Breast Lump or Breast Change

You may assume that a painful lump is harmless, that a painless lump is cancer or that breast symptoms affect only women. Most breast and chest lumps are not cancer, but every new unexplained lump or persistent change should be examined. Pain, age and pregnancy status influence the possibilities but cannot reliably determine the cause.

Know what is normal for your breast or chest Breast tissue naturally varies between people, between the two sides, during the menstrual cycle, with pregnancy, during breastfeeding, after menopause, with weight change, during hormone treatment, and after surgery. Breast awareness means knowing the usual appearance and feel of your breasts, chest and armpits so that you notice a new change. You do not need to use a rigid examination technique or check on one particular day. Anyone with breast tissue can develop a breast lump Breast symptoms can affect women, men, trans people, non binary people, and children and adolescents. Breast cancer is much more common in women, but men can also develop it. Symptoms in men include a lump, nipple change, discharge or ulceration. The amount and distribution of breast tissue may be altered by hormones or chest surgery, but any new unexplained change deserves assessment. Most breast lumps are not cancer Common non cancerous causes include cysts, fibroadenomas, hormonal nodularity, fat necrosis, infection or abscess, milk filled cysts during breastfeeding, gynaecomastia, scar tissue, or benign duct changes. You cannot reliably distinguish these from cancer by touch alone. GP assessment is advised for any breast or armpit lump or another unusual breast or nipple change. A lump may be firm or soft, smooth or irregular, mobile or fixed, tender or painless, or clearly defined or difficult to outline. None of these features proves whether the lump is benign or malignant. A painful lump can still need investigation, while many breast cancers are painless. General lumpiness may vary with periods Hormonal changes can cause tenderness, fullness, nodularity, symptoms in both breasts, or changes that worsen before a period. A new persistent focal lump still requires assessment even when background lumpiness is cyclical. Breast cysts and fibroadenomas are common A cyst is a fluid filled sac. It may be smooth, mobile, tender, more noticeable before a period, or variable in size. Ultrasound can help distinguish a fluid filled cyst from solid tissue. A fibroadenoma is a non cancerous solid breast lump, commonly found in younger people. It may feel smooth, firm, mobile, or well defined. Clinical assessment and imaging are still needed because touch cannot confirm the diagnosis. Fat necrosis can follow injury or surgery Fat necrosis occurs when fatty breast tissue is damaged, following a direct injury, surgery, radiotherapy, or breast reconstruction. It can produce a firm lump or skin change that resembles cancer on examination. Imaging and sometimes biopsy are needed to distinguish them. Breast pain alone is usually not cancer Breast pain may be related to menstrual hormones, pregnancy, breastfeeding, poorly fitting support, chest wall muscle pain, medicines, injury, or infection. Pain linked to periods commonly affects both breasts and improves when the period ends. Breast pain by itself is not usually a symptom of breast cancer, but persistent focal pain or pain with another change should be assessed. Cancer can cause more than a lump Possible warning changes include: A lump or swelling in the breast, chest or armpit. Skin dimpling or puckering. Skin resembling orange peel. Unexplained redness. Change in breast size or shape. A newly inverted nipple. Nipple rash or ulceration. Blood stained nipple discharge. Persistent one sided nipple discharge. An armpit lump. A non healing sore Redness and skin changes may be less obvious on brown or black skin, so compare texture, warmth, swelling and contour as well as colour. Some nipples have always pointed inward. A newly retracted or distorted nipple is different and needs assessment, especially when one sided or accompanied by a lump, skin change or discharge. Nipple discharge has several possible causes Possible causes include pregnancy, breastfeeding, benign duct changes, a papilloma, mastitis, medicines, high prolactin, or cancer. Important details include whether discharge comes from one or both nipples, occurs spontaneously or only when squeezed, is bloody, clear, milky or pus like, comes from one duct or several, or occurs with a lump or nipple change. GP assessment is advised for nipple discharge. Avoid repeatedly squeezing the nipple to check because this can perpetuate discharge and irritation. Pregnancy and breastfeeding cause normal breast changes During pregnancy, breasts may become larger, tender, more nodular, darker around the nipples, more vascular, or able to produce colostrum. A new persistent focal lump still needs assessment. Pregnancy does not prevent breast cancer, and imaging such as ultrasound can be used safely when clinically indicated. A blocked or inflamed milk producing area may cause a tender lump, local fullness, pain, symptoms worse before feeding, or reduced milk drainage. Feeding support should assess attachment, milk removal, oversupply, pumping and pressure from clothing or equipment. A lump that does not improve requires clinical review. Mastitis causes inflammation and illness Mastitis may cause a painful area, heat, swelling, firmness, redness or colour change, fever, flu like symptoms, or a tender lump. It is most common during breastfeeding but can occur outside lactation. Contact a GP or NHS 111 when symptoms are not improving within 12 to 24 hours or are worsening. Continuing to feed or express according to current breastfeeding advice is often appropriate, but excessive massage or forceful emptying can worsen inflammation. A breast abscess is a collection of pus, with possible features including a painful swelling, a localised lump, heat or redness, fever, persistent mastitis symptoms, or a soft or fluctuant centre. It usually requires imaging and drainage in hospital. Inflammatory breast cancer can cause rapid breast swelling, redness or darker discolouration, warmth, thickened skin, orange peel texture, or nipple inversion, and may occur without a clear lump. Persistent inflammation that does not respond as expected to treatment requires urgent breast assessment. Do not accept repeated reassurance based solely on breastfeeding when a change remains. Adolescents, men and hormone therapy Breast development in adolescents can be uneven, tender, nodular, or temporarily asymmetrical. Fibroadenomas and developmental tissue are common benign explanations for lumps in younger people. A persistent discrete lump, rapid enlargement, skin change, nipple discharge or marked asymmetry still requires assessment. Non urgent specialist referral is recommended for unexplained breast lumps in people under 30, while people aged 30 or over generally meet the suspected cancer referral threshold. Gynaecomastia is enlargement of glandular breast tissue in someone with male reproductive anatomy, relating to puberty, ageing, medicines, liver disease, hormonal conditions, anabolic steroids, or weight related fatty tissue. It often feels like tender tissue beneath the nipple. A one sided hard lump, nipple change, discharge or armpit lump needs assessment for other causes. Oestrogen, testosterone and other hormonal treatments can change breast size, tenderness, nodularity, and tissue density. A new focal lump or nipple or skin change should still be assessed rather than attributed automatically to hormone treatment. Family history changes risk, not the meaning of one lump Relevant health problems in the family may include breast cancer at a young age, ovarian cancer, cancer in both breasts, male breast cancer, several affected relatives, or a known inherited cancer associated variant. Tell your GP about affected relatives and their age at diagnosis. Most people with a breast lump do not have a strong hereditary cancer syndrome. Assessment and referral Your clinician may ask when you first noticed the change, whether it has grown, whether it is related to periods, whether there is pain, whether there is nipple discharge, whether you are pregnant or breastfeeding. Whether you have had injury, surgery or radiotherapy, which medicines and hormones you use, whether there are relevant health problems in the family, and whether you have had previous breast problems. Examination usually includes both breasts or chest areas and the armpits. Suspected cancer referral is recommended when you are aged 30 or over with an unexplained breast lump, with or without pain. You are aged 50 or over with one sided nipple discharge, retraction or another concerning nipple change. Skin changes suggest breast cancer. Or you are aged 30 or over with an unexplained armpit lump. People under 30 with an unexplained breast lump should still be considered for specialist referral, usually through a non urgent route unless other features increase concern. Referral does not mean cancer has been diagnosed. The breast clinic may use triple assessment, combining clinical examination, imaging (ultrasound, mammography or other imaging) and tissue sampling when needed. A core biopsy removes small tissue samples with a needle. The choice depends on age, pregnancy, tissue density and the clinical finding. Screening does not replace symptom assessment A recent normal mammogram does not mean a new lump can be ignored. Screening is performed at intervals and cannot prevent every cancer from developing between screens. Report new symptoms regardless of when your last screening took place. Repeated checking or pressing a lump may increase tenderness, cause bruising, make size harder to judge, or increase anxiety. Note the location and arrange assessment instead.

Breast assessment compares a new change with what is usual for you: is there a discrete lump or general lumpiness, has the skin, nipple, size or shape changed, is there discharge, inflammation or an armpit lump, are pregnancy, breastfeeding, hormones, injury or infection relevant, and does the finding require urgent breast clinic assessment. The key action is noticing a change and arranging assessment, not trying to diagnose it by touch.