Benign breast conditions

If you’ve found a lump in your breast, don’t panic: although some may be painful, the majority of breast lumps are non-cancerous (benign) and not life threatening.

This article reviews the main types of benign breast conditions and briefly covers the various treatment options available.

Is benign breast disease common?

Yes, it is – about nine out of ten breast lumps are benign. And, every year, about 3% of women in the UK will visit their GP due to a breast-related issue. In a recent study, researchers reviewed 302 referrals in Sheffield and reported that 60% of the women had a benign breast condition, 33% were diagnosed as normal and only 7% were found to suffer from cancer.

What causes benign breast lumps?

During a woman’s reproductive years, her breast tissue is particularly sensitive to fluctuations in hormonal levels – especially those of oestrogen, progesterone, oestradiol, luteinising hormone (LH) and follicle stimulating hormone (FSH). The ongoing changes in breast tissue that occur as a woman ages coupled with hormonal shifts can cause the breast to feel lumpy, painful and swollen. The lump may or may not be tender and is usually discovered by the woman herself while showering or during breast self-examination.

Breast infection or injury, stress and certain medications such as birth control pills or hormonal replacement therapy (HRT) can also increase the incidence of lump formation or pain in the breast.

Can these lumps lead to cancer?

Benign breast lumps do not usually cause cancer except in the following circumstances:

• Atypical hyperplasia – this is the term used when breast cells grow bigger in both size and number, and develop an unusual shape. This can happen in the breast lobules (atypical lobular hyperplasia, ALH) or in the ducts (atypical ductal hyperplasia).
  Your doctor may recommend removal of these abnormal breast cells, which can be done using a vacuum-assisted excision biopsy. This procedure, which may not require a general anaesthetic, is carried out by sucking the breast tissue through a probe using a vacuum for suction and a mammography or ultrasound as a guide.
• Lobular neoplasia – this condition describes an increase in the number of cells in the breast’s lobules and a change in their appearance and behaviour. This cellular change includes either ALH or lobular carcinoma in situ (LCIS) – the risks of cancer are greater with LCIS.
• Gross cysts – these are cysts that feel like a solid lesion and cannot be aspirated using a needle aspiration technique.
• Solitary duct papilloma – this is a single tumour that develops in the large milk ducts surrounding the nipple, where it can appear as a small lump. This papilloma often causes clear or bloody nipple secretions and can increase the risk of cancer if it contains other changes such as abnormal cells.

Types of benign breast conditions

Benign phyllodes tumour – this rare tumour is a hard lump that can develop in the supportive tissue of the breast. It usually occurs in pre-menopausal women aged between 40 and 50 years old but can also affect younger women. While more often benign, the tumour can also be borderline malignant (cancerous) or malignant.

Once formed, the lump can grow quite fast, increasing in size and causing the breast to become inflamed. For an exact diagnosis, your GP may refer you to a breast clinic where you will need to undergo a breast exam, a mammogram and/or an ultrasound scan.

A sample of the breast cells in the lump may also be required for analysis under a microscope. This can be obtained using the fine needle aspiration cytology (FNAC) technique or a core biopsy which involves using a larger needle than in the FNAC. Both tests can determine whether the lump is cancerous or not.

Breast calcifications are small spots of calcium that appear in ageing breast tissue. These spots can also occur after breast surgery, after implants have been inserted, after a fibroadenoma or cyst is formed in the breast, or if you’ve recently had an injury or infection in your breast.

Breast cysts are small fluid-filled sacs that are very common in pre-menopausal women over 35 and can vary in texture (soft or hard), size and shape.

Duct ectasia – as a woman reaches menopause, her ducts may become shorter and wider; a process known as ‘ectasia’. If breast secretions accumulate in the widened ducts, duct ectasia occurs (meaning the lining of the ducts becomes inflamed).

Fat necrosis occurs when part of the breast’s fatty tissue is damaged, usually following trauma to the breast. The area may feel like a firm and round lump that appears inflamed, bruised or dimpled, and may or may not be painful. The lumps tend to disappear without treatment.

Fibroadenomas are quite common among women below 40 and are the result of excessive growth of the glands and connective tissue in the breasts due to increased sensitivity to oestrogen. Fibroadenomas can become larger but often decrease in size again and eventually disappear.

Intraductal papillomas are non-cancerous tumours that originate in a milk duct in the breast. They can have a wart-like appearance.

Mondor’s disease or superficial thrombophlebitis refers to inflammation of the vein just below the breast skin or chest wall. The vein may look like a long, narrow cord lying just under the skin and may be painful.

Periductal mastitis involves inflammation and infection of the ducts just below the nipple. The breast may look red and feel tender and hot, with discharge from the nipple. Because cigarette smoke can damage the ducts behind the nipple, smokers are more likely to be affected by the condition.

Do you need treatment for benign breast conditions?

Unless they cause symptoms, you won’t usually require any treatment for benign conditions such as small fibroadenomas, hyperplasias or lipomas.

However, you may need treatment for the following conditions:

• Benign phyllodes tumour – depending on the size of the lump, you may either require a wide local excision or a mastectomy. The aim of the surgery is to remove the whole tumour plus an area of healthy tissue (known as a clear border) around it, to ensure that it does not recur. If a clear border cannot be obtained, a second surgery may be needed.
  After excision, a benign tumour may reappear and it may or may not become cancerous – your doctor will probably advise you to have a mammogram every two years.
• Breast calcifications – if the calcifications appear undefined, they may be a sign of early breast cancer. Your doctor may want to analyse the calcification spots and might recommend surgery to excise them.
• Breast cysts – most cysts disappear without treatment. However, large, painful cysts may need to be aspirated (in which the fluid is removed using a needle).
• Duct ectasia – in rare cases, this condition can cause significant nipple discharge. If this happens, the affected duct(s) may need to be removed.
• Lobular neoplasia – in this case, your doctors may recommend that you take the drug Tamoxifen.

What’s your next step?

It’s important that you inform your doctor about any changes you notice in your breast – because both benign and malignant lumps can cause similar symptoms, your GP will need to rule out cancer and may refer you to a breast clinic for further tests.