
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| * [[Sebaceous cyst]]
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| * [[Trauma]]
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| * [[Tuberculosis]] [[abscess]]
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| == History and Symptoms == | | ==[[Breast lumps epidemiology and demographics|Epidemiology and Demographics]]== |
| * Characteristics of lump:
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| *:* Location and duration of its presence, changes in size
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| *:* Associated [[nipple discharge]]
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| *:* Changes with [[menstrual cycle]]
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| *:*:* Cysts tend to be more prominent
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| *:* Premenstrually and may regress during follicular phase
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| *:* Tenderness
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| *:*:* Rapidly developing cysts may be tender
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| * Prior history of breast cancer or breast biopsy (atypical hyperplasia on prior biopsy most worrisome)
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| == Physical Examination == | | ==[[Breast lumps risk factors|Risk Factors]]== |
| * Suspicious findings
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| *:* Single lesion
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| *:* Hard
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| *:* Immobile
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| *:* Irregular borders
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| *:* Size > 2 cm
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| * Exam not reliable for distinguishing benign vs. malignant (PPV 73%, NPV 87% at referral center)
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| * Cancers may be tender on exam (~ 15% of cases)
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| * Exam should include evaluation for supraclavicular and axillary LAN
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| === Echocardiography or Ultrasound ===
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| * Ultrasonography:
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| *:* In women < 35
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| *:* May be helpful in conjunction with mammogram for women 35 and over
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| *:* Also for evaluation of nonpalpable mass detected on screening mammogram
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| *:* Simple cyst on ultrasound has extremely low risk cancer
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| === Other Imaging Findings ===
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| ==== Mammography ====
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| * Any woman age 35 or over with a breast mass
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| * Suspicious findings
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| *:* Increased density
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| *:* Irregular margins
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| *:* Spiculation
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| *:* Clustered
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| * Microcalcifications
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| * Can miss 10-20% of clinically palpable breast cancers
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| * Not cost-effective or clinically helpful in patients < 35 unless high suspicion cancer
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| === Other Diagnostic Studies ===
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| ==== Fine Needle Aspiration/Biopsy ====
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| * '''Fine Needle Aspiration'''
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| *:* Office procedure for evaluation of palpable cyst (22-24 gauge needle)
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| *:* Bloody fluid
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| *:*:* Send for cytology and refer for surgical biopsy
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| *:* Non-bloody fluid
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| *:*:* Cytology extremely low yield (do not send)
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| *:*:* If mass disappears, reexamine pt in 4-6 weeks
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| *:*:* If no recurrence, resume routine follow-up
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| *:*:* If recurrence, can repeat aspiration
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| *:*:* Consider biopsy if further recurrence
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| *:* Non-bloody fluid but residual mass after aspiration: surgical biopsy
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| *:* Solid mass (no fluid)
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| *:*:* Surgical biopsy or fine needle aspiration biopsy
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| * '''Fine Needle Aspiration Biopsy (FNAB)'''
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| *:* Aspiration of cells from a solid mass
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| *:* 21 gauge needle, operator-dependent
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| *:* Wide variation in sens (65-98%), spec (34-100%)
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| * '''Core Needle Biopsy'''
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| *:* 14-18 gauge needle allows for better histologic sample
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| *:* Used mostly for evaluation of non-palpable masses (mammogram or ultrasound guidance)
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| *:* Compares favorably with surgical biopsy at lower cost
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| * '''Excisional Biopsy'''
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| *:* Recommended if solid mass suspicious for cancer by exam or mammo
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| *:* Also recommended for palpable mass not seen on mammogram or for abnormal biopsy
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| == Treatment ==
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| ==== Recommendations ====
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| * Women < age 35
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| *:* If no distinct lump found or primary care physician (PCP) unsure: refer to breast specialist for 2nd opinion
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| *:* If non-suspicious lump on exam
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| *:*:* Reassess 3-10 days after onset of next menses
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| *:*:* If lump regresses, no further evaluation needed
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| *:* If lump remains palpable and feels cystic
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| *:*:* Fine needle aspiration (FNA)
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| *:*:* Management of bloody vs. non-bloody fluid as above
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| *:* If lump does not feel cystic
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| *:*:* Ultrasound
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| *:*:* If solid mass: FNAB, core biopsy or excisional biopsy
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| *:*:* If cyst, FNA as above
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| *:*:* If non-suspicious solid mass < 1 cm: likely fibroadenoma
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| *:*:* Can follow by physical examination every 3-6 months
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| *:* Mammography generally not helpful in this age group
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| * Women age 35 and over
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| *:* Mammography and ultrasonography (note: mammography has 10-20% false-negative rate)
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| *:* Cystic mass
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| *:*:* FNA with mgmt of bloody vs. non-bloody fluid as above
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| *:* Solid mass
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| *:*:* Core biopsy, FNAB or excisional biopsy if no suspicious features
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| *:*:* Excisional biopsy recommended if mass is suspicious by exam or mammogram
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| *:* No specific findings on mammogram and ultrasound: refer to surgeon for likely excision
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| == Acknowledgements ==
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| The content on this page was first contributed by: Rebecca Cunningham, M.D.
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| List of contributors:
| | ==[[Breast lumps screening|Screening]]== |
| ----
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| == Suggested Reading and Key General References == | |
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| == Suggested Links and Web Resources == | | ==[[Breast lumps natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| == For Patients == | | ==Diagnosis== |
| | [[Breast lumps history and symptoms|History and Symptoms]] | [[Breast lumps physical examination|Physical Examination]] | [[Breast lumps laboratory findings|Laboratory Findings]] | [[Breast lumps CT|CT]] | [[Breast lumps MRI|MRI]] | [[Breast lumps ultrasound|Ultrasound]] | [[Breast lumps other imaging findings|Other Imaging Findings]] | [[Breast lumps other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
| | [[Breast lumps medical therapy|Medical Therapy]] | [[Breast lumps surgery|Surgery]] | [[Breast lumps primary prevention|Primary Prevention]] | [[Breast lumps secondary prevention|Secondary Prevention]] | [[Breast lumps cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Breast lumps future or investigational therapies|Future or Investigational Therapies]] |
| | |
| | == Case Studies == |
| | [[Breast lumps case study one|Case #1]] |
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