From the Guidelines
Breast masses that are hard, irregular, immobile, and painless are concerning for cancer, and any mass accompanied by skin changes, nipple discharge, nipple retraction, or axillary lymphadenopathy warrants immediate evaluation. A cancerous breast mass typically feels firm or hard with irregular borders, unlike the smooth, well-defined edges of benign masses, as noted in the study by 1. It often feels fixed to surrounding tissue rather than mobile when manipulated. While most breast cancers are painless, any mass accompanied by skin changes (dimpling, redness, or puckering), nipple discharge (especially bloody), nipple retraction, or axillary lymphadenopathy (enlarged lymph nodes) warrants immediate evaluation, as stated in the guidelines by 1. Rapid growth of a mass or asymmetry compared to the other breast also raises concern. Age is an important factor, as masses in women over 50 are more likely to be malignant, and family history of breast or ovarian cancer increases risk, as mentioned in the study by 1.
Some key characteristics of concerning breast masses include:
- Hardness or firmness
- Irregularity or asymmetry
- Immobility or fixation to surrounding tissue
- Painlessness
- Skin changes, such as dimpling, redness, or puckering
- Nipple discharge, especially bloody
- Nipple retraction
- Axillary lymphadenopathy (enlarged lymph nodes)
- Rapid growth or change in size
- Asymmetry compared to the other breast
These characteristics are not definitive for cancer, as some benign conditions may present similarly, but they should prompt prompt medical evaluation, including imaging (mammogram, ultrasound) and possibly biopsy for definitive diagnosis, as recommended by 1 and 1. Early detection significantly improves treatment outcomes for breast cancer. The American College of Radiology Appropriateness Criteria recommend diagnostic mammography and targeted-breast ultrasound as the initial imaging evaluation for a palpable breast mass, as stated in the study by 1.
From the Research
Characteristics of Breast Masses Concerning for Cancer
The following characteristics of a breast mass may be concerning for cancer:
- A mass that is hard, irregular, or fixed in place 2
- A mass that is associated with skin changes, such as dimpling or retraction 2
- A mass that is associated with nipple changes, such as discharge or inversion 2
- A mass that is large in size, typically greater than 2 cm in diameter 3
- A mass that is located in the upper outer quadrant of the breast, where the majority of breast cancers occur 3
- A mass that is associated with axillary lymph node involvement, which can indicate metastatic disease 3
Risk Factors for Breast Cancer
Certain risk factors can increase a woman's likelihood of developing breast cancer, including:
- Family history of breast cancer 2
- Personal history of breast cancer or other breast diseases, such as ductal carcinoma in situ 2
- Genetic mutations, such as BRCA1 or BRCA2 2
- Age, with the majority of breast cancers occurring in women over the age of 50 4
- Hormone receptor-positive status, which can increase the risk of recurrence and metastasis 4
Diagnostic Evaluation
A diagnostic evaluation, including imaging studies and biopsy, is necessary to determine the nature of a breast mass and to rule out cancer 2, 3, 4.