What is New Breast Mass?

Breast lumps are pretty common, especially among women who can still have babies. Over a quarter of all women will have some sort of breast disease during their lives. Usually, these problems first show up as a new lump in the breast. While most of these lumps are found in adult women, both kids and men can also have them. In fact, it’s documented that men can get breast cancer as well, so it’s important to consider this when checking for the disease.

Breast cancer is the most common cancer in women all over the world, affecting about 12% of all women. Still, the majority of breast lumps are not cancerous. Regardless of this, it’s important to carefully check all lumps. Doctors usually use a three-step process when checking lumps, which involves a physical examination, an imaging test like an X-ray or ultrasound, and a lab test that checks a sample of the lump. This three-step approach helps doctors identify the most common types of lumps and diseases related to the breasts.

What Causes New Breast Mass?

The breast, also known as the mammary gland, is actually a type of specialized sweat gland. It is made up of different types of tissue – fibrous (tough and flexible), glandular (producing and releasing substances), and adipose (fat tissue). Every breast has around 15 to 20 sections called lobes, each drained by milk-transporting tubes called lactiferous ducts. These ducts gather beneath the nipple. The lobes are held up by fibrous and fatty tissues. The breast’s lymphatic drainage (part of the immune system that helps to remove waste and toxins) mainly goes through the axillary lymph nodes, which include the pectoral, subscapular, and internal mammary nodes.

Breast tissue is present in children and males but is more developed in females during the reproductive age because of the hormonal changes that occur at puberty. After menopause, the breast tissues shrink significantly. This happens because the levels of a hormone called estrogen reduce and the gland tissue is mostly replaced by fatty tissue. Changes in hormone levels can affect breast tissues and many breast diseases.

Speaking of diseases, when it comes to breast cancer, estrogen plays a vital role. One of the primary risk factors for developing breast cancer is an excess exposure to estrogens. This is why a person’s history of estrogen exposure is essential to understanding if they’re at risk. Certain factors increase estrogen exposure: getting your period at an early age, having your first pregnancy late, not having children, using oral contraceptives or hormone therapy, and late menopause. Meanwhile, breastfeeding can reduce the risk of breast cancer.

For male patients, previous hormonal treatments for prostate cancer, using finasteride or testosterone, instances of orchitis/epididymitis (inflammation of the testicles or epididymis), or a diagnosis of Klinefelter syndrome (a genetic condition) should be considered. Other things like drinking too much alcohol and obesity can also increase the risk, as they’re thought to boost estrogens in the body.

Risk Factors and Frequency for New Breast Mass

As per the World Health Organization, breast cancer is the most common cause of death from cancer around the globe, and roughly 12% of women will develop it in their lifetime. However, benign, or non-cancerous, breast diseases are even more prevalent, affecting 25% to 50% of adult women. These conditions account for about 3% of female patient visits to general practitioners. Most of these cases involve women noticing a new lump in their breast. Therefore, it’s essential for healthcare professionals to feel confident assessing and treating these patients, and following a consistent and thorough approach makes this possible. The triple assessment method discussed here has greatly improved patient outcomes by ensuring quick diagnosis and coordinated medical care between different specialists.

Signs and Symptoms of New Breast Mass

Evaluating a new breast lump, or mass, requires a detailed understanding of the patient’s health history and key information about the lump itself. Understanding when the lump first appeared and if it’s associated with any trauma or symptoms can provide crucial insights. However, it’s important to note that some lumps might only be discovered during routine screening, and thus the duration of the lump’s presence may not always be clear.

The lump may come with localized symptoms like tenderness, caused by conditions like an abscess or hematoma due to injury, or systemic symptoms that might suggest a more widespread disease. It’s important to note that while painful breast lumps are rarely cancerous, any pain should not immediately rule out the possibility. Changes in physical appearances, like nipple changes or skin changes, also need consideration as they could indicate less common types of breast tumors.

In addition to physical symptoms, insights from the patient’s medical history are important to note. It’s crucial to examine if the patient is currently on medications like oral contraceptives, hormone replacement therapy, corticosteroids, or other steroid medications like spironolactone, as these may have implications impacting further investigations.

Family history is equally crucial as it is one of the key risk factors for breast cancer. Essential insights include relatives diagnosed with non-breast cancers, especially at a young age.

Upon presenting with a breast mass that has a high chance of breast cancer based on these examinations and histories, further evaluations are carried out like systematic lung, bone, and liver checks. These checks involve chest X-rays, bone scans, liver ultrasonography, and abdominal CT scans. However, only patients with moderate to high risk of cancer metastasis undergo these evaluations.

The triple-assessment approach, which includes clinical examination, mammography or sonography, and biopsy, is vital in diagnosing breast diseases. Physical examination involves careful inspection of the breasts and axillae and checks for skin changes, nipple discharge, visible masses or asymmetry. Any breast mass found should be documented for location, size, shape, tenderness, fluctuance, mobility, texture, and pulsatility. Following the breast examination, the areas near the collarbone and armpit are checked for swollen lymph nodes, which could indicate the spread of the disease.

Testing for New Breast Mass

For assessing a breast mass, usually, we use imaging techniques like mammography, ultrasound, and MRI. Mammography, which is an X-ray imaging of the breast, is the first examination for women over 35 years who have noticed a breast lump. Though it’s not always perfect, it does help to screen many women for breast conditions. If breast cancer is present, mammography might not detect it in approximately 15% of instances.

Ultrasound imaging is a better tool for young women, men, and anyone with dense breast tissue, as this density can make mammograms less accurate. And MRI, though not often used due to cost and wait times, is particularly good for delineating, or outlining, a breast mass. If you’ve had breast implant surgery, an MRI will be used because mammography or ultrasound might not offer a clear picture.

When imaging reports are created, they follow a standard known as BI-RADS (Breast Imaging Reporting and Data System). This system assigns a category number, from 0 to 6, to the images. This number is an estimate of how likely it is that the mass could be malignant, or cancerous. The higher the number, the more likely the mass is cancerous. For example, a BI-RADS 5 indicates there’s a more than 95% chance of the mass being cancerous, while BI-RADS 3 indicates there’s less than 2% chance of malignancy.

In addition to imaging, an important part of diagnosing breast conditions is pathology analysis. This usually involves using a thin needle to extract cells (known as fine-needle aspiration cytology) or taking a small piece of tissue (core biopsy). The tissue then gets examined to see if there are cancerous or unusual cells. In some cases, this analysis might not be necessary if the physical exam and image assessments don’t hint at any risk.

A variety of other tests can be conducted based on the specific situation and available resources. Blood tests, for instance, are usually performed if surgery is being considered. Laboratory tests, brain scans, and genome mapping (if a patient is suspected of carrying a gene related to breast cancer) can also be performed. Other markers in the body’s cells can provide additional clues about the patient’s prognosis, the chance of recurrence, and the best treatment options.

Several indicators have been explored to better classify a new breast mass. For example, examining the amounts of certain proteins in the breast tissue could provide information about how aggressive the cancer may be, and help in determining which patients might benefit most from additional therapy after surgery. Other tests, like the Oncotype DX assay, assess multiple genes and provide a “recurrence score,” which predicts the chance of the cancer coming back in the future. While there is still ongoing research to optimize the most clinically relevant markers in diagnosing a breast mass, many of these tests can provide detailed insights about the patient’s condition.

Treatment Options for New Breast Mass

The treatment for a new lump in the breast relies on whether the lump is non-cancerous (benign) or cancerous (malignant), the patient’s health, and their preferences. A team of medical experts including oncologists (cancer specialists), radiologists, pathologists, surgeons, nurses, anesthesiologists, social workers, and psychologists usually handle cases of confirmed or suspected cancerous lumps. Typical treatments for breast cancer include surgery, chemotherapy, radiation therapy, hormone therapy, and immunotherapy.

The approach to treating benign breast lumps varies depending on the cause:

1. Breast cyst: A simple breast cyst often goes away on its own without any intervention. If cysts keep coming back or cause discomfort, draining the cyst can be an option. There is some disagreement about the benefits of examining the fluid from the cyst under a microscope because of the risk of false positives, which means the test suggests cancer when it’s not present.

2. Fibroadenoma: These are non-cancerous growths that often go away on their own without treatment. However, some factors such as quick growth, large size (over 3 cm), changes in the Breast Imaging Reporting and Data System (BI-RADS) category, and suspicious tissue samples might indicate the need for intervention. One common method for managing fibroadenomas is open surgery, but a procedure called ultrasound-guided vacuum-assisted breast biopsy can be used for diagnostic purposes. If they are large, painful, or causing distress, a surgical consultation should be considered.

3. Fat necrosis and hematoma: These conditions generally don’t require treatment besides pain management and monitoring. But a surgical consultation might be necessary if the lump is causing significant pain or appearance concerns.

4. Breast abscess: These are pockets of pus that usually need to be cut open and drained to remove the infection. Smaller abscesses and those associated with breastfeeding might respond to oral antibiotics and needle drainage, although these methods carry a recurrence risk. Generally, breastfeeding should continue and a referral should be made for further management. If an abscess doesn’t resolve, is large, or has multiple compartments, it may require hospitalization for intravenous antibiotics and surgical or imaging-guided drainage. In these cases, a breast surgeon should be consulted promptly. Abscesses in women who aren’t breastfeeding should be evaluated in a specialized clinic to rule out inflammatory breast cancer.

5. Gynecomastia: This is the enlargement of the male breast tissue. If a probable cause can’t be found, the patient should be referred to an endocrinologist, a hormone specialist.

6. Mastitis: This is an infection in the breast tissue that results in swelling and pain. Various standard antibiotic treatments are available for mastitis. The choice of antibiotic depends on the type of bacteria causing the infection, their resistance to certain antibiotics, and a history of recurrent mastitis. Some commonly used antibiotics include dicloxacillin-flucloxacillin, cephalexin, and clindamycin. Treatment is usually recommended for 7 to 14 days.

The reasons for breast enlargement can vary significantly depending on the individual’s personal characteristics. This enlargement could be due to hormonal changes, a reaction to medication, a liver-related issue, or muscle growth typical in athletes or bodybuilders. In women, a new breast lump is most commonly caused by a disease known as fibrocystic disease, particularly prevalent in premenopausal women aged 35 to 50. This condition, which affects over 50% of women of reproductive age, includes changes like simple and complex cysts, fibrosis, adenosis, and hyperplasia, and is usually symptomless.

In the case of fibrocystic disease, a new distinct breast lump is most likely a simple cyst. These are typically soft, well-delineated, round, and smooth, and may or may not be tender. Breast cysts usually do not require treatment, often resolving on their own, and do not require a tissue biopsy if identified via a mammography. However, if a cyst is complex or contains debris, it should be further investigated to exclude the potential of it being cancerous. These cysts can appear in multiple places, on both breasts, and can reoccur. Post-menopausal women on hormone replacement therapy may see an increase in fibrocystic disease.

Another condition, breast adenosis, involves the enlargement and proliferation of the breast glands. Although it does not usually cause distinct breast masses, it can make the breast feel lumpy and should be considered when diagnosing breast lumps. Like fibrocystic disease, it is common and often symptomless. In young women, fibroadenomas, grouped masses of glandular and stromal tissue, are more commonplace, and they account for over 50% of breast masses in women under 30 years old. These benign lesions often feel firm, rubbery, and movable and are usually self-limiting but occasionally require surgical intervention if they are large or causing patient discomfort.

In high-risk women, particularly post-menopausal women or those with a history of high estrogen exposure, the likelihood of breast cancer is higher. These lumps often feel hard, irregular in shape, and affixed to tissues above or below them. All suspected breast masses should undergo a thorough assessment to rule out cancer. Notably, not all breast cancers present with a palpable mass, with many discovered during routine screenings of symptomless individuals.

Most breast masses in children (>95%) are benign fibroadenomas that usually do not require treatment but do require monitoring. In men, breast lumps should be investigated carefully to rule out cancer. Gynecomastia, the abnormal development of breast tissue in males, can also cause breast lumps. This condition can be linked to chromosomal abnormalities, liver failure, certain syndromes, and specific medications. Physical variations can also cause gynecomastia in newborns, adolescents, and older males.

Breast masses can also occur due to local trauma or infection. A new breast lump following recent trauma could be due to fat necrosis or hematoma (a collection of blood) formation, both of which can occur after direct trauma, surgery, biopsy, and radiation therapy. A breast abscess, a pocket of pus usually caused by mastitis, may appear in women who are breastfeeding. Symptoms include extreme tenderness, redness, and hardening of the skin above the abscess. The most common bacteria causing breast abscesses are staphylococcus and streptococcus.

What to expect with New Breast Mass

When trying to predict the outcome of a breast lump, several factors are taken into account. One of these important factors is the levels of sex hormones in the body. These are natural hormones that are known to increase the risk of breast cancer and can cause tumors in the breast to grow faster in women after menopause.

Moreover, by checking the levels of these hormones in a post-menopausal woman who has a breast lump, doctors may be able to predict the risk of her developing breast cancer up to 20 years in advance. The chances of getting breast cancer are directly linked to these sex hormone levels in the blood.

It’s also important to note that there are five main things that can affect the levels of these sex hormones: alcohol, exercise, diet, body weight, and smoking.