1. While I was feeling my left breast the other day, I felt what I believe to be a cyst, a little bigger than a pea. While I was touching it, I must have squeezed it slightly, because it popped, but with no external drainage. My breast hurt slightly for a minute or two after it popped. All of this was during my period. I am only in my early twenties. I haven’t found any other cysts or abnormalities since (or before) this one. Could this be a sign of cancer?
2. How does one know when to have a lump in the breast checked out, especially when the breast is always “lumpy”?
3. I am 30 and went to my doctor because I found 3 small lumps on my left breast. He thinks they are “glandular” and don’t require treatment. He says that at my age a mammogram would be inconclusive, so is not necessary. He doesn’t think they are cancerous, but if they grow that I should come back and see him. I am feeling nervous about waiting. Should I take his advice or seek a second opinion?
4. My last mammogram detected cysts about 3/4 ” in diameter and a follow-up ultrasound confirmed that these were cysts. My doctor recommended that I see a general surgeon. The surgeon said that the cysts should be removed under general anesthesia and not removed under local anesthesia or aspirated. My questions are: Are there any other options besides/better than removal of the cysts under general anesthesia and is the size and number of cysts significant?
5. In a screening mammogram, something was seen that called for compression views, and then an ultrasound. The ultrasound showed a .8 cm complex lesion, which my doctor says feels like a nodule or cyst. He wants to wait 6 months to repeat tests. What are a complex lesion and a nodule? Can the wait for more tests cause me harm?
6. I am 59 and have two breast lumps. How possible is it to be my age and have breast lumps that are not cancerous? I have been on estrogen replacement therapy for the past 10 years.
7. I’m 22 and have been having pain in my left breast that reoccurs every 4-6 weeks. The pain lasts 1-3 days and spreads under my arm, to my back, and even down my left arm. It keeps me awake at night. I had an ultrasound that showed two small cysts. What causes cysts to develop in the breast? Will I be more prone to getting breast cancer in the future?
8. Would you please tell me what the term apocrine metaplasia means? Thank you very much.
9. After a mammogram, my mother’s doctor mentioned that she had calcifications in her breast and had had them for several years. He said not to worry about them, but a friend had a mastectomy last year because of non-cancerous calcifications in a milk duct. Do calcifications eventually turn malignant?
10. I am 40 years old and just received mammogram results showing “a few scattered microcalcifications.” It recommended a follow-up breast study in six months with spot compression views. Why the six month wait?
11. For the last 2 years, for one week during ovulation, the nipple area on both breasts has become very tender and sore. This past month, I experienced the same soreness around the nipples but it progressed to the entire breast, which has not subsided. Could the soreness be a symptom of menopause or cancer?
12. I have pain under the nipple of my left breast. I had a mammogram that showed my breasts are ok. I still have pain under the nipple of my left breast all the time and it is worst just before menstruation. Should I have another mammogram or does the pain have something to do with my menstrual cycle?
13. I have a white little lump on the end of my nipple. It looks like a pimple but is white. I have had a mammogram and it was negative for the sign of any cancer. Should I be concerned?
14. I am 53, going through menopause. I have developed stretch marks beneath both breasts (I have gained 20 lbs. in the last 3 years). The marks on my left breast are inflamed looking, and also about half my breast skin looks like I have sunburn. No heat, no lump, minor tenderness, normal mammogram results. Any suggestions as to the problem?
15. Why would I leak green fluid out of both breasts?
16. What does it mean when nipples bleed (I’m not nursing, and am 20 years old)?
17. I have had a silicone implant since 1973, for asymmetry. A chest x-ray done recently shows a large amount of calcification around it, and my breast does seem to be a little misshapen over recent years. I also have some nipple drainage that happens only when expressed (yellow-white in color). My mammograms are ok. Should I be concerned?
18. Can an extremely itchy breast and nipple be dangerous or a sign of breast cancer?

Breast Lumps and Cysts

While I was feeling my left breast the other day, I felt what I believe to be a cyst, a little bigger than a pea. While I was touching it, I must have squeezed it slightly, because it popped, but with no external drainage. My breast hurt slightly for a minute or two after it popped. All of this was during my period. I am only in my early twenties. I haven’t found any other cysts or abnormalities since (or before) this one. Could this be a sign of cancer?

There are different types of lumps that can occur in the breast. Noncancerous lumps can be cysts, fibroadenomas or pseudolumps. Then of course there are cancerous tumors. We don’t know the cause of noncancerous lumps, though we do know they are somehow related to hormonal variations. A cyst is a fluid-filled sac, very much like a large blister, that grows in the breast tissue. Cysts are more common in women approaching menopause than in young women your age. Cysts do not go away unless they are aspirated. It is a simple procedure in which the doctor uses a needle about the size used to draw blood. The needle on a syringe is inserted into the cyst and draws out the fluid. The cyst collapses and usually does not fill up again, although some women have recurrences of cysts. The soreness goes away after aspiration. If an ultrasound shows that a lump is definitely a cyst, it is not necessary to have the cyst aspirated. If a cyst causes discomfort, aspiration can also relieve the discomfort. There are no risks associated with a needle aspiration.

Fibroadenoma is more common for your age group. This nonmalignant lump feels smooth and hard like a marble. It moves around easily within the breast tissue. Fibroadenomas are non-malignant (benign or non-cancer) solid tumors made up of fibrous or glandular tissues. If a woman has a fibroadenoma, it is movable, painless, smooth, round, and hard like a marble. They are most frequent between ages 20-40. They occur two times more often in African American women than in white women. They can be multiple and affect both breasts but usually a woman has only one fibroadenoma. A fibroadenoma is easily seen with a mammogram. It is treated by excision or left alone if it is accurately diagnosed as a fibroadenoma. Fibroadenomas are harmless and do not have to be removed. They do not turn into cancer. Only fibroadenomas that are very large, called giant fibroadenomas, can change to cancer at the center of the lump. This rare type of cancer grows slow and does not spread to other areas of the body. You are not at risk for breast cancer because you have had a fibroadenoma.

Pseudolumps are usually just exaggerated lumpiness. In all cases of finding a lump, the best thing to do is to have it checked out by a physician. Continue to do breast self exam every month, one week after your period starts, so that you can detect any changes in your breast tissue.

How does one know when to have a lump in the breast checked out, especially when the breast is always “lumpy”?

If you have felt a lump in your breast or a change in the lumpiness of your breasts, the first thing to do is to go to your doctor. If your doctor isn’t sure, you may be sent to a breast surgeon or breast specialist. Depending upon your age, the doctor will do a mammogram for additional information. If the mammogram shows evidence of a real lump, a biopsy may be done to find out what it is.

Lumpiness is not the same as having a dominant lump. Lumpiness can be normal breast tissue. If you do breast self exams on a monthly basis, I think you will be able to tell when a dominant lump occurs verses the normal lumpiness. You will know when something is different. If you are not sure, then by all means, go to the doctor.

I am 30 and went to my doctor because I found 3 small lumps on my left breast. He thinks they are “glandular” and don’t require treatment. He says that at my age a mammogram would be inconclusive, so is not necessary. He doesn’t think they are cancerous, but if they grow that I should come back and see him. I am feeling nervous about waiting. Should I take his advice or seek a second opinion?

Your question is a concern for so many young women who notice lumpiness in their breasts. Your breasts may be normally nodular but you would be familiar with your breasts with breast self exams to know if this is a pattern. If these lumps have developed recently, I think you may be more at ease if further testing is done. It is true that mammograms may not be conclusive at your age because young breasts are too dense. You may want to see a breast specialist for a second opinion. It may be difficult for you to tell if the lumps increase in size. It is a difficult call, so a second opinion may be of help.

My last mammogram detected cysts about 3/4 ” in diameter and a follow-up ultrasound confirmed that these were cysts. My doctor recommended that I see a general surgeon. The surgeon said that the cysts should be removed under general anesthesia and not removed under local anesthesia or aspirated. My questions are: Are there any other options besides/better than removal of the cysts under general anesthesia and is the size and number of cysts significant?

A large cyst is a sac filled with fluid, like a large blister that is usually in the middle of the breast tissue. Some of the larger cysts can be felt if they are close to the surface of the breast. Some are deep and can only be detected by mammogram. The ultrasound your physician ordered was to see if the lumps were cystic or solid. If they are cystic the sound waves go through them showing no shadows. If the lumps are solid, the waves from the ultrasound would have bounced back showing a shadow behind the lump. Dr. Susan Love states that cysts found through a mammogram and ultrasound don’t need to be aspirated or removed because it is known by these tests that they are not cancer. Cysts are rarely cancerous. However, it is important to be reevaluated in 6 months to see if there are any changes in the breast tissue.

Some physicians aspirate cysts with a needle in the office to draw out the fluid. This will help relieve the pain in painful cystic breasts. The cyst collapses like a punctured blister. Some doctors send the fluid to a lab to be analyzed; others do not because false positives are common. Sometimes, the doctor will aspirate a cyst to see if the lump is a cyst (filled with fluid) or not, instead of doing an ultrasound. Your doctor did the ultrasound to diagnose that you had cysts. Many women have multiple cysts so the number and size do not negate that they are cysts. What is significant is that you continue to see your doctor every 3 to 6 months as indicated by your physician for ongoing evaluation. I am assuming that you have more than one cyst and that they are deep in the breast tissue since they cannot be palpated. This could be the reason for general anesthesia to remove them but the answer to that must come from the surgeon. I hope you feel better about waiting another 6 months for another mammogram and a second evaluation. If you are still concerned and anxious about your breast with this information, you can consider getting a second opinion from another physician.

In a screening mammogram, something was seen that called for compression views, and then an ultrasound. The ultrasound showed a .8 cm complex lesion, which my doctor says feels like a nodule or cyst. He wants to wait 6 months to repeat tests. What are a complex lesion and a nodule? Can the wait for more tests cause me harm?

“Nodule” is a term to describe a collection of tissue that feels like a small knot. The literature describes a variety of names for conditions of the breast in which there are multiple, firm, tender nodules, fibrous tissue, and sometimes small cysts. These lesions are typically less than 1cm in diameter and can appear just like cancer on mammography and microscopic examinations. But they are nonmalignant. Similar lesions larger than 1cm have been called “complex sclerosing lesions” because they contain entrapped glandular elements in the center of the lesion. Studies are inconclusive as to whether these lesions are precancerous. Some doctors have found complex fibroadenomas (another common nonmalignant condition) to be a marker for increased risk of cancer.

You should go back to your physician for further explanation of your ultrasound findings. There are always individual differences to be considered. The most important message that I can give you is to keep in contact with your physician for follow up and do not fail to have your 6 month reevaluation.

I am 59 and have two breast lumps. How possible is it to be my age and have breast lumps that are not cancerous? I have been on estrogen replacement therapy for the past 10 years.

Cysts, one form of nonmalignant lumps, occur most often in women approaching menopause (early 50’s), but also occur in women if their 30’s and 40’s. Since you are taking estrogen, your body could be reacting as if you were pre-menopausal. The ultrasound test will tell the doctor if the lump is a cyst (a sac filled with fluid) or a solid lump. If it is a solid lump, a biopsy may be indicated. There are other types of nonmalignant lumps such as fibroadenomas (like a fibroid), which can occur at your age since you are taking estrogen.

I’m 22 and have been having pain in my left breast that reoccurs every 4-6 weeks. The pain lasts 1-3 days and spreads under my arm, to my back, and even down my left arm. It keeps me awake at night. I had an ultrasound that showed two small cysts. What causes cysts to develop in the breast? Will I be more prone to getting breast cancer in the future?

Your pain is extreme but pain does occur with cysts that develop rapidly. The pain can be relieved with aspiration of the fluid. You did not mention if your doctor performed a procedure call Fine Needle Aspiration Cytology (FNAC). This is a painless procedure in which the fluid is aspirated from the cyst and the cyst disappears. If the fluid is blood-stained, it will be sent to the lab for analysis.

There is nothing wrong with you. Cysts are part of the normal changing growth pattern. They arise from milk glands as the glandular part of the breast breaks down forming fluid pockets inside the breast tissue. Cysts can occur at any age but are most common in the 30’s, 40’s and 50’s, before menopause occurs. Cysts are smooth and movable to the touch if close to the outside of the breast. If the cyst is deep in the breast, sometimes it is difficult to feel it or it feels like a hardened area or lump in the breast. Cysts are hardly ever cancerous except for one type called intracystic papillary carcinoma. The incidence of this type is only one percent and it rarely spreads outside the lining of the cyst. Most women develop one or two cysts in their lifetime. However, a few women have many cysts at one time that recur until menopause. If new cysts continue to form or the cysts refill with fluid, it is necessary to see the physician every six months so they can be aspirated to help control them.

Cysts do not increase the risk of cancer. The only risk, if you have frequent cysts, is mistaking a lump for a cyst and not having it checked out. Hence, every time a new cyst or lump occurs, it must be checked by a physician.

Would you please tell me what the term apocrine metaplasia means? Thank you very much.

Apocrine metaplasia denotes a benign lesion that has no increased risk for the development of breast cancer. It is most commonly seen in the lining of cysts. Apocrine means a type of glandular secretion in which the end part of the secreting cell is cast off along with the secretion products that have accumulated. Metaplasia means a change in the type of cells in a tissue to another form of cells that are not normal for that tissue. This term probably is describing the origin of the increased number of cells in the walls of a cyst or lesion in the breast tissue. I want to emphasize that it is not a cancerous condition.

Calcium Deposits

After a mammogram, my mother’s doctor mentioned that she had calcifications in her breast and had had them for several years. He said not to worry about them, but a friend had a mastectomy last year because of non-cancerous calcifications in a milk duct. Do calcifications eventually turn malignant?

Calcifications are small deposits of calcium that look like fine specks on the mammogram. In most cases they are benign and normal but about 20% of microcalcifications are indicators of cancer or precancer. As a person ages, calcium leaves the bone and is deposited in such places as the arteries, joints and in the breast. Benign calcifications are identified as well defined, widely scattered and mostly the same size.

However, microcalcifications are one of the most important signs of early breast cancer found in mammograms. It is sometimes the only finding in 30-50% of breast cancer. Calcifications that are highly associated with breast cancer have definite characteristics: linear in shape, branching, irregular contour and are clustered in a small group. The number of calcifications does not indicate whether they are benign or malignant as cancer can have as few as five calcifications and as many as hundreds.

Mammograms do not accurately distinguish between noncancerous (benign) and cancerous (malignant) calcifications. An important follow-up test after calcifications are found in a mammogram is called magnification radiography as it can determine the size, number, shape and configuration. Those that are irregular and asymmetric are potentially malignant and do require a biopsy for a definitive diagnosis. A new biopsy procedure called mammotone is the most accurate for diagnosis.

I am 40 years old and just received mammogram results showing “a few scattered microcalcifications.” It recommended a follow-up breast study in six months with spot compression views. Why the six month wait?

Microcalcifications are small deposits of calcium that show up on a mammogram. They can be normal for some women but are also indications of cancer or precancer for others. If the calcifications appear very tiny and in a cluster in one breast, it is an indication of precancer and should be tested further with a biopsy. Large pieces of calcium that are diffuse or spread throughout the breast usually are noncancerous but need to be rechecked in 6 months. If there is no change in shape, size or number, it is probably benign (noncancerous). There is a middle size of calcifications that occur as only one or two. For this type, the doctor will also repeat the mammogram in 6 months. If it turns out to be precancer, there would more calcifications in 6 months. Even it is precancer, waiting 6 months will not harm you because precancer conditions take many years to develop into cancer. I recognize that this is worrisome for you to wait. If you are too nervous about this situation, you can request a biopsy to know for sure what the calcifications are.

Other Breast Changes

Pain

For the last 2 years, for one week during ovulation, the nipple area on both breasts has become very tender and sore. This past month, I experienced the same soreness around the nipples but it progressed to the entire breast, which has not subsided. Could the soreness be a symptom of menopause or cancer?

Pain in the breast is a common symptom, which is rarely due to cancer. The normal cyclical breast pain is related to hormone imbalances. Temporary increased estrogen production may result in breast pain, fullness and nodularity. The estrogen stimulates proliferation of the ductal system and supporting tissues in the breasts. Sometimes pain in the breast is due to conditions in the chest wall which feels like breast pain. Such conditions could be a pulled muscle, an inflammatory process of the cartilage around the ribs or heart angina which may be felt a breast pain. Your soreness could be related to changes in your hormones but you should report this to your doctor for further evaluation.

I have pain under the nipple of my left breast. I had a mammogram that showed my breasts are ok. I still have pain under the nipple of my left breast all the time and it is worst just before menstruation. Should I have another mammogram or does the pain have something to do with my menstrual cycle?

Breast pain, called mastalgia, can be cyclical, meaning it is related to the menstrual cycle. The intensity of pain increases with the level of hormones. There is another type of pain called noncyclical. It does not vary with the menstrual cycle. With this type, the pain occurs in one specific area and stays there as you identified your pain. It is also known as “trigger-zone breast pain”. Something in the breast tissue causes it but often the cause is unknown. You did the right thing by having a physical exam and a mammogram.

Since your pain intensifies just before your period, you may find some relief with treatments for cyclical pain. Start with a low fat diet, reduce your daily caffeine intake, and wear a good supportive bra. There are many treatments with hormones and hormone blockers but these may have side effects. Most treatments need to be under the care of a physician who will educate you about the pros and cons of various therapies and write you prescriptions for the most appropriate medications for your age and severity of pain.

Skin Changes

I have a white little lump on the end of my nipple. It looks like a pimple but is white. I have had a mammogram and it was negative for the sign of any cancer. Should I be concerned?

Skin problems that occur on other parts of the body can happen on breast nipples as well. Most of the infections and skin irritations on the nipple itself are benign (non-cancerous). It is wise to get this white little lump checked out by a physician to make sure it is benign. A form of cancer on the nipple is Paget’s disease. It looks like an open sore or scaly and is itchy like eczema. This type of cancer occurs on only one breast and does not go away with eczema treatment. The nipple needs to be biopsied and a mammogram done to see if it is cancer and if it is in one of the ducts. Paget’s disease can be limited to the nipple only or it can be invasive.

I am 53, going through menopause. I have developed stretch marks beneath both breasts (I have gained 20 lbs. in the last 3 years). The marks on my left breast are inflamed looking, and also about half my breast skin looks like I have sunburn. No heat, no lump, minor tenderness, normal mammogram results. Any suggestions as to the problem?

I’m sure you’ve thought it may be an infection and indeed it may be. Do see your doctor right away for assessment and to be put on antibiotics. But if it doesn’t get better after a week or two, then your doctor needs to consider the rare form of breast cancer called inflammatory breast cancer. It starts with redness of the skin but it is usually accompanied by warmth and swelling. There is no lump involved with inflammatory breast cancer. The redness is caused by the cancer cells in the lymph vessels of the skin which makes the skin red because the normal drainage of the lymph is blocked. Cancer can be diagnosed with a biopsy of the skin and the tissue under the skin. There is no need to do a biopsy if it is a simple infection of the breast tissue. Your doctor needs to see you to make a diagnosis.

Discharge

Why would I leak green fluid out of both breasts?

Discharge from the breast does alarm women because they think it is abnormal. A large percentage of women have discharge, especially with stimulation through intimate love and sucking of the nipple. This act increases the hormone prolactin. Prolactin hormone stimulates the breast of lactating women to produce milk. The more frequent the stimulation, the more discharge. The ducts in the breast carry the milk or fluid to the nipple. When a woman is not lactating, there still can be a small amount fluid in the ducts which is normal. This fluid can be green, gray, white or brown. The amounts of discharge can vary with different women.

Women on birth control pills, some antihypertensives (such as Aldomet), and some tranquilizers (such as Thorazine) produce more prolactin and may have more discharge. It usually is nothing to be concerned about. Often, there is more discharge at puberty and menopause than in the in-between years. When to be alarmed about discharge is when the discharge is only on one side, comes out without squeezing or sucking, or is persistent or happening all the time. If you feel that your discharge has any of these qualities, see a breast specialist for special tests to determine if there is an abnormal problem.

Most nipple discharges are caused by benign conditions, such as duct ectasia or benign papillomatosis, and are more frequent in young women. Duct ectasia is a dilatation of one or more ducts and a presence of inflammation of the plasma cells around the walls. The condition may be caused by a build-up of secretions in the ducts that are dilated from a previous pregnancy or it could be a primary inflammation in the ducts. Ectasia can cause discharge that is green, brown or white. It can be watery or thick. Unless the discharge is heavy and causes staining of the clothing, it is usually left alone. Surgery can be done to remove the dilated or infected duct(s). Duct ectasia is benign with no known relationship to cancer. Papilloma is a benign lesion growing in the epithelium of the duct. This usually is found near the nipple. This, too, usually is not related to cancer, but there is a more rare form of papilloma, called peripheral papilloma, which can progress to cancer.

A small amount of green discharge may be nothing to worry about, but it also could be an infection or abscess. See your doctor just to make sure. If nipple discharge is persistent, only on one side, clear and sticky like egg white, or bloody, a woman should go the doctor as soon as possible. Most of these benign nipple discharges do not require a biopsy but they do require a medical examination.

What does it mean when nipples bleed (I’m not nursing, and am 20 years old)?

Bloody discharge from nipples can be associated with many different conditions. These conditions can range from inflammation in the ducts, reaction to drugs, dilatation of the mammary ducts (duct ectasia), noncancerous lesions in the nipples or within the breast, or cancerous tumors. The bloody discharge must be examined under the microscope (called cytological examination) for a diagnosis. So, please see your physician as soon as possible to have diagnostic tests done. Cytology is definitely indicated when the discharge is bloody.

I have had a silicone implant since 1973, for asymmetry. A chest x-ray done recently shows a large amount of calcification around it, and my breast does seem to be a little misshapen over recent years. I also have some nipple drainage that happens only when expressed (yellow-white in color). My mammograms are ok. Should I be concerned?

I’m sure many women who have had implants for many years do have concerns about changes in their breasts. Older implants may become hard or more firm with the years and some have a problem called capsular contracture. This is when thick scar tissue forms that causes the breast to harden. When questionable areas develop with implants, such as the calcifications you have, you should return to your team of physicians, the plastic surgeon and the breast specialist, for a thorough evaluation. If the calcifications look suspicious and need to be biopsied, a plastic surgeon usually is involved in the surgery so that there is no damage to the implant. There is also another possibility that implants have to be replaced over time.

Itchiness

Can an extremely itchy breast and nipple be dangerous or a sign of breast cancer?

Itching nipples usually is not a sign of a problem, especially if it is both breasts. It could indicate an allergy to the soap in which you wash your bras, or the material in your bras. Girls with developing breasts often experience itching breasts as the skin stretches. Try using a lotion to the skin and nipples or an ant-itch lotion to see if you get relief. If you are very uncomfortable, please check it out with a physician.

For more information:

Go to the Breast Cancer health topic.