Worried about a lump in your breast? That’s understandable — but know that breast lumps can be caused by a number of factors other than breast cancer. While breast lumps should always be taken seriously, there are several questions to consider that will help determine just how quickly you should get to the doctor.
The most common cause of breast lumps: Fibrocystic changes
Some women who experience pain in their breasts will receive a diagnosis of “fibrocystic changes” (FCC). That means the pain isn’t caused by cancer or tumors. But if it’s not cancer, what is it?
FCC, also known as fibrocystic breasts, is the most common benign condition of the breast, occurring in about 50 percent of women at some point during their lives. Highly influenced by reproductive hormones and the menstrual cycle, FCC is most often found in women under the age of 50. Post-menopausal women rarely experience FCC.
Your breasts are made up of fat; glandular tissue (e.g., milk lobules and milk ducts); and fibrous (stromal) tissue, a connective tissue (akin to scar tissue or ligaments in consistency) that holds everything together. Sometimes, this fibrous tissue becomes more prominent: This is called fibrosis. Doctors don’t know exactly why this happens but suspect it’s related to reproductive hormones, particularly estrogen.
Your breasts may also develop a cyst or numerous cysts, which are round fluid-filled sacs. These cysts start inside breast glands and can remain very small or can become quite large. As cysts grow, they push against breast tissue, which can be painful.
Taken together, these two conditions — fibrosis and cysts — are called fibrocystic breasts or fibrocystic changes. The condition was formerly known as fibrocystic breast disease, but doctors have determined it’s so common, and generally harmless, that it doesn’t qualify as a disease.
FCC vs. cancer: Can you feel the difference?
While it’s impossible to tell simply by touch the difference between a lump caused by cancer and one by FCC, these general guidelines may help you make an initial determination before you see a doctor.
A cancerous breast tumor usually feels hard; may be round, or irregularly shaped; is fixed in place; and is nearly always painless. A cyst will feel round and smooth; will be very moveable; and is often painful. Fibrosis will feel firm or rubbery to the touch and may seem “ropy” rather than round. And fibrosis, like a cyst, can hurt.
Another significant difference is that fibrocystic changes are often noticed in both breasts, while breast cancer usually appears in just one. And FCC often evolves during the course of your menstrual cycle, with lumps enlarging and becoming more painful and tender just before and during your period. After your period, lumps may get smaller, or even disappear altogether. A breast cancer tumor doesn’t change over the course of your period.
Still, if you have any doubts at all about a lump you’ve noticed in your breast — it doesn’t change over the course of your period, feels hard rather than soft, and is fixed in place — it’s best to get it checked out.
An ultrasound can usually distinguish cysts fairly easily. And if an ultrasound doesn’t reveal cysts, your doctor may recommend an MRI or diagnostic mammogram, followed by a biopsy, if necessary, to determine if the mass is simply fibrosis or something more serious.
Not all tumors are cancer
Fibroadenoma, a benign (non-cancerous) breast tumor, can be thought of as a condition that resides somewhere between fibrocystic changes and breast cancer.
A fibroadenoma is simply an overgrowth of fibrous and glandular breast tissue. Like FCC, a fibroadenoma can be scary. But again, it’s usually distinguished by its mobility: When you press on it, it might feel like it’s slipping out from under your fingers and moving around. Also, a fibroadenoma, unlike a cancerous tumor, may change in sync with your period and may be tender or painful.
Fibroadenomas are most common in women between the ages of 15 and 30, and in pregnant women. In fact, fibroadenomas are the most common type of breast mass in women under the age of 30.
If a fibroadenoma is larger than 3 centimeters; if it grows quickly or become noticeably painful; or if a biopsy reveals atypical hyperplasia (very active growth by cells), your doctor may recommend having it surgically removed. Even though it’s benign, it might be bothersome. And if it shows atypical hyperplasia, this is a condition that raises your risk for breast cancer, so your doctor may decide to remove that risk right at the outset.
What to do about FCC
Again, fibrocystic changes can be painful, and that pain is often the result of a large cyst or fibroadenoma. A cyst can be drained, which will definitely reduce the pain. If the same cyst keeps recurring, it may need to be removed surgically. A painful fibroadenoma can also be removed.
Other than that, over-the-counter pain medicine such as acetaminophen or ibuprofen may help. Some women report relief from a good support bra during the day and a sports bra at night. Some claim that reducing caffeine intake (coffee, tea, chocolate, soft drinks) relieves their symptoms. And because fluid buildup just before your period seems to make FCC worse, some doctors recommend reducing your salt intake during that time.
All in all, there’s no simple solution to alleviating FCC symptoms. It’s more of a trial-and-error process to find out what works for you. And what works is usually a combination of smaller things, rather than one silver bullet.
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