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Benign Breast Tumours

Most lumps discovered in the breast are benign. Even for lumps where a biopsy is considered appropriate, studies suggest that over 80 percent are not cancerous.

Although this is a reassuring thought, it is vital to report any changes in your breast to your doctor as soon as possible, so these changes can be checked.

Several tests are used to distinguish these conditions from each other and from breast cancer. Often a clinical breast exam and ultrasound are sufficient for diagnosis. For other conditions, a biopsy may be appropriate to ensure that cancer or hyperplasia is not present.

There are several common types of benign breast disease.

Fibrocystic Changes

As they age, some women feel multiple lumps in their breasts. Sometimes called benign breast disease, the connective tissue in these women's breasts becomes ropy or fibrous.

This is more obvious with age, as the milk-producing glands begin to be displaced by softer, fatty tissue. It may also be more apparent during pregnancy. Lumps are usually felt around the nipple, the areola and in the upper, outer part of the breast. Unless a woman is taking hormone replacement therapy, this lumpiness usually dissipates after menopause.

Cysts and fibroademonas are both examples of fibrocystic changes:

Cysts

Cysts are fluid-filled sacs like blisters. They can be easily identified by ultrasound because they are fluid filled.

They occur most often in women 35-50 and may swell in the weeks before a woman's menstrual period. If they are painful and require treatment, they can usually be drained with a fine needle aspiration.

Fibroadenomas

A fibroadenoma is a solid tumour that contains both connective tissue (fibro) and tissue from the milk glands (adenoma). A fibroadenoma usually feels round and rubbery.

It is the most common type of lump found by women in their teens and twenties and is more common in black women. Fibroademonas can often be clearly identified by ultrasound, although sometimes a core needle biopsy is suggested. They may be removed if they are growing or are very large.

Fat necrosis

This condition most often occurs in overweight women with large breasts or following surgical breast procedures or breast trauma. Fat necrosis causes hard, painless lumps and may make the skin appear bruised or red. These tumours are usually removed to ensure they are not cancerous.

Infections can also cause lumps and breast pain. With an infection, the nipple may also release a cloudy discharge. Clear or slightly cloudy nipple discharges may also occur with other benign conditions.

Hyperplasia

Hyperplasia means excess cell growth. If you have a breast lump your doctor may suggest a biopsy to examine the tissue for signs of hyperplasia or cancer. If signs of hyperplasia or excess cell growth are observed in the tissue, your risk of breast cancer may be slightly increased and your doctor will encourage you to monitor your breasts carefully for further changes.

Hyperplastic cells appear in about 25 percent of biopsies of benign conditions.

If the cells are hyperplastic and also appear abnormal this is called atypical hyperplasia. Atypical hyperplasia (AH) is present in about five percent of biopsies of benign conditions. Women who have been diagnosed with AH have a moderately increased risk of breast cancer.

A large American study which followed thousands of women with AH for many years showed that eight percent of women with AH but no family history of breast cancer, and 20 percent of women with AH and a family history developed breast cancer in 10 years. If you are diagnosed with AH, your doctor will likely recommend more frequent clinical breast exams and/or mammograms.

The use of preventative drugs such as tamoxifen may also be considered in some women with AH.

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