Benign breast disease
Benign breast diseases are conditions in the breast that are common and are not cancers. Benign conditions in the breast are of many types and can present in a similar way as early breast cancer. It is common for patients to have symptoms in the breast which concerns them about the possibility of breast cancer. It is important that such symptoms are assessed by the doctor and appropriate tests done to exclude cancer. In most patients, such tests reveal a benign breast condition.
Some benign breast conditions can increase the risk of developing breast cancer in the future and in such cases, the doctor will advise regarding the best options to deal with them.
Fibroadenoma of the breast
This is a common condition in patients aged 15-30 years. It is a collection of gland-like cells and connective tissue in the breast. Together they form a lump which the patient may be able to feel. It feels rubbery with clear edges and is freely mobile within the breast. Some women may notice pain or discomfort in the area.
A fibroadenoma may be single or multiple in one or both breasts. They can vary in size but commonly less than 2cm. Some fibroadenomas can be larger and increase to 5cm or more. Fibroadenomas can be simple or complex. The complex ones can be a mixture of solid and cyst like components.
The diagnosis of fibroadenoma is made by clinical examination. An ultrasound scan, mammogram and needle sampling of the lump can be done to confirm the diagnosis. The risk of a fibroadenoma turning into breast cancer is very small.
Once a diagnosis is confirmed, small fibroadenomas can be left alone without any treatment. Large, complex and those fibroadenomas causing symptoms can be removed with surgery.
Phyllodes Tumour of the Breast
This is a type of a breast condition which usually presents as a lump. A phyllodes tumour can range from being a benign condition to one that behaves like cancer and many in between the two. The patient commonly notices a lump in the breast just like a fibroadenoma.
If a phyllodes tumour is diagnosed on needle aspiration (FNAC), surgery is done to remove it. The histopathology report will identify clearly the type of tumour. Most of these tumours are benign and do not need any further treatment after surgery. In the small minority that is borderline or cancerous, other treatment options such as radiotherapy may be needed.
If a patient is having cancer treatment, mainly chemotherapy, biological or immunotherapy and has symptoms of fever above 99 degrees or feels very unwell, they should seek the help of their doctor immediately. The doctor usually advises the patient to have an urgent blood test to look for the level of blood cells such as neutrophils. This urgent test should be done immediately and not the next morning or in a few hours. If the blood counts are normal, there is no need for worry, but if they are low, the patient needs admission for antibiotics to be given into the vein. If the patient has neutropenic sepsis, prompt treatment with intravenous antibiotics is very important to prevent the infection from turning into a life-threatening one.
A ductal papilloma is a growth in the duct of the breast. It is wart-like in shape. As it grows in the duct of the breast, symptoms produced by it include a discharge from the nipple. The discharge can be clear, brown or blood-like. There may be a lump or pain in the area in some patients.
Treatment of this condition is a minor surgery called microdochectomy where the duct along with the papilloma is removed.
Breast cysts are very common in the general population and are the most common cause of benign lumps in women of ages 30-50. A cyst is a sac with fluid inside it. Cysts in the breast can be single or multiple in one or both breasts. The patient presents commonly with a lump in the breast. The lump is soft and freely mobile. An ultrasound scan and FNAC helps with the diagnosis and the FNAC can also be used to remove the fluid in the cyst. Cysts can be simple or complex based on whether they have a solid component in them or whether there are septations that divide the cyst into compartments. Depending on these features, it is decided whether a cyst needs to be removed or left in the breast without the need for any treatment.
Hyperplasia is where there is an increased number of cells and atypical hyperplasia means that there are an increased number of abnormal cells in the breast. These cells are not cancer cells but have a chance of turning into cancer over the next 10-15 years. Atypical hyperplasia can be in the ducts of the breast, called as atypical ductal hyperplasia or in the lobules, called as atypical lobular hyperplasia. Patients with atypical hyperplasia do not have any symptoms and this condition is only diagnosed when mammograms or other routine tests are done on the breasts. In patients who have a diagnosis of this condition, treatment options include close follow up with regular mammograms or surgical removal of the area of atypical hyperplasia. Tablets in the form of Tamoxifen or others can be used in some patients with ADH to reduce the risk of cancer in the future. This option has pros and cons and these can be discussed with the oncologist.