Are All Breast Lumps Malignant? Understanding When To Treatment

Breast lumps can be a cause of concern, often raising doubts and fear of cancer. It is true that some breast lumps are cancerous, but the majority are benign. To accurately diagnose a breast lump, a doctor needs to perform a clinical examination, use a imaging modality and needs tissue diagnosis if needed. This blog provides a comprehensive information of the types of breast lumps, risk of having a cancer and when to treat or follow up a breast lump.

Breast Lumps: Benign vs. Malignant

Breast lumps are sometimes scary, but the majority of them are benign. Here are the common types:

Benign Breast Lumps

• Fibroadenomas: Solid, round, non-cancerous tumors that move freely in the breast tissue on palpation between the ages of 15 to 35 years. They often go away on their own, but some require surgery.
  
• Breast Cysts: Up to 25% of breast lumps are fluid-filled cysts that can be tender and lumpy. They often get resolved without any treatment.
  
• Fibrocystic Breast Changes : Hormone level fluctuations can make the breast lumpy, dense, and tender, especially before menstruation. This is common between the ages of 30 to 50 years and usually resolves without treatment.
  
• Lipomas: Slow-growing, soft, painless, and fatty tumors. They can be followed up or surgically removed after a tissue diagnosis if large.
  
• Intraductal Papilloma: A small, benign growth in a milk duct near the nipple that may cause nipple discharge. Common in ages 30 to 50 years. Multiple papillomas (especially more than 5) can increase cancer risk and need to be surgically removed.
  
• Duct Ectasia: Also known as periductal mastitis, common in the peri-menopausal period. It causes milk ducts to swell, thicken, and become blocked. It does not increase the risk of cancer and often responds to antibiotic treatment.
  
• Traumatic Fat Necrosis: These breast lumps are scar tissue resulting from an injury to the breast, surgery, or radiation therapy. They do not increase cancer risk.
  
• Galactocele: A milk-filled retention cyst occurring almost exclusively in lactating women, caused by mammary duct obstruction. Ultrasound-guided aspiration is preferred; recurrent or complicated cases may require simple excision.
  
• Mastitis or Abscess: Infection or inflammation of the breast due to bacteria or blocked milk ducts, causing tenderness, redness, swelling, and fever. Treatment includes antibiotics, ultrasound-guided aspiration, and surgical drainage if needed. It does not increase cancer risk.
  

Malignant Breast Lumps: Malignant lumps are hard, irregular, and often fixed to surrounding tissues. It is important to know that clinical examination alone cannot diagnose cancer. Further evaluation using imaging modalities like ultrasonography, mammogram, or MRI—and confirmation through tissue diagnosis (FNAC or biopsy)—is necessary.

Role of Mammography in Evaluation of Breast Lumps

Mammography is one of the most important and convenient tools in breast imaging. It uses low-dose X-rays to produce high-resolution images of the breast. This modality is used in screening programs because of its low cost and convenience, and also in diagnostic settings as it can characterize the breast lump or identify the cause of any symptom.

• Screening Mammograms: Used to identify and detect any changes in the breast in women who do not have any signs or symptoms. The aim is to detect cancer early so that treatment can be less invasive.
  
• Diagnostic Mammograms: Used to evaluate any specific breast changes, such as a lump, pain, nipple retraction, ulceration, nipple discharge, or changes in the size or shape of the breast.
  

BIRADS: The Radiological Grading System

The Breast Imaging Reporting and Data System (BI-RADS), developed by the American College of Radiology (ACR), is a uniform way for radiologists to characterise and describe the nature of breast lumps. BI-RADS helps radiologists to standardize their interpretations. Each BI-RADS category, ranging from 0 to 6, has a follow-up plan and a course of action associated with it, to help the treating doctors appropriately manage a patient’s care.

BIRADS: The Radiological Grading System

The Breast Imaging Reporting and Data System (BI-RADS), developed by the American College of Radiology (ACR), is a uniform way for radiologists to characterise and describe the nature of breast lumps. BI-RADS helps radiologists to standardize their interpretations. Each BI-RADS category, ranging from 0 to 6, has a follow-up plan and a course of action associated with it, to help the treating doctors appropriately manage a patient’s care.

When to Follow Up on a Breast Lump and When to Treat?

When should you follow up on a breast lump? This is the question most frequently asked by patients. As discussed in the previous section, the answer depends on the patient’s age, BIRADS category, and other risk factors.

• Benign breast lumps (BIRADS 1 or 2) can be followed up with routine annual screening and are usually harmless as the risk of developing cancer is almost 0%.


• Probably benign lumps (BIRADS 3) have a risk of less than 2% of cancer and thus can be followed up every 6 months.


• Other breast lumps with BIRADS 4 or 5 need further evaluation with FNA or biopsy (biopsy is preferred as it gives more information).


• Women who have a higher risk of breast cancer due to family history, genetic mutations like BRCA1/BRCA2, or other genetic predispositions, need screenings with MRI to detect any changes.

Final Thoughts

Noticing a breast lump can be unsettling, but it’s important to know that the majority of lumps are non-cancerous. BIRADS is helpful to characterise and differentiate benign and malignant breast lumps. It answers the important question—when a breast lump doesn’t require any treatment. Regular self-examination and noticing any new or unusual changes in the breast is the first step for maintaining breast health.

By keeping yourself aware about breast self-examination and reaching out to your doctor, most breast lumps can be accurately diagnosed, treated, or followed-up.