A 28-year-old woman comes in for her annual checkup. Her physician notices a palpable, painless, 1-cm, well-demarcated mass in the left breast at the 3 o’clock position 2 cm from the nipple, with no associated skin changes, nipple retraction, or discharge. The patient has no personal or family history of breast cancer.
Given the patient’s age, physical findings, and medical history, the clinician believes it unlikely that the patient has cancer. How should she proceed with the workup of this patient?
PHYSICAL FINDINGS OF A BREAST MASS ARE NOT EXCLUSIVE
Benign lesions tend to have discrete, well-defined margins and are typically mobile. Malignant lesions may be firm, may have indistinct borders, and are often immobile.2 Although most breast masses found by palpation are benign, imaging is the critical next step in the workup to help determine if the mass is benign or malignant.
Benign palpable masses include:
- Fibroadenomas (Figure 2)
- Prominent fat lobules
- Lymph nodes
- Oil cysts
- Hamartomas (Figure 3)
- Fat necrosis
Malignant palpable masses include:
- Ductal carcinoma in situ (which rarely presents as a palpable mass.)
HISTORY AND PHYSICAL EXAMINATION
To ensure that imaging provides the most useful information about a palpable breast lump, it is important to first do a careful history and physical examination. Important aspects of the history include family history, personal history of breast cancer, and any previous breast biopsies. The onset and duration of the palpable mass, changes in its size, the relationship of these changes to the menstrual cycle, and the presence or lack of tenderness are additional important elements of the history.