What you need to know first
GPs typically make an urgent suspected cancer referral for an unexplained breast lump in anyone aged 30 or over; under 30, a non-urgent referral is often appropriate, though urgent referral can still be made if features are concerning (NICE NG12).
What a breast lump might be
The commonest causes of a discrete breast lump, broadly by age group:
- Under 30: most often a fibroadenoma (a smooth, rubbery, usually painless lump made of fibrous and glandular tissue) or a cyst (a fluid-filled sac).
- 30 to 50: cysts, fibrocystic change (generalised lumpiness linked to hormones), and fibroadenomas remain the commonest causes. The possibility of cancer rises with age and with family history, which is why assessment is important.
- Over 50: cysts and fibrocystic change are still common, but the proportion of lumps that turn out to be breast cancer rises meaningfully. Specialist assessment becomes more important, not less.
Less common causes include fat necrosis (usually after trauma or previous surgery), intraductal papillomas, and infection or abscess (typically linked to breastfeeding or smoking).
Figures often quoted for what proportion of breast lumps turn out to be cancer vary widely by age and referral setting; in a specialist breast clinic where all lumps referred are assessed, most are still benign — but a specific figure depends on the population seen.
How a breast lump is assessed
Breast lumps are assessed using triple assessment — clinical examination, imaging, and tissue sampling where indicated. The three together are how a specialist clinic is confident in a diagnosis, because no single test on its own is reliable enough.
At a Breastory one-stop clinic, all three happen in a single appointment:
- Clinical examination. Dr Tsang-Wright examines both breasts and both armpits, feeling the lump and the surrounding tissue.
- Imaging. A mammogram is usually done in women aged 40 and over; an ultrasound scan is done at every age, and is often the more useful test for a discrete lump in younger women. The images are reviewed with a consultant radiologist on the day.
- Biopsy, where indicated. If the examination and imaging cannot confidently confirm a benign cause, a small tissue sample is taken — usually a core needle biopsy under ultrasound guidance, under local anaesthetic. Not every lump needs a biopsy.
The results of examination and imaging are usually available at the end of the visit. Biopsy histology takes several working days.
What happens after the assessment
At the end of a one-stop visit you will typically be in one of these positions:
- A confident benign diagnosis based on examination and imaging together — no further action, or a routine review at a defined interval.
- A benign lump that needs a plan — for example a large or growing fibroadenoma you want removed, or a symptomatic cyst that can be drained.
- Awaiting biopsy results — with a follow-up already booked to go through the histology.
- A diagnosis of cancer or a suspicious finding needing onward investigation — with a full treatment plan discussed in a multidisciplinary team (MDT) meeting before anything is confirmed.
Whichever applies, you leave with a clear next step and a written summary. A letter to your GP is sent after every appointment with your permission.