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Breast cancer most commonly presents with a breast lump. 40-50% are in the upper outer quadrant. 70-80% are scirrhous - rocky hard - whereas the remainder are typically firm.
The lump may be tethered to surrounding structures including the pectoral fascia and pectoralis major, overlying skin and the breast itself. The patient may have noticed the lump due to distortion of the breast contour caused by tethering. Conversely, some lumps may be very mobile.
Most lumps are painless, but a significant minority exhibit pain and tenderness, sometimes premenstrually. Typically, the lump does not fluctuate nor transilluminate.
There may be more than one lump. 15-40% are multicentric within the same breast. Lobular carcinoma is bilateral in up to 30% of cases.