Breast Mass Resident Survival Guide

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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[1]. It is the most prevalent cancer in females and the second most common cause of death[2]. Several factors, like increasing age, high hormone levels, economic status, and ethnic groups, affect breast cancer incidence[3].
  • 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[4].
  • The risk of breast cancer increases with increasing age, as most cases are diagnosed after 50 years[3][5]. Mutations, like BRCA1 and BRCA2, also significantly increase the risk of breast cancer[6]. 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[7]. Any radiation treatment in the past is also a breast cancer risk[8].

Common Causes

  • Breast cysts
    • These are the fluid-filled sacs in the breast tissue[9]. 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[10]. The size of the cyst can vary intermittently based on hormonal influences, like menstruation and pregnancy. The cysts can be simple[11], consisting of fluid, or complex, with both fluid and solid components[12]. 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[13].
  • Galactocele
    • Galactoceles are benign breast lesions, predominantly seen in lactating women[14]. 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[15].
  • 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[16].
  • Fibroadenoma
    • Fibroadenomas are known as benign, non-malignant breast masses, which are made up of a combination of both glandular and stromal connective tissue[17]. 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[18].
  • Intraductal papilloma
    • Intra-ductal papillomas are non-cancerous tumors that grow inside the breast's mammillary ducts[19]. They comprise glandular tissue, fibrous tissue, and various blood vessels. These can be either solitary or multiple papillomas[20]. 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[21]. 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[22].

Diagnosis




  1. ↑ "What Is Breast Cancer? | Breast Cancer Definition".
  2. ↑ "Epidemiology of breast cancer: retrospective study in the Central African Republic | BMC Public Health | Full Text".
  3. ↑ 3.0 3.1 "What Are the Risk Factors for Breast Cancer? | CDC".
  4. ↑ "What Are the Symptoms of Breast Cancer? | CDC".
  5. ↑ DeSantis C, Ma J, Bryan L, Jemal A (2014). "Breast cancer statistics, 2013". CA Cancer J Clin. 64 (1): 52–62. doi:10.3322/caac.21203. PMID 24114568.
  6. ↑ Mersch J, Jackson MA, Park M, Nebgen D, Peterson SK, Singletary C, Arun BK, Litton JK (January 2015). "Cancers associated with BRCA1 and BRCA2 mutations other than breast and ovarian". Cancer. 121 (2): 269–75. doi:10.1002/cncr.29041. PMC 4293332. PMID 25224030.
  7. ↑ Brewer HR, Jones ME, Schoemaker MJ, Ashworth A, Swerdlow AJ (August 2017). "Family history and risk of breast cancer: an analysis accounting for family structure". Breast Cancer Res Treat. 165 (1): 193–200. doi:10.1007/s10549-017-4325-2. PMC 5511313. PMID 28578505.
  8. ↑ Opstal-van Winden A, de Haan HG, Hauptmann M, Schmidt MK, Broeks A, Russell NS, Janus C, Krol A, 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 B, Strong LC, Bhatia S, Cooke R, Robison LL, Swerdlow AJ, van Leeuwen FE (March 2019). "Genetic susceptibility to radiation-induced breast cancer after Hodgkin lymphoma". Blood. 133 (10): 1130–1139. doi:10.1182/blood-2018-07-862607. PMC 6405334. PMID 30573632. Vancouver style error: initials (help)
  9. ↑ Hughes LE, Bundred NJ (1989). "Breast macrocysts". World J Surg. 13 (6): 711–4. doi:10.1007/BF01658419. PMID 2696224.
  10. ↑ Azimi N, Azar A, Khan A, DeBenedectis CM (June 2019). "Benign Breast Cyst in a Young Male". Cureus. 11 (6): e4814. doi:10.7759/cureus.4814. PMC 6682391 Check |pmc= value (help). PMID 31404321.
  11. ↑ Venta LA, Kim JP, Pelloski CE, Morrow M (November 1999). "Management of complex breast cysts". AJR Am J Roentgenol. 173 (5): 1331–6. doi:10.2214/ajr.173.5.10541113. PMID 10541113.
  12. ↑ Houssami N, Irwig L, Ung O (December 2005). "Review of complex breast cysts: implications for cancer detection and clinical practice". ANZ J Surg. 75 (12): 1080–5. doi:10.1111/j.1445-2197.2005.03608.x. PMID 16398815.
  13. ↑ "Redirecting".
  14. ↑ Golden GT, Wangensteen SL (March 1972). "Galactocele of the breast". Am J Surg. 123 (3): 271–3. doi:10.1016/0002-9610(72)90283-8. PMID 5011932.
  15. ↑ Feig SA (January 1992). "Breast masses. Mammographic and sonographic evaluation". Radiol Clin North Am. 30 (1): 67–92. PMID 1732936.
  16. ↑ Vasei N, Shishegar A, Ghalkhani F, Darvishi M (June 2019). "Fat necrosis in the Breast: A systematic review of clinical". Lipids Health Dis. 18 (1): 139. doi:10.1186/s12944-019-1078-4. PMC 6560815 Check |pmc= value (help). PMID 31185981.
  17. ↑ Williams HJ (2018). "Educational Case: Fibroadenoma of the Breast". Acad Pathol. 5: 2374289518790926. doi:10.1177/2374289518790926. PMC 6109836. PMID 30159386.
  18. ↑ Ajmal M, Van Fossen K. PMID 30570966. Missing or empty |title= (help)
  19. ↑ Hodorowicz-Zaniewska D, Szpor J, Basta P (2019). "Intraductal papilloma of the breast - management". Ginekol Pol. 90 (2): 100–103. doi:10.5603/GP.2019.0017. PMID 30860277.
  20. ↑ Li A, Kirk L. PMID 30137824. Missing or empty |title= (help)
  21. ↑ Spencer JP (September 2008). "Management of mastitis in breastfeeding women". Am Fam Physician. 78 (6): 727–31. PMID 18819238.
  22. ↑ Beltrán Vaquero DA, Crespo Garzón AE, Rodriguez Bravo TC, Garcia Iglesias Á (February 2015). "[Infectious mastitis: a new solution for an old problem]". Nutr Hosp (in Spanish; Castilian). 31 Suppl 1: 89–95. doi:10.3305/nh.2015.31.sup1.8714. PMID 25659061.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Palpable breast mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ultrasound(age<30) / Mammogram(age>30)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fine-needle aspiration
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Not visulaized
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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