Breast Lumps, Bumps and Pain: What's Normal and What's Not
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Breast Lumps, Bumps and Pain: What's Normal and What's Not

Learning to distinguish your breasts' normal lumps is key to your long-term health. Here's how.

Knowing a lump from a bump

More than half of all women occasionally have lumpy, painful and swollen breasts. The good news is that nine out of ten breast lumps are not cancer but just benign conditions, says Alison Estabrook, M.D., chief of breast surgery at Columbia-Presbyterian Medical Center in New York City.

There are a variety of benign conditions that cause lumps and bumps. Here are several types of lumps, and what to do if you find one.

Overall lumpiness and a ropy or grainy texture

What it is: Lumpiness in generalized areas of both breasts, usually in the area around the nipples and the upper, outer parts of the breast is often an indication of fibrocystic breasts. According to the National Cancer Institute, this condition is characterized by overall lumpiness and a ropy or grainy texture, rather than one single lump.

What to do: Don't risk it -- ask your doctor or gynecologist for a clinical breast exam and consider a diagnostic mammogram and ultrasound screening. All lumps should be carefully monitored for changes, as fibrocystic breasts put you at increased risk for breast cancer. Be diligent about regular self-exams and yearly clinical exams. Report any changes immediately to your doctor.

Tender, lumpy breasts

What it is: Painful, lumpy breasts about 14 days before the onset of your period that fade each month. The condition can also be triggered by stress or excess salt or caffeine.

What to do: Don't risk it -- ask your doctor or gynecologist for a clinical breast exam and consider a diagnostic mammogram and ultrasound. All lumps should be carefully monitored for changes, as fibrocystic breasts put you at increased risk for breast cancer. Be diligent about regular self-exams and yearly clinical exams. Report any changes immediately to your doctor.

A single lump that's hard on the outside, squishy on the inside

What it is: Often it's a cyst. They typically occur as a distinct, solitary lump that feels like a solid, oval-shaped mass. Cysts occur most often in women 35 to 50 years of age. It's important to have a cyst diagnosed to make sure that it is not a breast cancer lump. Painful, benign cysts can be drained by a needle in the doctor's office. Cysts can recur.

What to do: Don't risk it -- ask your doctor or gynecologist for a clinical breast exam and consider a diagnostic mammogram and ultrasound. All lumps should be carefully monitored for changes since they put you at increased risk for breast cancer. Be diligent about regular self-exams and yearly clinical exams. Report any changes immediately to your doctor.

A small, solid round lump that can be moved

What it is: This is usually a fibroadenoma, a benign and usually painless condition. Most often they are found by a woman herself. A fibroadenoma usually appears as a single lump that feels like a small rubber ball inside the breast tissue and can easily be moved around. These are the most common type of lumps in women in their late teens and early twenties, according to the National Cancer Institute.

What to do: Don't risk it -- ask your doctor or gynecologist for a clinical breast exam and consider a diagnostic mammogram and ultrasound. All lumps should be carefully monitored for changes since they put you at increased risk for breast cancer. Be diligent about regular self-exams and yearly clinical exams. Report any changes immediately to your doctor.

Exaggerated general lumpiness

What it is: This is often pseudolumps or several areas of breast tissue that feel more prominent or persistent than usual, basically just exaggerated lumpiness. Although a pseudolump is innocent, it's usually distinct and persistent enough that it can confuse many surgeons into thinking it is a cyst, a fibroadenoma or a breast cancer lump.

What to do: Don't risk it -- ask your doctor or gynecologist for a clinical breast exam and consider a diagnostic mammogram and ultrasound. All lumps should be carefully monitored for changes since they put you at increased risk for breast cancer. Be diligent about regular self-exams and yearly clinical exams. Report any changes immediately to your doctor.

A firm, unmovable lump

What it is: This is usually a symptom of breast cancer. While benign breast lumps -- sacks of fluid or lumps of fat, move with the breast, cancers defy gravity. Thickened or dimpled skin is a sign of a lump that's unmoveable -- and a cause for concern.

What to do: First, remember that 90 percent of women who catch breast cancer early survive. But to be one of them, you must get a proper diagnosis and treatment. See your doctor. She will examine you thoroughly, then follow up with a mammogram. If there's a possibility that it's cancer, she may perform a needle biopsy, inserting a small needle into the lump to retrieve a cell sample to be reviewed by a pathologist for a diagnosis.

Other breast conditions

In addition to lumps, there are several other conditions to look out for.

Thickened and/or dimpled skin

What it is: This is usually a symptom of breast cancer. Cancers defy gravity. Unlike benign conditions, they don't move with the breast, resulting in puckered or bulging skin.

What to do: First, remember that 90 percent of women who catch breast cancer early survive. But to be one of them, you must get a proper diagnosis and treatment. See your doctor. She will examine you thoroughly, then follow up with a mammogram. If there's a possibility that it's cancer, she may perform a needle biopsy, inserting a small needle into the lump to retrieve a cell sample to be reviewed by a pathologist for diagnosis.

General breast pain

What it is: General pain and tenderness in both breasts is a common occurrence. It's sometimes accompanied by swelling due to water retention, occurring about two weeks before monthly menstruation and subsiding afterward. This is usually normal -- pain caused by hormonal changes in the monthly cycle.

What to do: Cut down on salt and fat intake to help reduce the swelling and tenderness, and keep your system hydrated by drinking lots of water. A good dose of exercise can help, too; it pushes out excess fluids and gives you a kick of endorphins, feel-good chemicals that give you an overall boost.

Persistent pain

What it is: This pain is different than cyclical breast pain in that it's located in a specific spot and does not come and go with the monthly cycle. Sometimes -- but not often -- it can indicate cancer. It may be the result of a cyst or physical injury.

What to do: See your doctor. She will examine you thoroughly to determine the cause. If she suspects it's a problem, she'll then follow up with a mammogram. If there's a possibility that it's cancer, she may perform a needle biopsy, inserting a small needle into the lump to retrieve a cell sample to be reviewed by a pathologist for diagnosis.

A scaly or tender nipple

What it is: An open, itchy sore on one nipple that resembles eczema. It could be a simple skin irritation. In a few women, this is a sign of Paget's disease, a rare form of breast cancer.

What to do: If this condition does not respond to over-the-counter hydrocortisone cream and persists for more than a week, see your doctor immediately. She will examine you and may perform a mammogram and a special type of biopsy designed for the nipple.

Nipple discharge

What it is: Persistent clear or bloody discharge from one nipple may indicate cancer or a precancerous condition in one of your breast ducts. If the discharge is gray, brown, green or white and comes from both nipples, it's usually a normal response to pressure on the breasts.

What to do: See your doctor immediately. She will sample some of the discharge to be evaluated in a lab. Then, she'll carefully examine your breast. You may be given a mammogram and a ductogram, a simple procedure in which a thin plastic catheter is inserted into the nipple to shoot dye into the duct. Then, the breast is X-rayed to indicate the problem. If there's a suspicion it's cancer, the doctor will perform a specialized biopsy to sample cells for diagnosis.

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