ORIGINALARTICLE

PREVALENCE OF MALIGNANT BREAST LESIONS IN PATIENTS PRESENTING WITH PALPABLE

LUMPS

Rafia Ahmad¹, Muhammad Shah², Shimee Shahzadi³, Shehzad Akbar Khan⁴

How to cite this article

ABSTRACT

OBJECTIVES

Ahmad R, Shah M, Shahzadi S, Khan

SA. Prevalence of Malignant Breast

Lesions in Patients Presenting with

Palpable Lumps. J Gandhara Med

Dent Sci. 2026;13(2):81-86

https://doi.org/10.37762/jgmds.13-2.830

This study aimed to estimate the histopathology-conrmed malignancy rate

among women presenting with palpable breast lumps and to describe the

clinicopathological prole.

METHODOLOGY

The cross-sectional study was conducted from February 23, 2025, to August

23, 2025, in the Surgical Unit of Hayatabad Medical Complex, Peshawar,

and enrolled 163 female patients with palpable breast lumps. Each of the

Date of Submission: 20-08-2025

women had clinical evaluations, then subsequently underwent either core

Date Revised:

Date Acceptance:

15-12-2025

07-03-2026

needle biopsy or excisional or incisional biopsy. Their histopathological

diagnosis was done after the biopsy. Demographic characteristics of women,

the various tumor characteristics, and each tumor's histopathology were

analyzed.

¹Postgraduate Resident, Surgical A Unit,

MTI-Hayatabad Medical Complex,

Peshawar

RESULTS

³Assistant Professor, Department of

Anatomy, Khyber Girls Medical

College Peshawar

The patient's mean age was 38.7 ± 11.4 years. Of the total number of

patients, 46 (28.2%) cases were conrmed malignant on pathology; 117

(71.8%) cases were benign. The majority of malignant cases (82.6%)

were invasive ductal carcinoma. Meanwhile, the most commonly diagnosed

benign lumps were broadenomas (35.6%). It was also noted that the

malignancy risk increased with age. It was 7.7% in patients aged less than 30

years, 26.2% in patients aged 31-50, and 48.7% among patients older than

50 years.

⁴Professor, Department of General

Surgery, Hayatabad Medical Complex,

Peshawar

Correspondence

CONCLUSION

²Muhammad Shah, Associate

Professor, Department of General

Surgery, Hayatabad Medical Complex,

Peshawar

In this cohort, approximately one-third of the palpable breast lumps were

malignant, and there was a predominance of invasive ductal carcinoma.

Higher malignancy risks were noted among older women and with larger

tumor sizes. In high-burden, resource-limited settings, there is a critical need

for prompt biopsy and pathological evaluation of all palpable breast lumps to

improve the timeliness and prognosis for optimal care.

+92-333-5829224

drmuhammadshah@yahoo.com

KEYWORDS: Breast Lump, Malignancy, Histopathology, Prevalence,

Invasive Ductal Carcinoma

continent, thus highlighting the need for the prompt

assessment of symptomatic breast disease in local

INTRODUCTION

clinical practice.⁵Factors such as ethnicity and

geography, along with the availability of care and the

methods by which it is delivered, can inuence the

incidence and prevalence of these diseases.⁶Of the

many risk factors, age is paramount. Older patients

have a much greater chance of a palpable breast lesion

being cancerous than their younger counterparts.⁷

Moreover, even in women younger than 30,

mammograms and ultrasound are important for the

level of risk determination and for assessing the

severity of the disease.⁸The preferred method for

assessing new palpable breast lumps is the triple

assessment, which includes clinical history and

examination, breast imaging (ultrasound and/or

mammogram, depending on the age and risk), and,

when necessary, tissue diagnosis.⁹There is increased

Breast lumps are among the most common reasons for

women to seek surgical or oncological evaluation, with

clinical signicance ranging from benign lesions like

fibroadenoma to potentially lethal breast cancer.¹While

most palpable breast lumps are benign, a clinically

detectable mass can also represent an underlying

malignancy and therefore warrants accurate, timely, and

risk-stratified assessment.²Breast cancer, in general, is

the most common cancer diagnosed in women

worldwide, and it also accounts for a major proportion

of cancer-related deaths.³In Pakistan, breast cancer

constitutes

the

most

common

cancer,

with

GLOBOCAN 2022 estimating 30,682 new cases and

15,552 deaths in 2022.⁴Recent national literature

reports on breast cancer prevalence in Pakistan describe

the country as having one of the highest rates on the

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J Gandhara Med Dent Sci

Prevalence of Malignant Breast Lesions in Patients

diagnostic certainty and fewer missed malignancies

to be original and unaected by prior therapeutic or

diagnostic approaches to be eligible for the study.

Exclusion criteria for the study include: previously

diagnosed breast cancer females who had undergone

breast surgery, or had undergone chemotherapy,

hormonal therapy, or radiation, because these factors

could alter the tissue structure or complicate the

histology. Recurrent lumps, cases with inadequate

documentation, and cases where biopsy samples were

found to be insucient for a thorough pathological

analysis were also excluded in order to preserve

methodological consistency and surgical detail. All

eligible women underwent a detailed clinical evaluation

performed by senior surgical faculty. A detailed

medical history was taken, which included duration of

the symptom, rate of progression, associated pain,

nipple discharge, previous breast disease, hormonal

exposure, lactation history, pregnancy status, age at rst

menstruation, menopause, and family history of breast

and ovarian neoplasms. A breast examination was

conducted according to oncology standards, including

visual observation in dierent positions and systematic

palpation of the breast and the regional lymphatic

basins. Tumor characteristics, including size, laterality,

quadrant of origin, contour, xation, and regional nodal

abnormality, were recorded in detail. All participants

were required to undergo tissue sampling for

histopathology, as this was the method by which the

centre determined the gold standard for malignancy.

The treating surgical team selected the biopsy method

based on clinical indication and lesion characteristics

(including size, location, clinical suspicion, and

feasibility), and the planned procedure was explained to

each participant and performed after informed consent

was obtained. The core needle biopsy method using an

automated 14-gauge device was favored for its superior

diagnostic accuracy, reproducibility, and greater safety.

Excisional biopsy was oered in patients with smaller,

well-circumscribed lesions where complete removal

was clinically appropriate. In contrast, an incisional

biopsy was oered for larger or more inltrative tumors

where sampling would be required to plan for the

closure of the multilayered surgical technique

afterward. All samples were placed in 10% neutral

buffered formalin and transferred to the hospital

pathology laboratory as quickly as possible to maintain

cellular integrity. In the pathology department, each

lesion was determined to be either benign or malignant,

and malignant tumors were further typed and graded

morphologically according to the most recent WHO

guidelines. Adequate tissue was obtained for

histopathological interpretation in all included cases.

Determining the prevalence of malignant breast lesions

in women with palpable breast lumps was the primary

aim of the study. Secondary analyses included age

when there is concordance among these components.

Though there have been signicant advancements in

imaging technologies and their impact on risk

assessments, follow-up is still warranted for low-

suspicion ndings (e.g., BI-RADS 3/probably benign

lesions) as they continue to pose a small but clinically

significant risk for malignancy.¹⁰This is also true for

cases of clinical-radiologic discordance as well as those

that evolve on surveillance. Despite the high national

burden of breast cancer and the frequent presentation of

palpable breast lumps, there remains a need for

contemporary, center-specific evidence from Pakistani

tertiary care hospitals describing the histopathological

spectrum of palpable breast lumps and quantifying

malignancy prevalence using histopathology as the

reference standard-particularly in regions where

delayed presentation is common and diagnostic

pathways vary across institutions. Therefore, this study

aims to determine the prevalence of malignant breast

lesions among women presenting with palpable breast

lumps and to describe associated clinical characteristics

in our setting.

METHODOLOGY

This hospital-based descriptive cross-sectional study

was conducted at the General Surgery Department of

Hayatabad Medical Complex, Peshawar, a large tertiary

referral hospital serving patients from Khyber

Pakhtunkhwa and surrounding areas. The study was

conducted from February 23, 2025, to August 23, 2025.

A consecutive (non-probability) sampling technique

was used, and all eligible women presenting for the rst

time with a newly identied palpable breast lump were

enrolled. All eligible patients during the study period

consented

participate

and

completed

histopathological evaluation; therefore, there were no

refusals and no dropouts. A sample size of 163 was

obtained through the use of the single population

proportion formula (n = Z²p(1−p)/d²), where Z = 1.96

(95% condence level), the expected prevalence of

malignancy p = 0.27 (based on previous regional

estimates), and the absolute precision (margin of error)

d = 0.07. The prevalence found in this study represents

the prevalence of malignancy in hospitals because it is

proportional (as

fraction) of the number of

symptomatic women who present with palpable breast

lumps and not prevalence on a population level. All

women attending the outpatient department for the rst

time with a newly identied palpable breast lump were

enrolled following the study’s eligibility criteria.

Women with a clinically identiable breast mass,

whether discovered by mistake or with symptoms, were

included in the study’s population. The presentation had

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Prevalence of Malignant Breast Lesions in Patients

Table 1: Baseline Characteristics of Study Participants (n = 163)

stratication, lesion characteristics, and the ratio of

Variable

Frequency

%age

malignant to benign pathologies. Data analysis was

processed through statistical software (IBM SPSS

Age Groups

<30 years

31-50 years

23.9

52.1

24.0

25.0). All the variables were summarized using

descriptive statistics. Frequencies and percentages were

used to summarize the categorical variables, and the

mean ± standard deviation or the median (interquartile

range) was used for continuous variables. Where

necessary, inferential comparisons were carried out

using the Chi-square test (categorical variables) and the

independent-samples t-test (continuous variables), with

p-values ≤0.05 considered signicant. The study

protocol was reviewed and approved by the

Institutional Review Board/Ethics Committee of

Hayatabad Medical Complex, Ref No. HMC-QAD-F-

>50 years

Breast Side

Right

Left

54.6

45.4

Quadrant Involved

Upper outer

Upper inner

Lower outer

Lower inner

Central/retroareolar

Symptom Duration

< 3 months

3-6 months

> 6 months

41.7

14.7

22.7

11.7

9.2

00/141-2, Dated:10-02-2022. Written informed consent

was obtained from each participant prior to enrolment.

58.3

31.9

9.8

RESULTS

Family History

Positive (First-degree)

Negative

Reproductive Factors

Premenopausal

Postmenopausal

Mean tumor size

138

15.3

84.7

Participants represented a mean age of 38.7 ± 11.4

years with a range of 16-72 years. Most patients were in

the age range of 31–50 years (52.1%), while some

patients (23.9%) were less than 30 years old, and 24.0%

were over 50 years old. The right breast was aected in

54.6% of patients, with the upper outer quadrant being

the most commonly involved region (41.7%). The

median tumor size at presentation was 3.1 ± 1.6 cm;

most (58.3%) tumors were diagnosed within 3 months;

however, tumors diagnosed more than 3 months after

presentation were larger. 15.3% of the respondents

reported a positive family history of breast cancer in

first-degree relatives. Table-1

111

3.1 ± 1.6 cm

68.1

31.9

Histopathology conrmed malignancy in 46/163

women (28.2%; 95% CI 21.9%–35.6%). Among

malignant lesions (n=46), IDC accounted for 82.6%,

followed by invasive lobular carcinoma (8.7%),

medullary carcinoma (4.3%), and mucinous carcinoma

(4.3%). All histopathological ndings are presented in

Table 2.

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Prevalence of Malignant Breast Lesions in Patients

Table 4: Association of Tumor Size with Malignancy (n = 163)

Table 2: Histopathological Findings (n = 163)

Tumor Malignant Benign Total Odds

Pathology

Frequency %age

Size

(n, %)

Ratio

value

Benign lesions

Fibroadenoma

117

71.8

35.6

19.0

4.3

7.4

5.5

28.2

23.3

2.5

1.2

(95% CI)

>3 cm 32 (47.8)

≤3 cm 14 (14.6)

5.36 (2.56– <0.001

(52.2)

11.22)

1.0

Fibrocystic disease

Benign phyllodes

Mastitis/abscess

Others

Malignant lesions

Invasive ductal carcinoma

Invasive lobular carcinoma

Medullary carcinoma

Mucinous carcinoma

(85.4)

(Reference)

DISCUSSION

This study involved 163 women presenting with breast

lumps at a single-center tertiary care hospital. The

overall 28.2% prevalence of malignancy found on

histopathology is consistent with some regional data,

although slightly higher, indicating the signicant

impact of cancer in this highly symptomatic patient

cohort.¹¹The malignancy rate in this study is

comparable to other similar studies from developing

countries. For example, a study reported 24.2%

malignancy rate among breast lumps.¹²Ibrahim et al

also reported a carcinoma rate of 29.3% in women over

30 with palpable lumps from South Punjab.¹³Such data

highlights the presence of a signicant cancer burden

within palpable breast lumps in Pakistan and other

similar developing countries. Our observed prevalence

of breast cancer is also in agreement with other studies.

Malignancy rate of 26.9% has been recorded among

595 women with palpable masses in a study by Ibrahim

et al.¹⁴The presence of breast lumps in unscreened

women populations has a signicant risk and broadens

the scope for timely interventions. The distribution of

histopathological subtypes reects expected patterns. In

our cohort, IDC was the most common malignant

lesion, a nding which is universally acknowledged in

pathology. This is further corroborated by the literature

worldwide, which indicates that invasive ductal

carcinoma (IDC) is the most common histological

subtype. Among the benign lesions, the most frequently

reported was broadenoma, again in keeping with the

The rate of malignancy was 7.7% in the participants

<30 years, 26.2% in women 31 to 50 years, and 48.7%

in women>50 years. The size of the tumors was also

associated with the level of malignancy, as tumors >3

cm were determined to yield signicantly higher

malignancy rates than those <3 cm (p < 0.05).

Furthermore, malignancy was strongly associated with

postmenopausal

status

(61.5%

malignant

postmenopausal women vs. 12.6% in premenopausal

women) and a positive family history (52.0% malignant

in those with a family history vs. 24.6% in those

without). Among the 46 patients with conrmed

malignancy, axillary lymph node involvement was

observed in 58.7% (n=27) of cases. Table-3

Table 3: Age-Wise and Risk Factor Association with Malignancy

Variable

Total Patients Malignant (n, %)

Age Group

<30 years

03 (7.7%)

22 (26.2%)

19 (48.7%)

31–50 years

>50 years

Family History

Positive

138

13 (52.0%)

33 (23.9%)

Negative

clinico-pathological prole of the larger studies.^15,16

Menopausal Status

Premenopausal

Postmenopausal

Nodal Status (n=46)

Node-Negative

Node-Positive

cross-sectional series from Karachi reports that 75.3%

of breast lesions were benign, with broadenoma as the

most common subtype.¹⁷In our cohort, age was the

strongest determinant of malignancy, with older

patients having a higher proportion of cancer. This age-

related gradient is well described in the literature, as

111

14 (12.6%)

32 (61.5%)

Mukhtar et al. reported

higher frequency of

Tumor size was signicantly associated with

malignancy. Lesions >3 cm had a higher malignancy

proportion than lesions ≤3 cm (47.8% vs 14.6%), and

tumor size >3 cm was associated with increased odds of

malignancy (OR 5.36; 95% CI 2.56–11.22; χ² = 19.84,

df = 1, p = 0.0000084). Table-4

malignancy in patients >30 years in South Punjab.¹⁸

This emphasises a well-established clinical tenet in

oncologic surgery that older patients deserve the utmost

attention and prompt intervention when presenting a

breast lump. Besides age, we further revealed that

larger tumor size (>3 cm) was highly correlated with

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Prevalence of Malignant Breast Lesions in Patients

malignancy, and malignancy was more common in

combinations thereof. Further research, including

standardized imaging and long-term follow-up to assess

outcomes, disease stage at diagnosis, and survival, is

recommended. Furthermore, studying possible risk

postmenopausal women and those with positive rst-

degree family history. Moreover, over 50% of

malignant cases were clinically involved in the axillary

nodes, highlighting the possibility of clinically determinants, including reproductive and family history

advanced disease at presentation and the necessity of and breast density, may provide insight into predictors

fast-tracked diagnostic and referral channels for of malignancy in this population.

symptomatic individuals. The imaging data can serve as

background information in addition to our ndings, CONCLUSIONS

which are based on histopathology. Imaging was not

included as a study variable; therefore, we did not In women who reported palpable breast lumps in our

assess either imaging-histopathology concordance or tertiary care surgical outpatient, one out of every four

the diagnostic accuracy of mammography/ultrasound in had histopathological evidence of malignancy, of which

our cohort. However, the published literature supports invasive ductal carcinoma was the most common

the use of imaging in the evaluation of palpable breast subtype. Increasing age and large tumor size (>3 cm)

were also signicant predictors of malignancy,

lumps. For example, studies assessing mammographic

BI-RADS categorization have reported that lesions with postmenopausal status, and positive rst-degree family

higher BI-RADS categories have higher malignancy history. Clinical axillary nodal involvement was

rates, particularly BI-RADS 5 lesions.¹⁹On the same reported in more than half of malignant cases,

indicating that a signicant number of patients present

with clinically advanced disease. These ndings

note, ultrasound performance has been described as

good in certain environments; a study published in

India reported a sensitivity of 80% and specicity of emphasize the importance of timely evaluation and

97% when ultrasound results were compared with biopsy-based conrmation in symptomatic breast

histopathology.²⁰Taken together, some reports verify lumps, particularly in higher-risk presentations, and

the usual methodology of integrating clinical support strengthening standardized diagnostic pathways

that integrate clinical assessment, appropriate imaging

where available, and histopathology in resource-limited

examination, relevant imaging, and tissue diagnosis,

and acknowledge that our research, in particular,

provides

prevalence

estimates

conrmed

by settings.

histopathology. Together, our ndings support a few

important points. First, nearly one in three palpable CONFLICT OF INTEREST: None

breast tumors in our surgical outpatient group is

FUNDING SOURCES: None

malignant. This fact necessitates an immediate

pathological examination of the lesions. Second,

surgical units in similar settings must maintain a low

threshold for performing a biopsy, especially for older

patients or those who present with signs or features that

are clinically suspicious, because the cancerous lesions

found indicate such a high level of the disease. Third,

implementing established imaging pathways (e.g.,

ultrasound in younger women and mammography in

older women) can strengthen diagnostic processes.

However, this will need to be measured in the future,

once systematic data on imaging and histopathology are

captured.

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AUTHORS CONTRIBUTION

Rafia Ahmad - Concept & Design; Data Acquisition; Data

Analysis/interpretation; Drafting Manuscript; Critical Revision;

Final Approval

https://doi.org/10.29309/TPMJ/2023.30.04.7391.

Muhammad Shah - Concept & Design; Data Acquisition; Data

Analysis/interpretation; Drafting Manuscript; Critical Revision;

Supervision; Final Approval

13. Ibrahim EH, Ali TA, Sharbatti S, Ismail MK, Bylappa SK, et al.

Histopathological prole of dierent breast lesions: A single-

center observational study. Cureus. 2024;16(5):e60408.

Shimee Shahzadi - Concept & Design; Data Acquisition; Data

Analysis/interpretation; Drafting Manuscript; Final Approval

Shehzad Akbar Khan - Concept & Design; Data Acquisition;

https://doi.org/10.7759/cureus.60408

PMCID: PMC11156016.

PMID:

38840633;

14. Ibrahim EH, Ismail AM, Salman HA, Ghonaim MM.

Histopathological prole of dierent breast lesions: An

Data

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Drafting

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Egyptian tertiary care center study. Int

Surg Pathol.

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

2024;32(1):1-7. https://doi.org/10.1177/10668969231198741.

15. Afrin T, Khanam H, Talukder A. Histomorphological patterns

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Histopathol Cytopathol. 2023;7(2):63-67.

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