Breast Changes: Should I Be Concerned?

Most women have changes in their breasts during their lifetime, many of them caused by hormones. For example, your breasts may feel more lumpy or tender at different times in your menstrual cycle.

Other breast changes can be caused by the normal aging process. As you near menopause, your breasts may lose tissue and fat, and they may become smaller and feel lumpy. Most of these changes are not cancer, however, if you notice a breast change, don't wait until your next mammogram. Make an appointment to get it checked.

Dr. Michael Wertheimer, Director of the BreastCare Center at Beth Israel Deaconess Medical Center, agrees. "You should contact your doctor and be evaluated for any unusual changes that persist for more than a month," he says.

Breast changes to see your health care provider about:

A lump (mass) or a firm feeling

•          A lump in or near your breast or under your arm
•          Thick or firm tissue in or near your breast or under your arm
•          A change in the size or shape of your breast

Lumps come in different shapes and sizes. Most lumps are not cancer, but you should always get a lump checked. Don't wait until your next mammogram. You may need to have tests to be sure that the lump is not cancer.

If you notice a lump in one breast, check your other breast. If both breasts feel the same, it may be normal. Normal breast tissue can sometimes feel lumpy.

Doing a breast self-exam (BSE) regularly can help you learn how your breast normally feels and make it easier to notice and find any changes. But remember—doing a BSE regularly is not a substitute for regular mammograms.

"Lumps occur frequently in the breasts in most women during their lifetime," Dr. Wertheimer says. "Many are benign, but ALL should be reported and evaluated by your doctor. Breast self examination is still a reliable way to find breast lumps in addition to mammography."

Nipple discharge or changes

• Nipple discharge (fluid that is not breast milk)
• Nipple changes, such as a nipple that points or faces inward (inverted) into the breast

Nipple discharge may be different colors or textures. It is not usually a sign of cancer; it can be caused by birth control pills, some medicines, and infections. Get nipple discharge checked, especially fluid that comes out by itself or fluid that is bloody.

Skin changes

• Itching, redness, scaling, dimples, or puckers on your breast

If the skin on your breast changes, get it checked as soon as possible.

Bottom line, anything that seems different or unusual should be evaluated by your doctor. And while breast self-exams are important, they are no substitute for regular mammograms.

"Screening and early detection by mammography currently discovers 60-70% of all new cancers, usually at a very early, curable stage -- many of which can be discovered no other way because they are too small," says Dr. Wertheimer. "Screening mammography is a critical part of early detection that has allowed more cures in breast cancer patients in recent years."

Breast Changes During Your Lifetime That Are Not Cancer

Your breasts will also go through changes in your lifetime that are normal and do not indicate cancer, including:

Young women who have not gone through menopause often have more dense tissue in their breasts. Dense tissue has more glandular and connective tissue and less fat tissue. This kind of tissue makes mammograms harder to interpret--because both dense tissue and tumors show up as solid white areas on x-ray images. Breast tissue gets less dense as women get older.

Before or during your menstrual periods, your breasts may feel swollen, tender, or painful. You may also feel one or more lumps during this time because of extra fluid in your breasts. These changes usually go away by the end of your menstrual cycle. Because some lumps are caused by normal hormone changes, your health care provider may have you come back for a return visit, at a different time in your menstrual cycle.

During pregnancy, your breasts may feel lumpy. This is usually because the glands that produce milk are increasing in number and getting larger.

While breastfeeding, you may get a condition called mastitis. This happens when a milk duct becomes blocked. Mastitis causes the breast to look red and feel lumpy, warm, and tender. It may be caused by an infection and it is often treated with antibiotics. Sometimes the duct may need to be drained. If the redness or mastitis does not go away with treatment, call your health care provider.

As you approach menopause, your menstrual periods may come less often. Your hormone levels also change. This can make your breasts feel tender, even when you are not having your menstrual period. Your breasts may also feel more lumpy than they did before.

If you are taking hormones (such as menopausal hormone therapy, birth control pills, or injections) your breasts may become more dense. This can make a mammogram harder to interpret. Be sure to let your health care provider know if you are taking hormones.

When you stop having menstrual periods (menopause), your hormone levels drop, and your breast tissue becomes less dense and more fatty. You may stop having any lumps, pain, or nipple discharge that you used to have. And because your breast tissue is less dense, mammograms may be easier to interpret.

While most of these changes are not cancer, if you notice a change, don't wait until your next mammogram, make an appointment to get it checked. If you would like to make an appointment at the BIDMC BreastCare Center, please call 617-667-2900.

Above content provided by the National Cancer Institute in partnership with Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.