Breast lump

Data gathering

  • Red flags
  • Others
    • lump – first noticed, changed in size, armpits
    • breast – pain
    • nipple – changes, discharge
    • menstrual history
    • FH
    • Risk factors – never had a child, never breastfed, early menarche, late menopause, HRT, alcohol
  • Examine
    • Inspect – sitting, hands behind head
    • breast symmetry
    • nipple changes
    • skin changes – dimpling, redness, oedema
    • Palpation – hand above head
    • breast – vertical strip method
    • axilla
    • supraclavicular and cervical LN


Clinical management

  • the following should be referred via two week wait:
    • a discrete, hard lump with fixation, with or without skin tethering
    • >30 year old + discrete lump that persists after their next period or presents after menopause
    • persistent focal area of lumpiness or focal change in breast texture
    • previous breast cancer, who present with a further lump or suspicious symptoms.
    • Women with skin distortion or signs of oedema in the skin.
    • Women with unilateral eczematous skin or nipple change that does not respond to topical treatment.
    • Women with nipple distortion of recent onset.
    • Women with spontaneous unilateral bloody nipple discharge.
    • Women with persistent unexplained axillary swelling.
    • Men aged 50 years and older with a unilateral, firm subareolar mass, with or without nipple distortion, or associated skin changes.
    • Women aged younger than 30 years who present:
      • With a lump that enlarges.
      • With a lump and other reasons for concern, such as family history.


  • The following should be referred and seen routinely:
    • Women aged younger than 30 years with a lump without sinister features or other concerns.
    • Women under 50 years who have nipple discharge that is from multiple ducts or

      is intermittent and is neither bloodstained nor troublesome

    • Women with breast pain and no palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms.

NB: lump should be described by location, size, mobility, texture


Breast cancer family history

  • Red flags
    • Family tree
    • Age of diagnosis
    • Bilateral
    • Male
    • Ovarian, prostate cancer
    • Ashkenazi Jew
  • Treatment
    • Breast aware – self checks, attending screening
    • Lifestyle – weight loss, exercise, reduce alcohol and smoking
    • Medications – stop COCP, HRT
  • Follow-up / Safety-net
    • Refer to genetics clinic for counselling – if moderate risk