A palpable lump in the breast is a distinct mass of tissue detected through touch during a self-examination or clinical exam. While finding a lump frequently causes concern, the majority are non-cancerous; approximately 80 to 85% of palpable breast masses are ultimately diagnosed as benign. These masses can develop in any area of the breast tissue, including near the armpit.
Identifying Physical Characteristics of Lumps
The initial assessment of a palpable lump relies on its physical qualities, which provide clues about its nature. Texture can range widely, from soft and squishy to firm, rubbery, or hard.
Mobility is another feature; benign masses often feel mobile, moving slightly within the surrounding tissue. In contrast, a fixed mass tethered to the chest wall raises greater suspicion. The lump’s shape is assessed by noting if it has regular, smooth borders or irregular, jagged edges. Size varies significantly. The presence of pain or tenderness is also noted, though pain alone does not reliably distinguish between a benign and a malignant cause.
Common Benign and Malignant Causes
The underlying cause of a palpable mass is categorized as either benign or malignant. Benign lesions are overwhelmingly more frequent, often related to normal hormonal fluctuations.
Fibrocystic changes are a common benign condition, involving the development of fibrous, rubbery tissue and fluid-filled sacs, known as simple cysts. Cysts often feel smooth, round, and movable, and their tenderness may increase just before the menstrual period due to hormonal changes.
A fibroadenoma is another frequent benign mass, which is a solid lump composed of glandular and stromal tissue. Fibroadenomas are most common in younger women (ages 15 to 35). They are typically firm, rubbery, and highly mobile masses that are generally painless. Less common benign causes include lipomas (fatty tumors), mastitis (infection), and fat necrosis, which forms a lump after an injury.
Malignant lumps, while less common, typically present as hard and firm masses with irregular, poorly defined borders. These masses are more likely to be fixed or stationary within the breast tissue and are often painless. The risk of a palpable lump being malignant increases with age, making thorough investigation a priority for any new or changing mass.
Standard Medical Evaluation and Diagnostic Steps
The definitive way to determine the nature of a palpable lump is through the structured diagnostic process known as the “Triple Assessment.” This comprehensive approach combines three investigative components to achieve a highly accurate diagnosis.
Clinical Breast Examination and History
A healthcare provider assesses the lump’s size, texture, mobility, and any associated skin or nipple changes, while also noting the patient’s risk factors.
Imaging
Imaging typically involves a mammogram for women over 35 and an ultrasound. Ultrasound is particularly useful for younger women or for distinguishing between a fluid-filled cyst and a solid mass.
Tissue Diagnosis (Biopsy)
A biopsy is necessary for any suspicious or indeterminate lesion. This procedure uses a fine needle aspiration (FNA) or a core needle biopsy (CNB) to collect cells or a small tissue sample. A pathologist then analyzes this sample to definitively rule out or confirm the presence of malignant cells. The Triple Assessment is considered the standard because its combined results offer a positive predictive value of nearly 100% when all three elements suggest cancer.