Finding a lump in the breast, however small, makes women think one thing: cancer. It's an understandable reaction. Breast cancer remains the most common cancer in the UK, with around 50,000 new cases diagnosed each year.
The NHS encourages women to check regularly for lumps yet, reassuringly, only around 10 per cent of women who do have a lump will have cancer.
According to Simon Marsh, a consultant breast surgeon at Colchester Hospital University NHS Foundation Trust, there are many possible causes for breast lumps - other than cancer - and they come in all shapes and sizes.
Lady lumps: To assume they indicate cancer is an understandable reaction, but there are many possible causes for breast lumps other than cancer
Fortunately, the technology for finding out whether a lump is dangerous or benign has advanced in recent years.
'Ten years ago, we would perform something called a fine-needle aspiration, which involves inserting a small needle into the lump and extracting a few cells, which would then be looked at under a microscope,' says Mr Marsh, who also works at the London Breast Clinic.
'Often this would not give a definite answer, so the lump would have to be surgically removed. Now we can take a larger sample using a technique called a core biopsy.'
This, he explains, involves inserting a different type of needle to extract a 'core' of breast tissue around 1 mm-by-15 mm in size, which gives doctors much more tissue to analyse. This makes diagnosis easier.
'Together with improvements to mammograms and ultrasound scans, which now give more accurate images, this means we can nearly always work out what a lump is without removing it with an operation,' says Mr Marsh.
He adds that a cancerous lump will often feel hard and craggy, and will usually be painless. However, any lump should be taken seriously and you should visit your GP if a lump has not disappeared within two to four weeks (the length of a typical menstrual cycle).
Here Mr Marsh explains the other types of non-cancerous lump commonly found in the breast . . .
Oval-shaped lump that moves under the skin when touched
Possible cause: Fibroadenoma
These can affect women of any age, though are most common in those aged 20 to 30. They are formed when healthy gland and connective breast tissue clump together.
This lump, which is usually 1-2 cm wide, can be moved around within a small area in the breast.
'It's a little like frozen peas clumping together, but we don't really know why they occur in some women and not in others,' says Mr Marsh. When touched, it will move around in a limited area under the skin.
Possible causes: Lumps could be caused by fibroadenoma, pockets of hardened fat, cysts, or a breast abscess, among others
One theory, he adds, is that certain women have so-called 'sensitive' breast tissue, which reacts to changes in hormone levels, and this may trigger the growth of fibroademonas.
They can occur anywhere in the breast but are most common in the upper outer section. In some patients, they can grow quite large. 'In those in their late teens or early 20s we sometime see a giant fibroadenoma, which might be eight to 12 cm or more,' he adds.
TREATMENT: Fibroadenomas do not increase the risk of cancer so they can safely be left alone. However, in some cases they start to hurt - if this occurs or if women find them unsightly, they can be surgically removed.
Hard lump that occurs after major bruising
Possible cause: Fat necrosis (hardened fat)
'They can look and feel hard and firm, just like a cancer,' says Mr Marsh. 'However, if a lady comes in with a lump and says she has had a knock in the chest area - the classic is a seatbelt injury - then if there has been significant bruising it is probably fat necrosis.'
As the swelling from the bruising subsides, the fat tissue becomes hard and forms a lump, typically around 2-3cm in size, that can sometimes be painful.
TREATMENT: Fat necrosis can look like cancer on a mammogram, so a core biopsy is usually taken. Once the diagnosis is confirmed as fat necrosis, the lump can be safely left as it will gradually disappear - although it can take years to settle.
A sore, squishy lump that appears suddenly
Possible cause: A breast cyst
These are pockets full of fluid, and can appear overnight. They may move slightly under the skin and often feel tender.
The skin around them may sometime look a bit red, and they are most common in women aged 40 to 60 (this may be because changing hormone levels can alter the texture of the breast tissue and cause fluid to collect in cavities). They can appear anywhere in the breast.
A slightly different version, called a galactocoele, can occur in breastfeeding mothers. In this case, the cysts are full of milk.
TREATMENT: The fluid can be drained by a doctor with a small needle. 'Some ladies don't like needles and choose not to have this done,' says Mr Marsh.
'About a third of cysts will get smaller, a third will stay the same size and a third will get bigger over a few weeks to months.'
Cysts are less common in women over 70 but if they do occur the fluid may be sent for examination, as occasionally a cyst in this age group can hide a small cancer that is producing the fluid.
Small lump that can move under the skin
Possible cause: A lipoma
Occur when fat cells clump together under the skin. The cause is unknown - it is unrelated to weight - but they can run in families.
These painless lumps, which feel soft and squishy, can be found all over the body, except the palms and the soles of the feet (because there is no fat in these areas).
TREATMENT: Small lipomas of 1-2cm may be left as they are harmless. Larger ones may be removed because if they get bigger (they can grow to around 18cm) they can press on other surrounding structures and cause discomfort or pain. This can nearly always be done under a local anaesthetic.
Vigilance: The NHS encourages women to check for lumps regularly, yet only around 10% of women who do have a lump will have cancer
Hot, red, painful lump when breastfeeding
Possible cause: A breast abscess
A breast abscess occurs when bacteria from the breastfed baby's mouth gets into the breast tissue, causing an infection.
This causes an abscess - a small pocket full of pus that may reach a size of 5-10cm. They can occur in young women who have not had children, although this is very rare and the reasons behind this are unknown.
TREATMENT: The pus may be syringed out using a needle after the area has been numbed with local anaesthetic at a clinic. Abscesses tend to recur after a week, so the process may need to be repeated a few times before they go for good.
Firm, round lump that moves under skin
Possible cause: Phyllodes tumour
They are very similar to fibroadenomas but usually occur in women aged 30 to 40 and tend to grow bigger - 2-5cm on average.
They are formed of glandular and connective tissue of the breast - which helps support the breast and give it shape.
They can be found anywhere on the breast but are most common on the outer and upper section, towards the armpit.
'The vast majority of these types of lump are harmless (benign), but around 10 per cent can be cancerous,' says Mr Marsh.
He explains these are called malignant phyllodes tumours, but are highly unlikely to spread around the body.
TREATMENT: The lump is usually removed surgically and tested for cancer, as core biopsies often can't determine whether a phyllodes tumour is cancerous.
Small, rigid lump under nipple
Possible cause: An adenoma of the breast.
Adenomas are formed by a clump of glandular cells. The glands sit just behind the nipple and produce milk during breastfeeding.
The lumps feel smooth and round, like fibroadenomas but are not mobile, ie, they don't move about.
They tend to grow no bigger than the size of a marble and can occasionally be painful.
TREATMENT: A core biopsy will be needed to prove they are benign.
'But it can sometimes be difficult to tell with these,' says Mr Marsh. 'If there is any doubt they are removed.'
Soft lump no bigger than 5-6cm across
Possible cause: A hamartoma
This feels soft like normal breast tissue - and is, in fact, a benign growth of all sorts of normal breast tissue that has grown in a disorganised way (as opposed to a cancer that is an overgrowth of abnormal cells).
These types of lump can occur anywhere in the body - even in the lungs. They can be hereditary but their exact cause is unknown and can occur at any age.
TREATMENT: A hamartoma will be left unless they get very big and painful - in which case they can be surgically removed.
AND IN MEN...
Knobbly disc of tissue behind a man's nipple
Possible cause: Gynaecomastia
These lumps, which vary in size from 2-10cm, are initially tender.
They are caused by a mild hormonal imbalance that affects the glandular tissue under the nipple.
They will often settle over a number of months, and can sometimes give the appearance of men having breasts.
They are common among men having treatment for prostate cancer, in teenage boys going through puberty and in older men.
All these groups experience changing levels of the sex hormones testosterone and oestrogen, which is thought to trigger gynaecomastia.
The lumps can also be due to heavy drinking or certain medications such as some indigestion remedies and steroids.
'If the liver is busy breaking down lots of tablets or alcohol it seems to “forget” to regulate and excrete the sex hormones, so the levels may alter slightly, leading to the development of gynaecomastia,' says Mr Marsh.
TREATMENT: These nearly always go away by themselves, although they can take up to a year to disappear and so are best left alone. Sometimes the drug tamoxifen in a low dose will be given to help with the tenderness stage.
If it gets very big, or painful, it can be surgically removed.
Read more: http://www.dailymail.co.uk/health/article-2422812/Breast-lumps-ARENT-sign-cancer-Every-woman-fears-worst-finding-lump--benign.html#ixzz2f6tn2ivG
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