A breast nodule is a commonly reported clinical finding with two primary causes: benign breast disease and breast cancer. While less than 20% of breast nodules are malignant, it is often difficult to distinguish between benign and malignant characteristics based on clinical presentation alone. Therefore, every breast nodule warrants thorough evaluation, regardless of patient sex, as breast cancer can also occur in men.

Patient Awareness and Self-Examination

Women who are familiar with the normal feel of their breasts and regularly perform monthly breast self-examinations may detect nodules as small as 6.4 mm. However, fear of cancer may cause some women to delay reporting a newly discovered lump.

History and Physical Examination

When evaluating a patient who reports a breast lump, take a detailed history:

• Onset and duration of the lump

• Changes in size or tenderness in relation to the menstrual cycle

• Associated symptoms: pain, discharge, nipple changes, or breast shape alterations

• Breastfeeding status

• Systemic symptoms: fever, chills, fatigue

• History of breast trauma

Assess risk factors for breast cancer:

• High-fat diet

• Family history (mother or sister with breast cancer)

• Personal cancer history

• Nulliparity or first pregnancy after age 30

Physical Examination

Perform a comprehensive breast exam, focusing on the upper outer quadrant, where most breast cancers are found. During palpation, assess:

• Location, size, shape, and consistency of the nodule

• Mobility (fixed vs. mobile)

• Borders (well-defined vs. poorly delineated)

• Texture (soft, rubbery vs. hard or indurated)

• Associated signs: nipple discharge, skin dimpling, redness, edema (peau d’orange), lymphadenopathy

Inspect both breasts for asymmetry, nipple retraction, or skin changes. For better visualization, ask the patient to raise arms overhead or press hands on hips to exaggerate skin dimpling.

Common Medical Causes of Breast Nodules

Special Considerations

• Reassure the patient, as most breast nodules are benign.

• Delay teaching self-examination until the patient’s anxiety has subsided.

• Prepare the patient for further investigations: mammography, ultrasound, needle aspiration, or biopsy.

• In breastfeeding women with suspected mastitis, advise milk expression and temporary cessation of breastfeeding from the affected side, substituting formula until recovery.

Patient Counseling and Education

• Teach breast self-examination techniques and the importance of early detection.

• Provide information on managing mastitis and signs that require urgent medical attention.

• Encourage regular breast screening, particularly for high-risk individuals.

Age-Specific Notes

Pediatric

• Nodules in children and adolescents are usually benign and related to hormonal changes.

• Juvenile mastitis can cause firm, tender nodules, especially in boys.

Geriatric

• Among women aged 70 years and above, approximately 75% of breast lumps are malignant. Prompt investigation is essential.

References

1. Benner C, Carabin H, Sánchez-Serrano LP, Budke CM, Carmena D. Analysis of the economic impact of cystic echinococcosis in Spain. Bull World Health Organ. 2010;88(1):49–57.

2. Masroor I, Azeemuddin M, Khan S, Barakzai A. Hydatid disease of the breast. Singapore Med J. 2010;51(4):72–75.