Normal breast tissue is present in both males and females of all ages. This tissue responds to hormonal changes and, therefore, certain lumps can come and go.

Breast lumps may appear at all ages:

• Infants may have breast lumps related to estrogen from the mother. The lump generally goes away on its own as the estrogen clears from the baby's body. It can happen to boys and girls.
• Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
• Teenage boys may develop breast enlargement and lumps because of hormonal changes in mid-puberty. Although this may distress the teen, the lumps or enlargement generally go away on their own over a period of months.
• Breast lumps in an adult woman raises concern for breast cancer, even though most lumps turn out to be not cancerous.

Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts.

Fibrocystic changes can occur in either or both breasts. These changes occur in many women (especially during the reproductive years) and are considered a normal variation of breast tissue. Having fibrocystic breasts does not increase your risk for breast cancer. It does, however, make it more difficult to interpret lumps that you or your doctor find on exam. Many women feel tenderness in addition to the lumps and bumps associated with fibrocystic breasts.

Fibroadenomas are non-cancerous lumps that feel rubbery and are easily moveable within the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender and, except in rare cases, do not become cancerous later. A doctor may feel fairly certain from an exam that a particular lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy them.

Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period. Cysts may be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears completely after it is drained, no further treatment is needed. If the fluid is bloody, it is sent to the lab to look for cancer cells. If the lump doesn't disappear, or recurs, it is usually removed surgically.

Other causes of breast lumps include:

• Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.
• Breast cancer, detectable by mammogram or ultrasound, then a biopsy. Men can get breast cancer.
• Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These tend to resolve on their own in a matter of days or weeks. If not, the blood may have to be drained by your doctor.
• Lipoma -- a collection of fatty tissue.
• Intraductal papilloma -- a small growth inside a milk duct of the breast. Often occurs near the areola, the colored part of the breast surrounding the nipple, in women between the ages of 35 and 55. It is harmless and frequently cannot be felt. In some cases the only symptom is a watery, pink discharge from the nipple. Since a watery or bloody discharge can also be a sign of breast cancer, this must be evaluated by your doctor.

Treatment of a breast lump depends on the cause. Solid breast lumps are often removed surgically, or at least a biopsy is taken. The biopsy is to check whether it is cancerous or not. Cysts can be drained. Breast infections require antibiotics.

For fibrocystic changes, birth control pills are often helpful. Other women are helped by:

• Avoiding caffeine and chocolate
• Taking vitamin E, vitamin B complex, or evening primrose oil supplements
• Limiting fat and increasing fiber in the diet

If breast cancer is diagnosed, most women receive a combination of surgery, radiation, chemotherapy, and hormonal therapy. These options would be carefully assessed and thoroughly discussed with your doctor.

Call your doctor if:

• You find a new breast lump during your monthly self-exam
• You have bruising on your breast but did not experience any injury
• You have nipple discharge, especially if bloody or pinkish (blood tinged)
• The skin on your breast appears dimpled or wrinkled (like the peel of an orange)
• Your nipple is inverted (turned inward) but normally is not inverted

Also call if:

• You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination
• You are a woman over age 40 and have not had a mammogram in the past year

Your doctor will obtain a complete history from you, with special attention to factors that may increase your risk of breast cancer. A thorough breast examination will be performed. If you don't know how to perform breast self-examination, ask your health care provider to teach you the proper method.

Medical history questions regarding breast lumps include:

• When and how did you first notice the lump?
• Do you have other symptoms such as pain, nipple discharge, or fever?
• Where is the lump located?
• Do you do self-breast exams and is this lump a recent change?
• Have you had any type of injury to your breast?
• Are you taking any hormones, medications, or supplements?

Tests that may be performed include:

• Study of nipple discharge under the microscope
• Needle aspiration of a cyst with examination of the fluid under a microscope
• Biopsy of the lump
• Ultrasound to see if the lump is solid or cystic
• Mammogram

If you have a family history of breast cancer, your doctor may also suggest testing for genes that predispose you to breast cancer.

Breast cancer screening is an important way to find breast cancer early, when it is most easily treated and cured.

• If you are over age 20, consider doing a monthly breast self-exam. See: Breast self exam
• If you are over age 20, have a complete breast exam by your provider at least every 3 years -- every year if you are over 40.
• If you are over age 40, get mammogram once a year. If you are high risk, experts say you should start getting a mammogram at age 30.

Having fibrocystic breast tissue, mastitis, or breast tenderness related to PMS does NOT put you at greater risk for breast cancer. Having fibrocystic breasts does, however, make your self-exam more confusing since there are many normal lumps and bumps.

To prevent breast cancer:

• Exercise regularly
• Reduce fat intake
• Eat lots of fruits, vegetables, and other high fiber foods
• Do not drink more than one or one and a half glasses of alcohol a day

Saslow D, Boetes C, Burke W, et al. American cancer society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89.

Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002; 29(1): 1-20.

Klein S. Evaluation of palpable breast masses. Am Fam Physician. 2005; 71(9): 1731-1738.