Top things to know
1 in 8 females and 1 in 800 males will be diagnosed with breast cancer in their lifetime
Breast tissue responds to the hormones produced throughout the menstrual cycle and may feel swollen, lumpy, or tender at certain points in the cycle
Paying attention to the appearance of your breasts or chest is an important part of knowing what is normal for you
The way breasts look or feel can change over the course of a menstrual cycle in response to fluctuating hormones. Finding a lump, feeling pain, or noticing other breast or chest changes can cause worry, but these symptoms are common and are most often benign (not cancerous). By paying attention to your body, you can learn what is normal for you or when to seek care from a healthcare provider.
Breast cancer risk
All people (regardless of sex) have breast tissue and could potentially get breast cancer, but the risk is much higher in females. Over a lifetime, 1 in 8 females and 1 in 800 males in the USA will be diagnosed with breast cancer at some point in their lives (1). Gender affirming hormone therapy for transgender men and transgender women does not appear to increase the chance of being diagnosed with breast cancer, but more research is needed (2, 3).
Breast cancer is most common in people over 40 years old and the risk continues to increase with age (1). While breast cancer is uncommon in younger people, it is more likely to be diagnosed at a later stage and to be fatal in this group (4, 5). It’s a good idea to get anything new or concerning checked out by a healthcare provider who can provide reassurance and relief if it is okay, or make a plan if treatment is required.
Some other factors that could make your risk higher than average include (6, 7):
Family history of breast cancer, ovarian cancer, or other cancers
Early menarche (first period)
Late entry into menopause
A long period of time between menarche and first pregnancy
Use of estrogen and progestin for menopausal hormone therapy
Feeling a breast or chest lump can be scary, but it’s important to remember that most are not cancerous. For people going to see their healthcare provider because of a breast lump, 9 out of 10 times it is not cancer (8). Breast tissue responds to the hormones produced throughout the menstrual cycle and may feel lumpier at certain points in the cycle (9).
Two types of benign lumps that are common are cysts (fluid-filled sacs) and fibroadenomas (benign masses made up of glands and fibrous breast tissue). They are most common between menarche and menopause (when periods stop permanently). Cysts and fibroadenomas usually feel firm, are often smaller than 2 cm (0.8 in), but can be much larger or even microscopic, and are typically mobile (can be moved from side to side with your fingers) (10). It’s also common to have multiple cysts or fibroadenomas in the same breast.
Some people may notice that their breasts or chest feels generally lumpy, ropey, or like a bean bag. This is called fibrocystic breasts and is typically found on both sides. Feeling this type of lumpiness throughout the breasts or chest is usually not a sign of cancer (11).
Of course there are some breast or chest lumps that do turn out to be cancer. A lump in someone who is older than 40 years old is more likely to be cancer than a lump in someone younger (12). A lump that is larger than 2 cm (0.8 in), feels very hard, and can not easily be moved from side to side with fingers is more likely to be cancer and should be examined by a healthcare provider (13). If you notice a new lump, a healthcare provider can order tests to diagnose what it is.
Breast pain and tenderness
Breast pain and tenderness is very common and is usually not cancer. For people experiencing only breast pain, it is cancer in just 1-3 out of 100 people (8, 14).
Cyclical breast pain comes and goes in relation to your period and is the most common kind of breast pain, affecting about 7 out of 10 people (15). It is a pattern of pain that typically occurs during the luteal phase (between ovulation and the start of a period) with each menstrual cycle. Cyclical breast tenderness is a sign that ovulation has occurred (16) and is typically experienced in the 5-10 days leading up to the start of a period, but goes away after the period starts (16). It is most often described as aching, heavy, and tender, but can also feel sharp or shooting (16).
Pain that is not cyclical (meaning that it’s not related to the menstrual cycle or doesn’t go away) could be due to something in the breast or rib cage like inflammation, infection, injury, or could be a sign of cancer (10). Non-cyclical breast pain that is persistently in one spot—especially if there is also a breast lump—should be evaluated by a healthcare provider (14).
Experiencing nipple discharge may be surprising, but is usually not a sign of cancer. In one study, 7-15% of people who reported nipple discharge to their healthcare provider were diagnosed with breast cancer (17). Discharge that is milky, produced from both breasts, and only present when the nipple is squeezed is likely benign (10). For someone who has not been recently pregnant or lactating (producing milk) however, nipple discharge may be a symptom of a hormonal imbalance and should be evaluated by a healthcare provider.
Some types of nipple discharge are more concerning. Discharge that is bloody, only from one breast, and comes out spontaneously (without being squeezed) could be a sign of cancer and should be thoroughly checked out (10).
Skin and general appearance
Paying attention to the appearance of your breasts or chest is an important part of knowing what is normal for you. Noticing the shape and size, as well as what the skin looks like, will help you detect whether anything is changing.
It’s normal for breasts to not be exactly symmetrical, but if one breast suddenly becomes much larger, this could be a sign that something is wrong and it should be checked out. If it looks like the skin or nipple is being pulled from the inside—this is called retraction—and it should be evaluated by a healthcare provider. If the skin on the breast has sores, becomes red, thick and firm, or looks like the dimpled skin of an orange, a healthcare provider should evaluate it (10).
Breast self-exams and self-awareness
Self-examination of the breasts is no longer recommended by the American College of Obstetricians and Gynecologists (ACOG) or the American Cancer Society (18, 19). Some people may feel stressed about doing the self-exam the “right way” or anxious about trying to figure out if what they find is normal. Others may feel like they have more information and are more in control of their bodies by examining themselves. Whether you do self-exams or not, self-awareness of what is normal for you is what’s important.
Paying attention to how your body looks and feels is an important part of staying healthy. If you notice any changes, or have concerns about your breasts or chest, make an appointment with a healthcare provider. They may do an exam or order tests like an ultrasound or a mammogram to gather more information.
Tracking breast tenderness and other cycle experiences along with your period in Clue can help you understand your body better.
This article was originally published October 29, 2018.