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It’s a typical morning and you’re in the shower, belting out Lady Gaga’s latest album, sudsing up your armpits, when you feel it: a panic-inducing lump in one of your breasts. You stop singing midchorus. Your heart starts racing. And a singular, terrifying thought forms. Wait, do I have cancer?
Discovering a breast lump can be deeply unsettling—and for good reason. Breast lumps are a symptom of breast cancer, the most common cancer in American women after skin cancer. Yet in many cases, bumpy boobs are actually NBD. So how can you distinguish between the benign and the worrisome? What should you do if you find an alarming growth? And how can you lower your risk of breast cancer?
We posed these questions—and others—to three breast experts. Here’s everything you need to know about lumps and bumps on boobs.
Important facts about breast lumps and breast cancer
Okay, so you identified a questionable bulge in your boob. Now you’re probably wondering what the hell it might be.
First, some good news: At least 90% of breast lumps discovered in women ages 20 to 50 are benign, says Julie R. Gralow, M.D., clinical director of breast medical oncology at Seattle Cancer Care Alliance and professor of breast oncology at the University of Washington School of Medicine. Of course, it is possible to get breast cancer when you’re young, but it’s not very common—in the U.S. the median age of breast cancer diagnosis is about 62.
Now the sobering news: The average-risk American woman has a one in eight chance of developing breast cancer in her life. And for women 55 and older, the most common cause of a new breast lump is breast cancer, says Gralow. In other words, “age really matters,” she says.
Race and ethnicity also matter. Overall incidence of breast cancer is about the same in white and Black American women, and lower in American women of other races and ethnicities. But breast cancer death rates are 40% higher in Black women than white women in the United States, explains Lisa Newman, M.D., chief of breast surgery at Weill Cornell Medicine and NewYork-Presbyterian. And Black women are also more likely to die from metastatic, or stage 4, breast cancer.
What explains this enraging disparity? Systemic racism and unconscious bias weigh heavily. Poverty rates and lack of health insurance associated with systemic inequality create barriers to health care access and delay breast cancer diagnoses, explains Newman. Another component, adds Gralow, is the mistrust that some BIPOC have in health care providers based on years of mistreatment and experimentation on the Black community.
Also at play: Certain biologically aggressive patterns of breast cancer are more common among Black women, says Newman. Case in point: Black women are diagnosed with triple negative breast cancer (a type of breast cancer that tends to be fast-growing and has a higher risk of recurrence with fewer treatment options) at almost double the rate of white, Hispanic, and Asian women, says Swati Kulkarni, M.D., breast surgeon at Northwestern Memorial Hospital and professor of surgery at Northwestern Feinberg School of Medicine. Researchers are currently trying to understand the genetic and biological explanations for these correlations, but in the meantime, it’s especially important for Black women to be aware of their breast health and follow breast cancer screening recommendations, Newman advises.
Causes of lumps in breasts
“It is perfectly normal for most women to have some degree of ‘lumpy/bumpiness’ or ridges in their breast texture,” says Newman. These densities, described generally as “fibrocystic breast changes,” are influenced by hormone fluctuations. There are several different types of fibrocystic breast changes:
A fibroadenoma is an encapsulated clump of solid breast tissue, says Newman. Essentially, some of your normal fibrous breast cells “just kind of ball up on top of themselves,” explains Gralow.
Fibroadenomas, which are typically round and smooth, are more common in your 20s and 30s. In general, these lumps shouldn’t grow quickly, but they can grow slowly. Fibroadenomas will also likely fluctuate in size with your monthly cycle. They are typically (though not always) mobile, meaning they will move if you push on them, says Gralow. And they can go away as you get older and your estrogen levels drop, she adds. Sometimes fibroadenomas are painful.
Most fibroadenomas do not increase your risk of breast cancer, says Kulkarni, though a small subset is problematic and may need to be removed.
A cyst is an encapsulated fluid collection, says Newman. Cysts are a common cause of breast lumps in premenopausal women, says Gralow, and like fibroadenomas, they are usually mobile, round, smooth, and sometimes painful, and fluctuate in size with your cycle. Most cysts do not increase your risk of breast cancer, though a small subset is problematic and may need to be removed, says Kulkarni.
Nonspecific fibronodular or fibrofatty breast tissue are areas of your breast where the tissue is especially dense and feels lumpy as a result. For instance, the upper outer part of your breast (the part that's closest to your armpit) tends to be one of the densest areas, says Gralow.
In some cases, breast lumps are, unfortunately, caused by breast cancer. Breast cancer lumps are typically irregular in shape, though sometimes they can feel smooth and round. Unlike fibrocystic breast changes, cancer lumps don’t typically fluctuate in size; once they start growing, they usually keep growing, says Gralow. Cancer lumps can be fixed or mobile. Most cancerous breast lumps are painless, but some breast cancers are associated with pain, says Newman.
How to recognize if you have a lump in your breast
Boobs are often lumpy and bumpy, especially when you're young and you've got hormones stimulating them, says Gralow. In general, premenopausal women will have denser (thicker) breast tissue compared with older women, says Newman. Breast architecture and density can also vary with body weight—in particular, very fit women who don't have much fat in their breasts may have naturally lumpy boobs, says Kulkarni.
So how can you distinguish normal lumpy breast tissue from a potentially worrisome lump?
It’s worth seeing a health care provider anytime you discover a new lump, advises Newman. But that doesn’t mean you should panic every time you feel a bump. Normal breast tissue will feel pretty symmetric on both sides, Gralow explains. So if you feel something bumpy in one boob, check the same area on your other breast. If that side feels similarly misshapen, you’re probably in the clear, since cancer doesn’t occur symmetrically in both breasts at the same time, says Gralow. Still, flag it next time you see your gyno or primary care doc just to be sure. If one breast feels notably different than another, however, it’s worth getting that checked by a health care pro right away. You should also visit your doctor if you have a lump that doesn’t grow or shrink with your menstrual cycle, or if your lump grows over time, says Kulkarni.
Lumps aren’t the only breast change worth noting. You should also visit your doctor if your nipples produce discharge, particularly if it's only on one side or if it occurs spontaneously, says Kulkarni. Most of the time this symptom is associated with a benign finding, but in about 10% of cases, it’s associated with something more worrisome, like noninvasive cancer, she explains. Other reasons to see your doctor ASAP: a nip that is irritated, tilted, peeling, or bleeding, and irregular swelling of the lymph nodes that are underneath your armpits or above your collarbone.
It’s also wise to keep an eye on any skin changes, which can be a symptom of inflammatory breast cancer. Classic medical textbooks describe this very rare type of cancer as causing swelling, indentation, and infection-like redness on the skin, says Kulkarni. But on a darker-skinned patient, the redness may not be as apparent. In those instances, it’s crucial to pay attention to skin swelling, she says. (Another rare type of breast cancer in which the skin on the nipple and areola can have changes similar to eczema or dermatitis can also potentially be more subtle and challenging to detect in darker breast skin, adds Newman.) “A patient will be more familiar with her own breast skin appearance than anyone else,” Newman says, which is why it’s important to keep close tabs on your boob health and alert your doctor if you see—or feel—anything irregular.
What to do if you think you have a lump
Women should never diminish their symptoms, says Kulkarni. If you discover a lump or a change in your boobs, or are otherwise concerned about something, definitely book a doctor appointment, stat. It’s important to get evaluated while you are experiencing symptoms, says Gralow, so if your physician has long wait times for appointments, find a different provider.
And remember: “Any new lump or change in the breast can easily have a benign explanation,” says Newman. Don’t immediately assume the worst—calmly book an appointment to have the pros take a look sooner rather than later. “Ignoring a possible cancer can have major adverse consequences,” she says.
Your doctor will likely perform a clinical breast exam (i.e., a physical exam), and if they suspect your lump is a benign fibrocystic breast change, they should, at the very least, ask you to monitor its size over the course of your next menstrual cycle, says Gralow. They should then follow up with you after your cycle to determine whether the lump fluctuated in size and whether further action is needed.
Following the clinical exam, the doctor may perform an ultrasound, which can help determine whether a lump is smooth or irregular, and solid or fluid-filled. If you’re older than 30, the doctor may also order a mammogram to get additional information, says Kulkarni.
If the breast imaging reveals your lump is fluid-filled and therefore a cyst, the doctor may choose to aspirate it, which involves sticking a needle in the cyst to drain the fluid. This will collapse the cyst. If the cyst doesn’t disappear, that means there is a solid component, in which case your doctor will likely perform a needle biopsy. This involves using a small needle to collect three to six cell samples from the lump, explains Kulkarni. These samples are then analyzed under a microscope by a pathologist.
If the lump appears to be a solid mass, the doctor may also elect to do a needle biopsy, says Kulkarni, or in some cases, a surgical biopsy, which involves creating an incision in the breast to remove a small piece of tissue, explains Newman.
If the biopsy reveals that the solid mass is benign, the doctor will likely leave it be, though in certain circumstances they may remove it (e.g., for patient’s peace of mind, if it’s enlarged or causing pain, or for cosmetic reasons if it’s pushing on the skin), says Kulkarni.
If the solid mass turns out to be cancerous or is otherwise worrisome, you will likely be referred to a specialist to determine next steps and talk through treatment options.
An important thing to remember: If, at the end of your appointment, you don’t feel like your doctor thoroughly investigated your lump, seek another medical opinion, says Newman. You shouldn’t forget about your lump until your doctor has confirmed, for certain, what it is, says Gralow.
How to understand your risk of breast cancer
All adult women are at risk of breast cancer, and this risk increases as we get older, says Newman. But there are other factors and conditions associated with breast cancer risk, and it’s important for women to be aware of them so that those at high-risk can take extra precautions—like getting a breast MRI in addition to an annual mammogram or, in some cases, taking a specific medication to reduce their risk of breast cancer.
So what factors and conditions should be on your radar?
Breast cancer is more common among women with certain family histories of cancer, such as breast cancer in a male relative or multiple relatives with breast and/or ovarian cancer—especially if they are close relatives and especially if they were diagnosed at a young age, says Newman. Women with these family patterns should consider undergoing genetic testing to determine whether they have inherited a DNA pattern associated with breast cancer risk, she suggests.
More than three quarters of breast cancers occur in women that have no family history of the disease. There are many other factors that influence your risk—like obesity and a sedentary lifestyle, two factors strongly associated with an increased risk of breast cancer, especially among postmenopausal women, says Newman. “Weight gain in your late 40s and 50s is the most worrisome,” adds Gralow, “but the physical activity that you get in your 20s absolutely impacts your risk of getting breast cancer in your 50s and 60s.” Excessive alcohol consumption also raises your risk, says Newman, as does combination hormone replacement therapy after menopause, she adds.
Pregnancy and breastfeeding can also impact your breast cancer risk—getting pregnant younger and breastfeeding longer are both associated with lower risk, says Gralow.
How to reduce your risk of lumps
There is nothing you can do to prevent or eliminate fibrocystic changes, says Newman. But there are steps people with breasts can take to reduce their risk of life-threatening breast cancer.
Breast self-exams, once heralded as the gold standard, are no longer recommended for women with an average risk of breast cancer. “We've never had a randomized clinical trial that showed that teaching breast self-exam reduced deaths due to breast cancer,” explains Gralow. (Some also worried that the practice was leading to an excessive number of “unnecessary” benign breast biopsies, adds Newman.)
That said, it’s still super important to be aware of how your breasts normally look and feel so that you can I.D. any changes (and seek medical attention as needed). Think of it as breast self-awareness: regularly scoping your boobs in the mirror, touching them as you shower, or even just noticing what it feels like when you bump your chest against something.
Average-risk women should also start getting annual mammograms at age 40, per the National Comprehensive Cancer Network and the American Society of Breast Surgeons. And high-risk women should ask their doctor about options for enhanced or supplemental breast cancer screening—like breast MRI or whole-breast ultrasound, says Newman.
Early detection aside, the best way to maintain good breast health is to take care of your entire body, says Kulkarni. Reduce your likelihood of breast cancer by eating healthy (lots of fruits and veggies, you know the drill), maintaining a healthy weight, exercising regularly, and curbing your alcohol consumption to no more than three to five drinks per week.
Jenny McCoy is a Colorado-based freelance journalist specializing in health and fitness.
