Breast Lumps in Women

The discovery of a lump in a woman’s breast will usually create a lot of anxiety. She will probably have found it herself and with the high public awareness of breast cancer, will want reassurance or rapid action. If within your scope of practice, a careful examination of both breasts and associated lymph nodes is mandatory. Otherwise make an immediate referral to a GP.

Published: 2nd August 2022 | Updated: 3rd February 2023

Differential diagnosis

Common Diagnoses

  • Carcinoma
  • Cyst
  • Abscess
  • Fibroadenoma
  • Fibrous Dysplasia

Occasional Diagnoses

  • Duct Ectasia
  • Fat Necrosis
  • Lipoma
  • Paget’s Disease of the Nipple
  • Galactocoele
  • Multiple Cysts
  • Spurious Lump (e.g. Palpable Underlying Rib)

Rare Diagnoses

  • Tuberculosis
  • Sarcoma
  • Lymphoma
  • Phyllodes Tumour (Benign)
  • Mondor’s Disease (Thrombophlebitis)

Ready reckoner

Key distinguishing features of the most common diagnoses

CancerCystAbscessFibroadenomaFibrous Dysplasia
Changes with Periods NoPossible No NoYes
DischargePossible NoPossible NoPossible
PainfulPossiblePossibleYes NoPossible
BilateralPossiblePossible NoPossibleYes
Highly MobilePossible No NoYes No

Possible investigations

  • There are generally no investigations that are appropriate in general practice. Specialist investigation may include aspiration, mammography, ultrasound (for example, to distinguish a solid from a cystic lump), biopsy and, when appropriate, cancer staging

Top Tips

  • Do not be tempted to investigate a lump yourself with imaging. If you are concerned enough to do this then the patient should have a full specialist assessment
  • Current guidance advises that patients aged under 30 with an explained breast lump require non-urgent referral – unless, of course, there are other pointers for cancer such as concerning nipple changes, in which case the referral should be urgent.
  • It is quite common for women to think they can feel a lump while the examining clinician has difficulty in detecting a discrete lesion. Re-examine after the patient’s next period – but then make a firm management decision. If in doubt, refer rather than delay further as the woman will understandably be very anxious.
  • In the very elderly, breast carcinoma may run a relatively benign course, responding very well to tamoxifen alone. In certain cases it might be worth discussing the situation with your local specialist, as treatment in primary care will provoke far less anxiety.

Red Flags

  • Skin dimpling, local flattening of the breast and nipple alteration indicate cancer until proved otherwise.
  • Even if the diagnosis is likely to be a fibroadenoma – as in a young woman with a highly mobile lump – refer, as unpleasant surprises do occur.
  • In any patient aged 30 or over with an unexplained breast lump, refer urgently.
  • A mass appearing after trauma may be fat necrosis – but recheck after a few weeks and refer if not resolved.
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Website disclaimer

Nursing in Practice Reference is based on the best-selling book Symptom Sorter.

The experts behind Nursing in Practice Reference are Marilyn Eveleigh who is Nursing in Practice’s editorial advisor and a primary care nurse in East Sussex, Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.

For use by healthcare professionals only, working within their scope of professional practice. Nursing in Practice Reference is for clinical guidance only and cannot give definitive diagnostic information. Appropriate referrals should be made following individual practices protocols and employer expectations, locally agreed pathways and national guidelines.