Women’s breast complaints come in all shapes and sizes. Lumps, pain, and other abnormalities affect most of us at one time or another.
It’s common to have concerns. We’ve been trained to be vigilant about breast cancer, the cause of some—but not most—breast complaints.
Below are the top five breast concerns that patients ask me about. Yes, they can be indications of breast cancer, but also many other non-cancerous conditions. Sometimes you can tell the difference, but most of the time you can’t without proper evaluation. So, always tell your doctor and get checked if you have the following.
Actually, you should tell your doctor about any change in your breast tissue, not just lumps.
Breasts are best checked at the end of each menstrual period. That’s when they are least swollen and sore. When examining your breasts, feel around for something hard that doesn’t belong there. It may feel like a frozen pea or lima bean, or may be smooth and very firm, like a marble.
Many women think if the lump moves, it’s not cancer. But that’s a myth. Breast cancers almost always begin in a movable state. It’s not until they grow larger that they attach to something and stop moving.
Most breast cancer lumps don’t hurt, although fast-growing breast cancers sometimes do.
Neither you nor your healthcare provider—no matter how good he or she is—can tell if a lump is or is not cancer without diagnostic imaging. When providers say, “Don’t worry. It’s probably OK,” it may delay diagnosing breast cancer. Don’t let your doctor guess. It’s best to get imaging.
In women age 30 and older, we’ll first do a mammogram to look for a mass or calcifications. Then we’ll do an ultrasound to evaluate characteristics of the mass (such as if it’s solid or fluid-filled) to help diagnose it. In women under age 30, we’ll do an ultrasound right away because younger, denser breasts are difficult to evaluate by mammogram. Any lump that is suspicious should be biopsied.
A lump also could be just lumpy breast tissue, a benign cyst, or a fibroadenoma.
Most women experience occasional breast pain. It’s usually not a sign of cancer.
It is common around the time of menopause due to hormonal fluctuations, and also can be due to taking hormonal therapy. In some women, pain is worsened by caffeine.
It’s when the pain is in one spot, particularly in older women, that it requires diagnostic imaging. Rarely this is the only sign of breast cancer.
Dense breast tissue is very common—present in nearly one in two women. Breast density refers to the appearance of the breast tissue on a mammogram.
A common misconception is that women with lumpy, bumpy breast tissue have dense breasts. But those conditions are not related. Your breasts can feel lumpy but not appear dense on a mammogram.
Extreme breast density is associated with an increased risk of breast cancer. In addition, cancers can be more difficult to detect in women with dense breasts. That’s why, in the last few years, most states have mandated that women be notified of their breast density. If after your next mammogram you get notified that your breasts are dense, don’t be concerned. It is likely not a change in your body, just in state law.
Women with dense breasts should discuss their breast cancer risk factors and screening options with their healthcare provider. Digital breast tomosynthesis, also called 3D mammography or “tomo,” improves cancer detection in women with dense breasts by 25 to 40 percent, with 15 percent fewer callbacks. Breast MRI also may be available to women at increased risk.
Family History of Breast Cancer
Only about 10 to 15 percent of breast cancers are truly hereditary. However, family history of breast cancer is very important. Update your healthcare provider on your family history each year.
Breast cancer may run in your family if you or a family member has had:
- Breast cancer diagnosed at age 50 or younger
- Breast cancer in both breasts
- Male breast cancer
- Triple-negative breast cancer
- Ovarian cancer
- Metastatic prostate cancer
Anyone with Ashkenazi Jewish ancestry may also have a high risk. BRCA gene mutations, the most common hereditary cause of breast cancer, are found in 1 in 400 people in the general population. But they’re in 1 in 40 Ashkenazi Jews.
If breast cancer runs in your family or you are Jewish with a family history of breast, ovarian, prostate, or pancreatic cancer, get genetic counseling. People with genetic mutations may benefit from enhanced screening, medications to reduce their risk, or even risk-reducing surgery.
Many women can express milky discharge from their nipples long after they’ve stopped breastfeeding. Other women may have expressible greenish, tan, or even black discharge from multiple ducts. Although this is alarming, it is usually due to debris in the ducts and is harmless.
For any nipple discharge, stop squeezing! Squeezing can make it worse.
The type of nipple discharge that requires a trip to your doctor is that which:
- Comes out on its own (without squeezing)
- Is bloody or clear
- Comes from a single duct on one breast
This type of discharge is a sign of breast cancer about 10 percent of the time. However, even when it’s bloody, it’s more often due to a benign intraductal papilloma.
Even If You Think It’s Nothing, Get Checked
Breast cancer is usually top of mind in the patients I see at the Breast Center. Although most breast complaints are not caused by cancer, getting them checked out is a must.
Never ignore a breast problem or wait to see if it goes away on its own. If it is cancer, it will be more curable the earlier it is detected.
Dr. Pederson is Director of Medical Breast Services at Cleveland Clinic’s Breast Center.