Most patients with breast symptoms present with pain, nipple discharge, palpable mass, or “lumpiness”. However, presentation of breast cancers most commonly present with an abnormal mammogram followed by a palpable mass, and as pain or nipple discharge and a small percentage of patients. For a mass to be palpable, it has to be approximately 2–3 cm in size. Mammography can detect smaller non palpable lesions at about one half of the size of palpable masses (1 cm). Mammography identifies abnormalities is either densities or calcifications. (Robbins, page 1045–1 046).
Breast symptoms
- Pain
- Common symptom which is often cyclic with menses
- Localized pain more commonly associated with trauma, ruptured cyst, infection or idiopathic
- Pain is the presenting symptom in 10% of breast cancers
- Nipple discharge
- Large duct papilloma-bloody/serous discharge
- Milky discharge–elevated prolactin, hypothyroidism, drug effect
- Malignancy risk
- 7%, women < 60 y/o
- 30%, women >60 y/o
- Palpable mass
- Lesions must be 2–3 cm to be clinically palpable
- Most palpable lesions are benign, but finding is not specific
- Malignancy risk
- 10%, women < 40 y/o
- 60%, women > 50 y/o
- Location distribution of breast carcinomas
- Upper outer quadrant – 50%
- Central / subareolar region – 20%
- Remaining quadrants – 10%
Breast lesions and risk of developing an invasive carcinoma
|
Relative
Risk
|
Absolute
Risk
(lifetime)
|
Breast
Lesion
|
|
1
|
3%
|
|
|
1.5 – 2
|
5-7%
|
|
|
4 – 5
|
13-17%
|
|
|
8 – 10
|
25-30%
|
References
Kumar, Vinay, Abul K. Abbas, and Jon C. Aster. Robbins and Cotran Pathologic Basis of Disease. Ninth edition. Philadelphia, PA: Elsevier/Saunders, 2015.