A palpable breast mass is a common clinical finding that necessitates thorough evaluation due to its association with a wide range of conditions, from benign breast disorders to breast cancer. While most breast lumps are benign, breast cancer frequently manifests as a palpable mass, making accurate differential diagnosis crucial. A structured approach to evaluating breast masses is essential to distinguish between benign and malignant conditions, ensuring appropriate patient management and avoiding unnecessary interventions. This process typically starts with a detailed clinical breast examination (CBE), followed by imaging techniques to characterize the lesion further. Mammography is often the preferred imaging modality for women over 40, whereas ultrasound is typically recommended for those under 30. For women in their 30s, both mammography and ultrasound may be utilized.
When clinical or imaging findings raise suspicion, tissue sampling becomes necessary. Core needle biopsy is generally favored for its accuracy and minimal complication rate. Achieving an accurate and timely diagnosis hinges on correlating clinical findings with imaging results, ensuring appropriate follow-up or biopsy when indicated. This educational resource aims to enhance healthcare professionals’ proficiency in understanding age-specific evaluation strategies for palpable breast masses, performing recommended assessments, and implementing effective interprofessional management plans to improve patient outcomes.
Objectives:
- Recognize the clinical characteristics of a suspicious new palpable breast mass.
- Differentiate age-related initial evaluation recommendations for patients presenting with a new palpable breast mass.
- Implement recommended management strategies for patients with a newly discovered palpable breast mass following initial assessment.
- Utilize interprofessional team approaches to improve care coordination and outcomes for patients with a new palpable breast mass.
Introduction
Palpable breast masses are a frequent concern in outpatient settings. Breast-related complaints, including palpable masses, account for approximately 3% of primary care visits among women.[1] Although the majority of these masses are benign, the presence of a palpable breast mass increases the likelihood of breast malignancy.[2] Therefore, a meticulous evaluation of every patient with a palpable breast mass is paramount for optimal outcomes. While breast masses are predominantly observed in adult women, they can also occur in children and men. Male breast cancer, although less common, is a significant condition requiring a high index of suspicion for timely diagnosis and treatment.[3],[4]
The differential diagnosis for a breast lump is broad, encompassing benign breast conditions to advanced malignancies. Consequently, a systematic evaluation process is vital to ensure accurate assessment without subjecting patients to unnecessary procedures. Evaluation typically commences with a comprehensive medical history and clinical breast examination (CBE), followed by imaging for almost all patients.[5] The choice of initial imaging modality for a palpable mass depends on the patient’s age. Subsequent management strategies are also guided by age and initial findings. Therefore, a thorough understanding of the diagnostic pathway for a palpable breast mass is crucial, as a systematic approach integrating clinical, imaging, and biopsy evaluations guarantees timely and accurate management and effective differential diagnosis.
Etiology of Breast Lumps: Understanding the Differential Diagnosis
Breast Anatomy and its Relevance to Palpable Masses
The breast, or mammary gland, is a specialized sweat gland composed of fibrous, glandular, and adipose tissues. Each breast consists of 15 to 20 lobes, drained by lactiferous ducts that converge beneath the nipple in the subareolar region. Fibrous and fatty stroma provide support to these lobes. Lymphatic drainage primarily occurs through the axillary lymph nodes, involving the pectoral, subscapular, and internal mammary nodes.[6] (Refer to Figure 1. Breast Sagittal View). Breast tissue is present in individuals of all sexes and ages but undergoes significant development in women during reproductive years due to hormonal fluctuations at puberty. Post-menopause, breast tissue undergoes involution; glandular tissue atrophies due to reduced estrogen levels and is largely replaced by fatty tissue. Breast tissues and many breast pathologies are sensitive to hormonal changes.[6] Understanding breast anatomy is fundamental in approaching the Differential Diagnosis For Lump In Breast, as different pathologies arise in specific tissue types and locations within the breast.
Diverse Etiologies in the Differential Diagnosis of Breast Lump
The underlying causes of palpable breast masses are diverse, leading to a broad differential diagnosis. Breast masses can arise from various etiologies, which differ depending on the patient’s age and clinical presentation. In women under 25, fibroadenomas are the most prevalent cause of breast masses. Other possibilities in this age group include giant juvenile fibroadenomas, cysts, hamartomas, fat necrosis, and inflammatory breast conditions like abscesses. Breast carcinomas are rare in this age group but remain a consideration in the differential diagnosis for lump in breast. In individuals aged 25 and older, common causes of palpable breast masses include fibroadenomas and benign cysts; however, the likelihood of malignancy increases with age.[7],[8] Therefore, age is a critical factor in narrowing down the differential diagnosis for lump in breast.
Risk Factors for Benign and Malignant Breast Masses: Guiding the Differential Diagnosis
While most palpable breast masses are benign, it’s important to recognize that patients with these masses have a higher chance of having breast malignancy.[2] Therefore, risk factors for breast cancer should always be considered when evaluating the differential diagnosis for lump in breast.
Excess estrogen exposure is the primary risk factor for breast cancer development. Clinicians should inquire about lifetime estrogen exposure in all patients presenting with a new breast mass. Factors increasing estrogen exposure include early menarche, late first pregnancy, nulliparity, oral contraceptive or hormone replacement therapy use, and late menopause. Breastfeeding, conversely, is a protective factor.[9] Male patients should be questioned about prior hormonal treatments for prostate cancer, finasteride or testosterone use, orchitis/epididymitis history, or Klinefelter syndrome diagnosis.[10] Other risk factors, such as excessive alcohol intake and obesity, are believed to elevate endogenous estrogen levels.[11] For detailed information on breast cancer risk factors, please refer to StatPearls’ companion resource, “Breast Cancer.”
Risk factors for benign breast disorders are less well-defined. However, recent research suggests that age, family history, and hormonal factors similarly influence the risk of benign breast lesions as they do for breast malignancy. A family history of breast cancer significantly elevates the risk for all types of benign breast conditions.[12]
Women of reproductive age with regular cycles, older age at first childbirth, prolonged breastfeeding, or current or past oral contraceptive use (≥8 years) appear to have a higher fibroadenoma risk. Postmenopausal women have an increased risk of epithelial proliferation with atypia.[12] Hormone replacement therapy also increases postmenopausal risks for epithelial proliferation with atypia, fibrocystic change, breast cysts, and fibroadenoma. Nulliparity increases breast cyst risk compared to women with 3 or more children but decreases the risk compared to women with only one child. Obesity did not appear to increase benign breast disorder risk in this study, and in some cases, was associated with reduced risk.[12] Considering these risk factors aids in developing a more targeted differential diagnosis for lump in breast.
Epidemiology of Breast Masses
Breast cancer is the most common cancer among women globally.[13] A palpable breast mass is the most frequent presenting symptom of breast cancer. However, benign breast disease is a more common cause of breast symptoms (palpable masses and pain) in the 3% of general practitioner encounters with female patients for breast complaints, with malignancy being less frequent.[14],[1] Understanding the epidemiology helps contextualize the differential diagnosis for lump in breast, recognizing that benign conditions are more common overall, but malignancy is a significant concern.
The incidence of benign breast conditions varies by age and lesion type. Fibroadenomas constitute 95% of palpable breast masses in adolescent girls and 12% in menopausal women.[8],[7] A recent study indicated that fibroadenomas, epithelial proliferation, and fibrocystic changes are most common in women around age 25, with incidence rates of 45, 32, and 42 per 100,000 person-years, respectively, increasing to 81, 55, and 140 per 100,000 at age 40, and declining after age 55.[12] These epidemiological trends are important to consider when formulating a differential diagnosis for lump in breast in different age groups.
Pathophysiology of Palpable Breast Masses
The pathophysiology of palpable breast masses is diverse, depending on the underlying cause. For detailed information on the pathophysiology of specific breast disorders, please refer to StatPearls’ companion resources: “Breast Cancer,” “Breast Cyst,” “Breast Fibroadenoma,” “Fibrocystic Breast Disease,” and “Breast Fat Necrosis.” Understanding the various pathophysiological mechanisms is crucial for a nuanced differential diagnosis for lump in breast.
History and Physical Examination in Evaluating Breast Lumps
Clinical assessment of palpable breast masses primarily involves obtaining a thorough and accurate history of the lesion’s symptomatic features, breast cancer risk factors, and a CBE.[15],[8] The CBE is the initial component of the standard triple assessment used to evaluate breast lesions for potential malignancy.[16] A detailed history and physical exam are paramount in guiding the differential diagnosis for lump in breast.
Clinical History: Key to Narrowing the Differential Diagnosis
When patients present with a new breast mass, a thorough history is essential to accurately characterize the lesion. Clinicians should inquire about the mass’s onset, duration, size changes, pain, nipple discharge, and skin changes (ulceration, eczema, tethering).[7],[8] These characteristics can provide initial clues to potential diagnoses, aiding in the differential diagnosis for lump in breast. For example, an acutely tender breast lump is more likely to be an abscess or hematoma from trauma. Breast cancer masses are rarely painful, but pain presence does not rule out neoplastic lesions. Recent pregnancy or breastfeeding history may suggest lactation-associated conditions (mastitis or galactocele).[17] Nipple changes or discharge warrant attention as they can be associated with certain less common breast tumors.[18],[9] Systemic symptoms like weight loss, dyspnea, and bone pain should also be investigated, as they may indicate potential malignancy.[19]
Determining the duration of mass presence isn’t always possible. Patients who do not regularly perform breast self-exams may not notice a lump until it reaches a significant size. Some breast lumps are identified through routine screening, which is not an accurate way to determine mass acuity. [7] Clinicians should also determine if the mass developed after trauma or other symptoms and if it appears to be rapidly growing or changing. These historical details are important in refining the differential diagnosis for lump in breast.
Breast Cancer Risk Factors: Integral to the Differential Diagnosis
Family history is a significant breast cancer risk factor. Obtaining an accurate family history is crucial, including relatives diagnosed with breast and non-breast cancers, especially at a young age. Risk calculators (Tyrer–Cuzick model) can help generate an accurate risk profile.[20],[7] A detailed understanding of the patient’s medical history and medications is also crucial for assessing breast cancer risk. As estrogen exposure is a primary risk factor, clinicians should inquire about lifetime estrogen exposure, including oral contraceptive and hormone replacement therapy use and reproductive history. Smoking and alcohol consumption history should also be obtained.[7],[12] Assessing these risk factors is crucial for tailoring the differential diagnosis for lump in breast and guiding subsequent investigations.
Clinical Breast Examination: The First Step in Differential Diagnosis
Clinical examination of a breast lump is the first stage in the triple-assessment approach. Clinicians should meticulously examine both breasts and axillae. A physical examination of other body systems should be performed as indicated by the history. While imaging modalities like mammography or ultrasound are valuable, physical examination findings are crucial for effective breast disease diagnosis and management.[21] Studies have consistently shown that optimal sensitivity and specificity are achieved by combining all three assessments.[16],[21] The CBE plays a vital role in narrowing the differential diagnosis for lump in breast based on palpable characteristics.
Clinical breast examination is often conducted with a chaperone for patient comfort. The entire chest and abdomen should be exposed, and the exam should be performed with the patient in supine or both supine and seated positions.[8],[7] Each breast and axilla should undergo visual inspection for skin changes, nipple discharge, visible masses or asymmetry, and tethering to underlying structures. Tethering can be accentuated by having the patient place their hands on their hips and lift their arms.[22],[8] Palpation is most easily performed with the patient lying back at approximately 30 degrees, with their palm up under their head.
Structured palpation of each breast is essential, typically using a 4-quadrant approach (upper outer, upper inner, lower outer, and lower inner quadrants), followed by areola and axillary tail palpation. Special attention should be given to the inframammary fold and axillary tail. The unaffected breast is examined first, and tissue consistency is assessed. Masses are most frequently detected in the upper outer quadrant due to the higher concentration of breast tissue there. The nipple-areola complex should also be examined.[7]
Palpable breast masses should be described by location, size, shape, tenderness, fluctuance, mobility, texture, and pulsatility. If nipple discharge is described but not immediately visualized, the patient can be asked to express it before the clinician attempts to do so.[23],[8] Following breast palpation, axillary and supraclavicular regions should always be palpated for lymphadenopathy. Any enlarged, tender, or firm nodes should be documented, including their number and characteristics. During axillary examination, the clinician should support the patient’s arm to relax the pectoralis muscles.[24] Detailed documentation of CBE findings is essential for guiding the differential diagnosis for lump in breast and subsequent management.
Evaluation of Breast Lumps: Imaging and Pathology
Breast Imaging Classification: BI-RADS
Breast imaging findings are classified using the Breast Imaging Reporting and Data System (BI-RADS) category, which correlates imaging findings with malignancy probability and recommends treatment strategies. This standardized system allows for structured description of breast imaging, including breast tissue density, mass presence and location, calcifications, asymmetry, and associated features. BI-RADS categories range from 0 to 6.[25] BI-RADS is critical in standardizing the assessment and differential diagnosis for lump in breast based on imaging.
The BI-RADS system has different mass classifications depending on the imaging modality. In mammography, a mass must be visible in 2 projections, have convex outer borders, and be denser centrally than peripherally to be classified as a mass.[26],[25] In ultrasound, a mass must be visualized in 2 planes. Masses are defined by shape, margin, and density. Shape can be round, oval, or irregular. Circumscribed margins suggest benignity, while microlobulated, indistinct, or spiculated margins are more likely malignant. Margins can also be obscured. Mass density is compared to surrounding tissues – higher, equal, or lower – or may indicate fat within the mass.[27],[25] These BI-RADS classifications are essential for refining the differential diagnosis for lump in breast.
Table
Table. Breast Imaging Reporting and Data System.
Radiological Assessment: Guiding the Differential Diagnosis
Mammography, ultrasound, and magnetic resonance imaging (MRI) are the most common radiological modalities for breast tissue imaging (see Figure 2. Superficial Vein With an Area of Intraluminal Thrombus, Ultrasound). Age-specific recommendations optimize diagnostic study effectiveness. The American College of Radiology Appropriateness Criteria for palpable breast masses recommend the following age-based imaging guidelines:
Ultrasound imaging is preferred over mammography in younger women and men because their breast tissue is denser, with less fatty tissue. Dense tissue reduces mammography accuracy and microcalcification detection.[29] MRI is generally not recommended initially due to high costs, false-positive rates, and lower specificity. It may be reserved for specific cases, such as differentiating scar tissue from recurrence post-lumpectomy or screening high-risk individuals (BRCA mutations).[5] Age-appropriate imaging selection is crucial for accurate differential diagnosis for lump in breast.
Pathology Analysis: Definitive Diagnosis in the Differential
The third component of triple assessment involves invasive procedures for pathological diagnosis. Pathology analysis includes fine-needle aspiration biopsy (FNAB) or core biopsy.[16] Cytology analyzes isolated cells, while histological examination of a biopsy provides more tissue architecture detail. Invasive procedures carry risks and should only be performed when suspicion exists. FNAB or core biopsy selection depends on clinician expertise, available equipment, and lesion site. However, core biopsy is generally preferred over FNAB due to a lower rate of insufficient tissue collection and higher sensitivity and specificity.[30],[8] Breast cancers diagnosed by FNAB require core needle biopsy confirmation with immunohistochemical evaluation before treatment.[7] For more information on these procedures, please refer to StatPearls’ companion resources, “Fine Needle Aspiration of Breast Masses” and “Stereotactic and Needle Breast Biopsy.” Pathology is often the definitive step in establishing the differential diagnosis for lump in breast, especially in cases of suspected malignancy.
Excisional biopsy, once standard for palpable breast masses and suspicious nonpalpable lesions, is now less common. Core needle biopsy is preferred as it is less damaging and provides accurate histologic diagnosis. Excisional breast biopsy is now mainly reserved for specific situations, including:
- Discordant imaging and core biopsy results
- Nondiagnostic core biopsy specimens
- Lesions inaccessible to core biopsy
- Atypical hyperplasia or lobular carcinoma in situ (LCIS) findings [8]
Treatment and Management Based on Differential Diagnosis
Initial management recommendations for new palpable breast masses are based on BI-RADS recommendations and patient age. The treatment strategy is directly linked to the differential diagnosis for lump in breast and the level of suspicion for malignancy.
Management recommendations for BI-RADS 2 to 5 breast masses are similar across age groups. BI-RADS 2 findings may be routinely followed if asymptomatic. BI-RADS 3 findings with low clinical suspicion can be monitored with CBE and diagnostic mammogram or ultrasound every 6 to 12 months for 1 to 2 years; however, tissue biopsy is recommended if clinical suspicion is high. Tissue biopsy should be performed for BI-RADS 4 or 5 findings on initial or second-line ultrasound imaging. Ultimately, breast lump treatment varies depending on the diagnosed condition after appropriate follow-up and histologic assessment. It may involve an interprofessional approach with input from oncology, radiology, pathology, surgical, specialist nursing, anesthetic, palliative care, social work, and psychology teams as needed.[8],[28]
For detailed information on specific management of breast disorders, please refer to StatPearls’ companion resources: “Breast Cancer,” “Breast Cyst,” “Breast Fibroadenoma,” “Fibrocystic Breast Disease,” “Phyllodes Tumor of the Breast,” “Male Breast Cancer,” “Inflammatory Breast Cancer,” “Breast Abscess,” and “Breast Fat Necrosis.”
Differential Diagnosis List for Palpable Breast Masses
Breast masses have diverse causes that vary by age and clinical presentation. In women under 25, benign conditions are the most common causes, including fibroadenoma, giant juvenile fibroadenomas, cysts, hamartomas, fat necrosis, and inflammatory breast conditions (abscesses). In those 25 and older, palpable breast masses are also commonly due to benign breast abnormalities, but malignancy risk increases with age.[7],[8] For more information, refer to StatPearls’ companion resources: “Breast Cancer,” “Breast Cyst,” “Breast Fibroadenoma,” “Fibrocystic Breast Disease,” “Breast Abscess,” and “Breast Fat Necrosis.”
Key considerations in the differential diagnosis for lump in breast include:
- Breast cyst
- Breast abscess
- Breast carcinoma
- Fibrocystic changes
- Fibroadenomas
- Lactating adenoma
- Phlegmon
- Prominent lactiferous sinus
- Traumatic fat necrosis
- Hematoma
- Hamartoma [1],[8],[17]
In males presenting with breast masses, a high degree of suspicion for malignancy is essential.[4] Male breast imaging should use ultrasound as male breast tissue is not suitable for mammography. Central masses behind the nipple in males may be gynecomastia. Gynecomastia is abnormal male breast tissue development associated with chromosomal disorders, liver failure, paraneoplastic syndromes, and drugs like spironolactone and calcium channel blockers.[31] Physiological gynecomastia can occur in neonates, puberty, and older males due to hormonal variations.[32] Therefore, gynecomastia must be included in the differential diagnosis for lump in breast in male patients.
Prognosis of Breast Masses
The prognosis of a palpable breast mass largely depends on whether the underlying cause is benign or malignant. Benign breast masses generally have an excellent prognosis. Breast carcinoma prognosis varies with the stage at diagnosis. Stage 0 and I have a 100% 5-year survival rate. Stage II and III breast cancer 5-year survival rates are about 93% and 72%, respectively. Stage IV breast cancer has a 5-year survival rate of only 22%.[33] Prognosis is a critical aspect of the differential diagnosis for lump in breast, particularly when considering malignant etiologies.
Complications of Breast Mass Evaluation
The primary risks in breast mass evaluation are associated with biopsy procedures. FNA and CNB risks include bleeding at the biopsy site, anesthesia risks, bruising, mild pain, infection, patient anxiety and discomfort, hematoma, and altered breast sensation. Core needle biopsy generally has a slightly higher complication risk due to the larger tissue sample obtained.[34] These potential complications should be considered when discussing the evaluation process with patients as part of the differential diagnosis for lump in breast workup.
Deterrence and Patient Education for Breast Health
Deterrence and patient education are crucial in managing palpable breast masses. Proactive patient education empowers individuals with breast health knowledge, normal breast anatomy, and the importance of early evaluation of unusual findings. Patients should be encouraged to perform regular self-breast exams and promptly report changes like new lumps, nipple discharge, skin changes, or rapid growth of existing masses. Awareness of risk factors, including family history and lifestyle influences, is essential for vigilance and early detection. Clinicians should address misconceptions and alleviate fears that may prevent patients from seeking timely care. Patient education is integral to the overall strategy for managing the differential diagnosis for lump in breast.
Deterrence efforts focus on promoting preventive strategies and ensuring care access through a patient-centered and interprofessional approach. Clinicians must emphasize routine screenings and follow-up evaluations when indicated. For higher-risk patients, including those with atypical imaging or biopsy findings, education about surveillance options, genetic counseling, and lifestyle modifications is crucial. Interprofessional teams ensure consistent and comprehensive patient information and enhance care plan adherence. Fostering trust, improving health literacy, and maintaining open communication improves early detection rates, optimizes outcomes, and reduces breast disease burden.
Enhancing Healthcare Team Outcomes in Breast Mass Management
Breast mass management requires a comprehensive interprofessional approach due to the wide range of potential causes and diagnostic and treatment complexity. Effective collaboration among primary care clinicians, specialists, and subspecialists is essential for accurate evaluation and appropriate management. Clear communication and defined roles are critical for care coordination and avoiding delays or missteps. Clinics using a triple assessment model exemplify interprofessional teamwork, involving physicians, specialist nurses, clinical pathologists, radiographers, sonographers, and radiologists. By fostering consensus through shared expertise, these teams provide accurate and timely diagnoses and ensure patient-centered care. Interprofessional collaboration is essential for effectively navigating the differential diagnosis for lump in breast and delivering optimal patient care.
Interprofessional collaboration extends beyond diagnosis to treatment and follow-up. Care may involve surgeons, oncologists, immunologists, genetic counselors, and specialized nurses who guide patients through their care journey, depending on the breast mass cause. Each team member provides unique expertise, from diagnostic imaging and biopsies to patient education and support. Open communication and collective knowledge allow healthcare teams to address medical, emotional, and psychological patient needs. This coordinated approach improves patient outcomes, enhances safety, and ensures comprehensive and patient-centered care in the context of the differential diagnosis for lump in breast.
Review Questions
Figure 1
Figure 1. Superficial Vein With an Area of Intraluminal Thrombus, Ultrasound. Gray-scale images of the patient’s area of palpable concern in the right breast demonstrate a superficial vein with an area of intraluminal thrombus. Contributed by H Barazi.
Figure 2
Figure 2. Breast Sagittal View. This illustration shows the chest wall, pectoralis, lobules, nipple, areola, milk duct, fatty tissue, and skin. PJ Lynch and Morgoth666, Public Domain, via Wikimedia Commons.
Figure 3
Figure 3. Breast Mammogram. A mammographic view of the left breast demonstrates skin thickening, diffusely increased breast density, and malignant-type calcifications in this patient with biopsy-proven inflammatory breast cancer. Contributed by H Barazi.
References
1.Salzman B, Collins E, Hersh L. Common Breast Problems. Am Fam Physician. 2019 Apr 15;99(8):505-514. [PubMed: 30990294]
2.Brown AL, Phillips J, Slanetz PJ, Fein-Zachary V, Venkataraman S, Dialani V, Mehta TS. Clinical Value of Mammography in the Evaluation of Palpable Breast Lumps in Women 30 Years Old and Older. AJR Am J Roentgenol. 2017 Oct;209(4):935-942. [PubMed: 28777649]
3.Kamal MZ, Banu NR, Alam MM, Das UK, Karmoker RK. Evaluation of Breast Lump – Comparison between True-cut Needle Biopsy and FNAC in MMCH: A Study of 100 Cases. Mymensingh Med J. 2020 Jan;29(1):48-54. [PubMed: 31915335]
4.Yuan WH, Li AF, Chou YH, Hsu HC, Chen YY. Clinical and ultrasonographic features of male breast tumors: A retrospective analysis. PLoS One. 2018;13(3):e0194651. [PMC free article: PMC5860767] [PubMed: 29558507]
5.Expert Panel on Breast Imaging: Moy L, Heller SL, Bailey L, D’Orsi C, DiFlorio RM, Green ED, Holbrook AI, Lee SJ, Lourenco AP, Mainiero MB, Sepulveda KA, Slanetz PJ, Trikha S, Yepes MM, Newell MS. ACR Appropriateness Criteria® Palpable Breast Masses. J Am Coll Radiol. 2017 May;14(5S):S203-S224. [PubMed: 28473077]
6.Khan YS, Fakoya AO, Sajjad H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Dec 10, 2023. Anatomy, Thorax, Mammary Gland. [PubMed: 31613446]
7.Malherbe F, Nel D, Molabe H, Cairncross L, Roodt L. Palpable breast lumps: An age-based approach to evaluation and diagnosis. S Afr Fam Pract (2004). 2022 Sep 23;64(1):e1-e5. [PMC free article: PMC9575372] [PubMed: 36226953]
8.Practice Bulletin No. 164: Diagnosis and Management of Benign Breast Disorders. Obstet Gynecol. 2016 Jun;127(6):e141-e156. [PubMed: 27214189]
9.Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res. 2017 Oct 02;50(1):33. [PMC free article: PMC5625777] [PubMed: 28969709]
10.Yalaza M, İnan A, Bozer M. Male Breast Cancer. J Breast Health. 2016 Jan;12(1):1-8. [PMC free article: PMC5351429] [PubMed: 28331724]
11.Travis RC, Key TJ. Oestrogen exposure and breast cancer risk. Breast Cancer Res. 2003;5(5):239-47. [PMC free article: PMC314432] [PubMed: 12927032]
12.Johansson A, Christakou AE, Iftimi A, Eriksson M, Tapia J, Skoog L, Benz CC, Rodriguez-Wallberg KA, Hall P, Czene K, Lindström LS. Characterization of Benign Breast Diseases and Association With Age, Hormonal Factors, and Family History of Breast Cancer Among Women in Sweden. JAMA Netw Open. 2021 Jun 01;4(6):e2114716. [PMC free article: PMC8233703] [PubMed: 34170304]
13.Ahmad A. Breast Cancer Statistics: Recent Trends. Adv Exp Med Biol. 2019;1152:1-7. [PubMed: 31456176]
14.Stachs A, Stubert J, Reimer T, Hartmann S. Benign Breast Disease in Women. Dtsch Arztebl Int. 2019 Aug 09;116(33-34):565-574. [PMC free article: PMC6794703] [PubMed: 31554551]
15.Perry MC. Breast Lump. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; Boston: 1990. [PubMed: 21250122]
16.Karim MO, Khan KA, Khan AJ, Javed A, Fazid S, Aslam MI. Triple Assessment of Breast Lump: Should We Perform Core Biopsy for Every Patient? Cureus. 2020 Mar 30;12(3):e7479. [PMC free article: PMC7188022] [PubMed: 32351857]
17.Mitchell KB, Johnson HM, Eglash A., Academy of Breastfeeding Medicine. ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeed Med. 2019 May;14(4):208-214. [PubMed: 30892931]
18.Duijm LE, Guit GL, Hendriks JH, Zaat JO, Mali WP. Value of breast imaging in women with painful breasts: observational follow up study. BMJ. 1998 Nov 28;317(7171):1492-5. [PMC free article: PMC28731] [PubMed: 9831579]
19.Tahara RK, Brewer TM, Theriault RL, Ueno NT. Bone Metastasis of Breast Cancer. Adv Exp Med Biol. 2019;1152:105-129. [PubMed: 31456182]
20.Brewer HR, Jones ME, Schoemaker MJ, Ashworth A, Swerdlow AJ. Family history and risk of breast cancer: an analysis accounting for family structure. Breast Cancer Res Treat. 2017 Aug;165(1):193-200. [PMC free article: PMC5511313] [PubMed: 28578505]
21.Provencher L, Hogue JC, Desbiens C, Poirier B, Poirier E, Boudreau D, Joyal M, Diorio C, Duchesne N, Chiquette J. Is clinical breast examination important for breast cancer detection? Curr Oncol. 2016 Aug;23(4):e332-9. [PMC free article: PMC4974039] [PubMed: 27536182]
22.Henderson JA, Duffee D, Ferguson T. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 16, 2023. Breast Examination Techniques. [PubMed: 29083747]
23.Barry M. Nipple Discharge. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; Boston: 1990. [PubMed: 21250127]
24.Sultania M, Kataria K, Srivastava A, Misra MC, Parshad R, Dhar A, Hari S, Thulkar S. Validation of Different Techniques in Physical Examination of Breast. Indian J Surg. 2017 Jun;79(3):219-225. [PMC free article: PMC5473793] [PubMed: 28659675]
25.Eghtedari M, Chong A, Rakow-Penner R, Ojeda-Fournier H. Current Status and Future of BI-RADS in Multimodality Imaging, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol. 2021 Apr;216(4):860-873. [PubMed: 33295802]
26.Barazi H, Gunduru M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 31, 2023. Mammography BI RADS Grading. [PubMed: 30969638]
27.Magny SJ, Shikhman R, Keppke AL. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 28, 2023. Breast Imaging Reporting and Data System. [PubMed: 29083600]
28.Expert Panel on Breast Imaging. Klein KA, Kocher M, Lourenco AP, Niell BL, Bennett DL, Chetlen A, Freer P, Ivansco LK, Jochelson MS, Kremer ME, Malak SF, McCrary M, Mehta TS, Neal CH, Porpiglia A, Ulaner GA, Moy L. ACR Appropriateness Criteria® Palpable Breast Masses: 2022 Update. J Am Coll Radiol. 2023 May;20(5S):S146-S163. [PubMed: 37236740]
29.Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI, Norlia A, Zulfiqar MA. The comparative accuracy of ultrasound and mammography in the detection of breast cancer. Med J Malaysia. 2014 Apr;69(2):79-85. [PubMed: 25241817]
30.Tripathi K, Yadav R, Maurya SK. A Comparative Study Between Fine-Needle Aspiration Cytology and Core Needle Biopsy in Diagnosing Clinically Palpable Breast Lumps. Cureus. 2022 Aug;14(8):e27709. [PMC free article: PMC9441185] [PubMed: 36081980]
31.Vandeven HA, Pensler JM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Gynecomastia. [PubMed: 28613563]
32.Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009 Nov;84(11):1010-5. [PMC free article: PMC2770912] [PubMed: 19880691]
33.Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, Anderson B, Burstein HJ, Chew H, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Hurvitz SA, Isakoff SJ, Jankowitz RC, Javid SH, Krishnamurthy J, Leitch M, Lyons J, Mortimer J, Patel SA, Pierce LJ, Rosenberger LH, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Wisinski KB, Young JS, Burns J, Kumar R. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022 Jun;20(6):691-722. [PubMed: 35714673]
34.Łukasiewicz E, Ziemiecka A, Jakubowski W, Vojinovic J, Bogucevska M, Dobruch-Sobczak K. Fine-needle versus core-needle biopsy – which one to choose in preoperative assessment of focal lesions in the breasts? Literature review. J Ultrason. 2017 Dec;17(71):267-274. [PMC free article: PMC5769667] [PubMed: 29375902]
