Evaluation of Benign Breast Conditions
Breast cancer is not the only issue that can affect a woman’s breast health. In fact, most breast lumps are not cancerous.
The term “fibrocystic changes” is used to describe a range of different benign breast conditions. In the past, the term “fibrocystic disease” was used for this condition. That term is no longer used as the breast tissue is not felt to be diseased. This condition is better thought of as common changes seen in breast tissue as it ages and matures. Benign breast conditions are not life threatening, but they can sometimes cause bothersome symptoms. One of the most common issues associated with fibrocystic changes is breast pain, also known as mastalgia or mastodynia. This pain can be related to a woman’s menstrual cycle and will typically occur just prior to a menstrual period. However, this is not always the case. Sometimes, breast pain has no relation to a woman’s menstrual cycle. In either case, evaluation to rule out any specific masses or cysts is encouraged. Even if the pain is not related to a specific lesion, there may be several other explanations. Pulled chest wall muscles, pinched nerves, or costochondritis (inflammation of the cartilage in the ribcage) and scapulothoracic bursitis (another structural issue) may also cause pain.
Cysts are fluid-filled sacs, more common in younger women. After menopause, cysts typically occur less frequently. Though most cysts are too small to feel, some are large enough to feel like lumps and can potentially cause breast pain. Often, these cysts require no treatment. If they are painful and interfering with breast exams, they could potentially be drained. This is something that can typically be taken care of in the office during your visit.
A fibroadenoma is a solid, benign tumor. They are most common in younger women. Although they often require no treatment, we consider removing them when they are large or if they are clearly growing. The majority of these lesions can just be observed. A plan for how to observe and follow a known fibroadenoma would be a part of your office visit.
Intraductal Papillomas are small benign growths that occur in the milk duct of the breast and can cause nipple discharge. A lump may be felt and could be painful. These were typically removed in the past but now it is becoming clear that the majority of intraductal papillomas can be left in place and will cause the patient no harm. With this knowledge, it is now much more common to observe these benign lesions. We currently do not have well established guidelines on which papillomas can be observed and which ones need to be removed. This is a situation where a careful evaluation by a breast surgeon and shared decision making is appropriate.
Sclerosing Adenosis is made up of small breast lumps caused by enlarged lobules. A potentially painful lump may be felt. These can sometimes be identified on a mammogram and may require a needle core biopsy. Typically, a core biopsy can be performed in the office at the time of your visit.
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