The majority of breast problems are not cancer but any discrete lump that persists for over 6 weeks needs checking. Fibroadenomas These usually develop in the late teens and early twenties following the menarche. They consist of groups of breast lobules. Some go away, others enlarge. Diagnosis is by ultrasound and needle test. Fibroadenomas are harmless but can be removed through a small incision as a day-case if they are painful or worrisome. Cysts These are small sacs of fluid, often multiple. They develop in middle age and eventually resolve on their own. HRT may encourage them to persist. Diagnosis is by needle test and ultrasound. They rarely need to be removed and can usually be aspirated with a needle. The do not turn cancerous. Breast pain (apart from cysts and infections) This is common complaint but very rarely signifies cancer. Reassurance is important. Treatment is nearly always medical and a range of treatments is possible. Attention to bra fitting and reduction in caffeine consumption can help. Nipple discharge This is seldom due to cancer. Bloodstained or serous discharge from a solitary duct on one nipple is usually due to a benign papilloma but still merits investigation. Removing the duct as a day case is diagnostic ad curative. Indications for urgent referral A discrete lump Skin ulceration Skin nodules Skin distortion Nipple eczema Recent nipple retraction or distortion Unilateral nipple discharge that stains clothes
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