Symptoms and Diagnosis of Breast Masses

Symptoms and Diagnosis

[ Symptoms ] Usually, a breast mass can be felt when it is 2 cm or larger. However, even in healthy women, hormonal changes can make it seem as though there is a mass in the breast. Because a woman’s breasts become larger when menstruation starts and become smaller when menstruation ends, 5–7 days after menstruation ends is the best time to check for a mass. However, if a mass that does not change in size according to the menstrual cycle is felt, or if a mass is felt after menopause, you should visit a hospital immediately for examination. In general, benign masses do not cause skin changes, are not hard, are soft, and move easily when touched. In contrast, malignant masses are hard and do not move easily when touched. However, because it is often difficult to distinguish benign from malignant by palpation alone, imaging tests are necessary.

[ Diagnosis ] First, an accurate medical history is needed to differentiate breast cancer. Risk factors for breast cancer are investigated, including when the breast mass was first felt, whether its size changes with the menstrual cycle, whether it keeps growing, whether there is pain, whether there are changes in the nipple, whether there is nipple discharge, and whether there is a family history of breast cancer, parity, use of female hormone therapy, and use of oral contraceptives. The symmetry of the breasts, nipple discharge, inflammation, and skin changes such as nipple inversion are observed, and then the entire breast is examined, including the nipple, areola, breast, and armpit. However, because palpation alone makes it difficult to clearly distinguish a breast mass as benign or malignant, imaging tests such as mammography or breast ultrasound are necessary.

Mammography can diagnose typical benign findings such as lipoma and calcified fibroadenoma, and it has the advantage of detecting microcalcifications, which suggest malignancy. Compared with mammography, breast ultrasound is more effective at detecting lesions in women under 30 or women with dense breasts, and it is useful for distinguishing the internal components of a breast mass, so it has the advantage of easily differentiating between breast cysts and fibroadenomas.

Fine-needle aspiration biopsy, which uses a needle to draw out the material inside a mass and examine the cells directly for cancer cells, is performed when a mass that does not change in size according to the menstrual cycle is felt in premenopausal women or when a breast mass is felt in postmenopausal women. Fine-needle aspiration biopsy may also be performed for the diagnosis and treatment of a breast cyst, and even if it is a breast cyst, if the aspirated fluid is blood-red, there may be associated breast cancer, so a cytologic examination for breast cancer must be performed. If a follow-up breast ultrasound 4–6 weeks later shows that the cyst has recurred or that there is a hard solid component, surgical excision is recommended. Breast MRI is a useful test for diagnosing breast cancer in women with risk factors for breast cancer or for determining the stage of cancer in women already diagnosed with breast cancer, and it is not used simply to diagnose a breast mass. If a hard mass (solid lump) is felt, all three examinations—breast examination, imaging tests (mammography or breast ultrasound), and fine-needle aspiration biopsy—are performed, and if all three tests suggest malignancy, surgical removal is necessary.

So far, I have explained the symptoms and diagnosis of breast masses. In the next article, we will look at the treatment of breast masses.

Source: Korea Centers for Disease Control and Prevention, National Health Information Portal