eMedicine Specialties > Emergency Medicine > Infectious Diseases

Breast Abscess and Masses

Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Tajinderpal S Saraon, MD,, Chief Resident, Department of Internal Medicine, State University of New York Downstate Medical Center; Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn

Updated: Apr 30, 2009

Introduction

Background

Breast masses can be broadly classified as benign or malignant. Common causes of a benign breast mass include fibrocystic disease, fibroadenoma, intraductal papilloma, and abscess. Malignant breast disease encompasses many histologic types that include, but are not limited to, infiltrating ductal or lobular carcinoma, in situ ductal or lobular carcinoma, and inflammatory carcinoma. The main concern of many women presenting with a breast mass is the likelihood of cancer; however, most breast masses are benign.
 
Breast infection most commonly affects women aged 18-50 years; in this age group, it can be divided into lactational and nonlactational infections. The process can affect the skin overlying the breast, where it can be a primary event, or it may occur secondary to a lesion such as a sebaceous cyst as hidradenitis suppurativa.^1,2

Pathophysiology

The mammary glands arise along the milk lines that extend along the anterior surface of the body from the axilla to the groin. During puberty, pituitary and ovarian hormonal influences stimulate female breast enlargement, primarily due to accumulation of adipocytes. Each breast contains approximately 15-25 glandular units know as breast lobules, which are demarcated by Cooper ligaments. Each lobule is composed of a tubuloalveolar gland and adipose tissue. Each lobule drains into the lactiferous duct, which subsequently empties onto the surface of the nipple. Multiple lactiferous ducts converge to form one ampulla, which traverses the nipple to open at the apex. 

Below the nipple surface, lactiferous ducts form large dilations called the lactiferous sinuses, which act as milk reservoirs during lactation.³ When the lactiferous duct lining undergoes epidermalization, keratin production may cause plugging of the duct, resulting in abscess formation.⁴ This may explain the high recurrence rate (an estimated 39-50%) of breast abscesses in patients treated with standard incision and drainage (I&D), as this technique does not address the basic mechanism by which breast abscesses are thought to occur.
 
Postpartum mastitis is a localized cellulitis caused by bacterial invasion through an irritated or fissured nipple. It typically occurs after the second postpartum week and may be precipitated by milk stasis. There is usually a history of a cracked nipple or skin abrasion. Staphylococcus aureus is the most common organism responsible, but Staphylococcus epidermidis and streptococci are occasionally isolated. Drainage of milk from the affected segment should be encouraged and is best achieved by continuing breastfeeding or use of a breast pump.¹  
 
Nonlactating infections may be divided into central (periareolar) and peripheral breast lesions. Periareolar infections consist of active inflammation around nondilated subareolar breast ducts—a condition termed periductal mastitis. Peripheral nonlactating breast abscesses are less common than periareolar abscesses and are often associated with an underlying condition such as diabetes, rheumatoid arthritis, steroid treatment, granulomatous lobular mastitis, and trauma.¹ Primary skin infections of the breast (cellulitis or abscess) most commonly affect the skin of the lower half of the breast and often recur in women who are overweight, have large breasts, or have poor personal hygiene.
 
Breast masses can involve any of the tissues that make up the breast, including overlying skin, ducts, lobules, and connective tissues. Fibrocystic disease, the most common breast mass in women, is found in 60-90% of breasts during routine autopsy. Fibroadenoma, the most common benign tumor, typically affects women younger than 30 years. Infiltrating ductal carcinoma is the most common malignant tumor; however, inflammatory carcinoma is the most aggressive and carries the worst prognosis.

Frequency

United States

• One out of every 8 women is diagnosed with breast cancer during her lifetime.
• Infectious complications occur in as many as 10% of lactating women.⁵ Lactational mastitis is seen in approximately 2-3% of lactating women,^3,6 and consequently breast abscess can develop in 5-11% of women with mastitis.⁶

Mortality/Morbidity

• Breast mass: Morbidity and mortality depends on pathology of the mass. Approximately 1 in 28 (3.6%) women die from breast cancer. Associated morbidity may include scarring, disfigurement, lymphedema, and significant psychologic stress.
• Breast abscess: Recurrent or chronic infections, pain, and scarring are causes of morbidity.
• Mastitis is usually seen in lactating women, but the presence in a nonlactating woman should spur evaluation for an inflammatory carcinoma⁵ or new-onset diabetes. Abscess formation complicates postpartum mastitis in fewer than 10% of cases. 
• Neonatal mastitis usually occurs in term or near-term infants, is twice as common in females, and progresses to development of a breast abscess in approximately 50% of infants.^7,8

Race

White women have a higher incidence of breast cancer than African American women after age 40. In contrast, African American women have a higher incidence rate before age 40 and are more likely to die from breast cancer at every age.⁹

Sex

Breast masses are overwhelmingly a disease of women. Fewer than 1% of breast cancers are found in males. Even neonatal mastitis occurs twice as frequently in females.^7,8

Age

Women older than 40 years account for more than 80% of breast cancer patients. The median age of diagnosis is 64 years.

• Nonpuerperal breast masses encompass the third to eighth decades of life.
• Puerperal breast abscesses and mastitis are commonly found in women of childbearing age, with a mean age of 32 years.¹
• Fibroadenoma is the most common cause of breast mass in women younger than 35 years.

Clinical

History

• Breast mass
  • Palpable mass, typically only in one breast
  • Family history of breast disease, malignant and/or benign
  • Menstrual and obstetrical histories are important.
  • Associated symptoms of pain, nipple discharge, and skin changes (eg, dimpling or inflammation, nipple inversion)
  • Length of time present, speed of growth
• Breast abscess
  • Localized breast edema, erythema, warmth, and pain
  • History of previous breast abscess is common.
  • Associated symptoms of fever, vomiting, and spontaneous drainage from the mass or nipple
  • May be lactating
• Mastitis
  • Localized breast erythema, warmth, and pain
  • May have fever and chills
  • May be lactating and may have recently missed feedings

Physical

Perform a thorough breast examination for any patient presenting with a breast complaint and for any older woman presenting with unexplained weight loss, anorexia, or bone pain.

• Breast mass
  • Firm mass of variable shape and size
  • Fifty percent of masses found in the upper outer quadrant of the breast
  • May have associated pain with palpation, but most are painless 
  • Nipple discharge or inversion
  • Skin retraction or tethering
  • Axillary lymphadenopathy
  • Inflammatory changes of the skin (ie, peau d'orange)
• Breast abscess 
  • Localized breast erythema, warmth, edema, and tenderness
  • Most frequently areolar or periareolar
  • Fluctuance
  • May have associated fever or axillary lymphadenopathy
  • Nipple discharge or inversion
• Mastitis  
  • Localized breast erythema, warmth, induration, and tenderness
  • Fever

Causes

Malignant

• Breast mass
  • Risk factors for breast cancer include female sex, age older than 40 years, family history of breast cancer, nulliparity, menarche before age 12 years, menopause after age 55 years, and late pregnancy.
  • The BRCA1 and BRCA2 genes are responsible for approximately 5% of all breast cancers and are inherited in an autosomal dominant fashion. Women with mutations in either of these genes have a lifetime risk of breast cancer of 60-85%, and a lifetime risk of ovarian cancer of 15-40%.¹⁰

• Fibroadenoma³
  • The most common cause of breast mass in female patients younger than 25 years is fibroadenoma.
  • These arise from the terminal duct lobular unit and appear clinically as singular, firm, rubbery, smooth, mobile, painless masses ranging in size from 1-5 cm.
  • They may grow to a large size, thereby affecting the contours of the overlying skin and overall shape of the breast.
  • Ultrasonography reveals a well-defined hypoechoic homogeneous mass 1–20 cm in diameter.⁵
  • Fibroadenomas appear as multiple masses in 10–15% of patients.⁵
• Phylloides tumor³
  • Phylloides tumor is also known as cystosarcoma phylloides or giant fibroadenoma.
  • Although generally benign, a malignant variant occurs in 10% of cases.
  • Incidence is highest among women in their 40s or 50s.
  • Most common presentation is that of a large (average size, 5 cm), solitary, firm, breast nodule. 
• Papillary adenoma of the nipple³
  • Papillary adenoma is also known as also known as erosive adenomatosis of the nipple, adenoma of the nipple, florid papillomatosis of the nipple, and subareolar duct papillomatosis of the nipple.
  • This is believed to originate in the terminal lactiferous ducts of the nipple and subareolar tissue.
  • Incidence is highest among women in their 40s.
  • It commonly presents with unilateral serous or bloody nipple discharge that increases before menses.
• Breast abscess
  • Staphylococcus aureus and streptococcal species are the most common organisms isolated in puerperal breast abscesses. Nonpuerperal abscesses typically contain mixed flora (S aureus, streptococcal species) and anaerobes.
  • A study by Schafer et al found a significant correlation between cigarette smoking and subareolar breast abscess.¹¹
• Mastitis
  • Mastitis occurs in 2-3% or more of lactating women, with its highest incidence in weeks 2-3 postpartum.^6,12
  • Periductal mastitis comprises 3-4% of all benign lesions of the breast.³
  • S aureus is the most common cause. Streptococci, enterococci, Staphylococcus epidermidis, Peptostreptococcus species, Prevotella species and Escherichia coli are less common causes.
  • True fungal mastitis is rare and should prompt evaluation for coexisting diabetes mellitus.
  • In infants, infections with Shigella, E coli, and Klebsiella species have been reported.⁸

Differential Diagnoses

Abscess
Breast Cancer
Cellulitis
Mastitis

Other Problems to Be Considered

Fibroadenoma
Fibrocystic disease
Fat necrosis
Granulomatous Disease

Workup

Laboratory Studies

• In patients suspected of having a breast abscess, a CBC with differential may be helpful. An aerobic and anaerobic culture may be taken during surgical drainage.

Imaging Studies

• Ultrasonography is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage. Simple cysts are seen on sonograms as round or oval with sharply defined margins and posterior acoustic enhancement. Complex cysts are characterized by a significant solid component, septations, lobulations, varied wall thickness, and the presence of internal debris. Abscesses usually appear as ill-defined masses and have central hypoechoic areas with either septations or low-level internal echoes, and posterior enhancement.¹³ For more information, see Breast Cancer, Ultrasonography.
• Schedule an outpatient mammography to further characterize the suspected breast mass. The sensitivity of mammography ranges from 74-95%, and specificity ranges from 89-99%.^14,15  Approximately 5-10% of screening examinations are interpreted as abnormal, but 90% of women with abnormal results do not have breast cancer.^14,15 For more information, see Breast, Benign Calcifications, Breast, Fibroadenoma, Breast, Nipple Discharge Evaluation, and Breast Cancer, Mammography. 

Procedures

• Ultrasound-guided needle aspirations can be performed on abscesses smaller than 3 cm; however, evidence in the literature shows that abscesses greater than 3 cm treated with needle aspiration have a high reoccurrence rate and may need further incision and drainage.^16,17,18
• For many years, I&D has been the standard of care for abscesses. Although I&D has a lower reoccurrence rate, it is more invasive than needle aspiration and frequently results in scarring with poor cosmetic outcomes.¹⁹

Treatment

Emergency Department Care

• Breast mass
  • Definitive diagnosis of the etiology can only be made by pathologic examination and is not an emergency. Timely follow-up care, including mammography and involvement of primary physician and surgeon, is essential.
  • Finding a breast mass can be stressful for patients; provide reassurance that not all breast masses are malignant.
• Breast abscess
  • Identify the problem and provide pain control, antibiotic therapy, and prompt surgical consultation.
  • Needle aspiration may be considered for abscesses less than 3 cm in size.^1,16,18,19
• Mastitis
  • Treat with antistaphylococcal antibiotics, warm compresses, and continued emptying of the breast by breastfeeding or breast pumping.¹

Consultations

• Patients with breast masses need to be seen by a general surgeon for definitive treatment. Immediate consultation in the ED is not mandatory, but it may help facilitate faster follow-up care once patients are discharged from the hospital.
• Patients with recurrent or large (>3 cm) breast abscesses should be seen by a surgeon for definitive care.

Medication

The goal of therapy is to eradicate the infection and minimize complications.

Antibiotics

Therapy must cover all likely pathogens in the context of the clinical setting.

Nafcillin (Unipen)

DOC for puerperal breast abscess. Treats infections caused by penicillinase-producing staphylococci. Used to initiate therapy when a penicillin G–resistant staphylococcal infection is suspected.
Because of occasional occurrence of thrombophlebitis associated with parenteral route (particularly in elderly persons), administer parenterally only for a short term (24-48 h) and change to PO if clinically possible.

Dosing

Adult

2 g IV q4h

Pediatric

150 mg/kg/d IV divided q6h

Interactions

Associated with warfarin resistance when administered concurrently; effects may decrease with bacteriostatic action of tetracycline derivatives

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

To optimize therapy, determine causative organisms and susceptibility; >10 d treatment to eliminate infection and prevent sequelae (eg, endocarditis, rheumatic fever); take cultures after treatment to confirm that infection is eradicated

Vancomycin (Vancocin, Vancoled, Lymphocin)

DOC for patients with puerperal breast abscess who are penicillin allergic. Potent antibiotic directed against gram-positive organisms and active against enterococcal species. Useful in treatment of septicemia and skin structure infections. Indicated for patients who cannot receive, or have failed to respond to, penicillins and cephalosporins or who have infections with resistant staphylococci.
To avoid toxicity, current recommendation is to assay vancomycin trough levels after the third dose drawn 0.5 h before next dosing. Use CrCl to adjust dose in renal impairment, prn.

Dosing

Adult

1 g IV q12h

Pediatric

40 mg/kg IV tid/qid

Interactions

Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in renal failure and neutropenia; red man syndrome is caused by too rapid IV infusion (dose administered over a few min) but rarely happens when dose given as 2-h administration or as PO or IP administration; red man syndrome is not an allergic reaction

Clindamycin (Cleocin)

DOC for nonpuerperal breast abscess. An alternate DOC for patients with mastitis who are penicillin allergic.
A lincosamide useful as treatment against serious skin and soft tissue infections caused by most staphylococcal strains. Also effective against aerobic and anaerobic streptococci, except enterococci.
Inhibits bacterial protein synthesis by inhibiting peptide chain initiation at the bacterial ribosome where it preferentially binds to the 50S ribosomal subunit, causing bacterial growth inhibition.

Dosing

Adult

300 mg IV/PO q6h

Pediatric

20-40 mg/kg IV/IM tid/qid

Interactions

Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption

Contraindications

Documented hypersensitivity; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis

Ampicillin-sulbactam sodium (Unasyn)

Alternative DOC for nonpuerperal breast abscess. Drug combination that utilizes a beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

Dosing

Adult

1.5 (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6-8h; not to exceed 4 g/d sulbactam or 8 g/d ampicillin

Pediatric

<3 months: Not established
3 months to 12 years: 100-200 mg ampicillin/kg/d (150-300 mg Unasyn) IV divided q6h
>12 years: Administer as in adults; not to exceed 4 g/d sulbactam or 8 g/d ampicillin

Interactions

Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction

Dicloxacillin (Dycill, Dynapen)

DOC for mastitis. Bactericidal antibiotic that inhibits cell wall synthesis. Used to treat infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.

Dosing

Adult

500 mg PO qid

Pediatric

12-25 mg/kg/d PO divided qid

Interactions

Decreases efficacy of oral contraceptives; increases effects of anticoagulants; probenecid and disulfiram may increase penicillin levels

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Monitor PT in patients taking anticoagulant medications; toxicity may increase in renal impairment

Oxacillin (Bactocill, Prostaphlin)

Bactericidal antibiotic that inhibits cell wall synthesis. Used in the treatment of infections caused by penicillinase-producing staphylococci. May be used to initiate therapy when a staphylococcal infection is suspected.

Dosing

Adult

500-1000 mg PO q4-6h
150-200 mg/kg/d IM/IV divided q6h

Pediatric

50-100 mg/kg/d PO divided q6h
150-200 mg/kg/d IM/IV divided q6h; not to exceed 12 g/d

Interactions

Oxacillin decreases effects of contraceptives and tetracycline; administered concomitantly with disulfiram and probenecid, may increase oxacillin levels; effect of anticoagulants increase with large IV doses of oxacillin

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function

Follow-up

Further Inpatient Care

• Consider admitting patients with large or complex breast abscesses for pain management, parenteral antibiotic therapy, and definitive management.
  • Treatment may include incision, drainage, and fistulectomy in the operating room.
  • The wound can be left to close by secondary intention or with simple sutures over a drain.

Further Outpatient Care

• Breast mass: Timely follow-up with primary physician and surgeon, mammography, and possible needle biopsy of the mass are indicated.
• Mastitis: Antibiotic therapy for 10-14 days, warm compresses, and continued breast emptying by breastfeeding or breast pumping q2h or when engorged is indicated. In breastfeeding mothers, use beta-lactamase stable penicillin (since breastfeeding). Dicloxacillin 500 mg PO qid or cephalexin 500 mg PO qid for 10-14 days are other choices. Instruct patients who are lactating that continued breastfeeding from the affected breast is not harmful to the baby. For nonpuerperal mastitis, use clindamycin 600 mg IV q8h or 300 mg PO q6h, or amoxicillin/clavulanate 500 mg PO tid.²⁰

Inpatient & Outpatient Medications

• Prescribe pain medication to patients with a breast abscess as necessary. NSAIDs, such as ibuprofen, are preferred as they are not transferred through breast milk. Preparations combining acetaminophen with codeine, oxycodone, or hydrocodone may be used depending on the level of discomfort.
• Prescribe parenteral narcotics for pain control while awaiting definitive surgical therapy.
• Continue antibiotic therapy for 14 days after drainage. 

Transfer

• Transfer typically is not necessary for patients with breast mass, abscess, or mastitis.

Complications

• Breast mass - Chronic pain, scarring or disfigurement, metastases, postsurgical complications (eg, ipsilateral lymphedema), and death.
• Breast abscess - Recurrent or chronic infection, scarring.
• Mastitis - Breast abscess formation in less than 10% of cases.

Prognosis

• Breast mass: Prognosis varies from excellent in patients with a fibroadenoma to poor in those with inflammatory breast cancer. Influencing factors include tumor size, histology, nodal involvement, distant metastases, and comorbid conditions.
• Breast abscess: Unfortunately, the recurrence rate of breast abscess is high (39-50% when treated with standard I&D). Studies of patients with fistulectomy have lower recurrence rates.
• Mastitis: Most patients experience resolution within 2-3 weeks.  All patients with symptoms that have not resolved within 5 weeks should be evaluated for resistant infection or malignancy.

Patient Education

• Educate women who are lactating on nipple hygiene because cracking and abrasions of the skin increase risk of infection.
• Instruct all women on the correct way to perform breast self-examination.
• For excellent patient education resources, visit eMedicine's Women's Health Center and Cancer and Tumors Center. Also, see eMedicine's patient education articles Breast Infection, Breast Lumps and Pain, Breast Self-Exam, and Breast Cancer.

Miscellaneous

Medicolegal Pitfalls

• Failure to arrange proper follow-up care for patients with newly diagnosed breast mass
• Failure to recognize need for drainage in patients with breast abscess
• Obstetrician-gynecologists, family practitioners, and internists constitute the largest group of defendants in litigation cases concerning breast cancer; cases involving the failure to diagnose breast cancer account for half of all breast cancer malpractice claims.²¹

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Keywords

breast mass, breast lump, breast abscess, breast cancer, mastitis, malignant breast disease, benign breast mass, breast infection, fibrocystic disease, fibroadenoma, malignant breast mass, postpartum mastitis, in situ lobular or ductal cancer, intraductal papilloma, infiltrating ductal carcinoma, inflammatory carcinoma, fibroadenoma

Contributor Information and Disclosures

Author

Andrew C Miller, MD, Chief Resident and Clinical Assistant Instructor, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center
Andrew C Miller, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians, American Medical Association, Emergency Medicine Residents Association, Islamic Medical Association of North America, Medical Society of the State of New York, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Tajinderpal S Saraon, MD,, Chief Resident, Department of Internal Medicine, State University of New York Downstate Medical Center
Disclosure: Nothing to disclose.

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Schering  Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Barry J Sheridan, DO, Chief, Department of Emergency Medical Services, Brooke Army Medical Center
Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Howard A Blumstein, MD, and Amy K Rontal, MD, to the development and writing of this article.

Clinical guidelines

Breast cancer screening. American College of Obstetricians and Gynecologists (ACOG). Breast cancer screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2003 Apr. 12 p. (ACOG practice bulletin; no. 42). [94 references]

Common breast problems. University of Michigan Health System. Common breast problems. Ann Arbor (MI): University of Michigan Health System; 2007 Oct. 10 p. [7 references]

ACR Appropriateness Criteria® palpable breast masses. Parikh JR, Evans WP, Bassett L, Berg WA, D/Orsi C, Farria DM, Herman CR, Kaplan SS, Liberman L, Mendelson E, Edge SB, Expert Panel on Women's Imaging - Breast. Palpable breast masses. [online publication]. Reston (VA): American College of Radiology (ACR); 2006. 4 p. [30 references]

ACR Appropriateness Criteria® nonpalpable breast masses. D'Orsi CJ, Bassett LW, Berg WA, Bohm-Velez M, Evans WP III, Farria DM, Lee C, Mendelson EB, Goldstein S. Nonpalpable breast masses. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 12 p. [25 references]

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