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A benign breast condition is any
non-cancerous breast abnormality. According to the American Cancer Society, when breast
tissue is examined under a microscope some type of abnormality is common in nine out of
every ten women. Though not life-threatening, benign conditions may cause pain or
discomfort for some patients. Some (not all) benign conditions can signal an increased
risk for breast cancer. The most common benign breast conditions include fibrocystic
breast condition, benign breast tumors, and breast inflammation. Depending on the type of benign breast condition and the
patient's medical situation, treatment may or may not be necessary.
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Overview: Breast Tissue Changes
The breast is composed of two main
types of tissues: glandular tissues and stromal (supporting) tissues. The glandular
tissues house the milk-producing lobules and the ducts (the milk passages). The stromal
tissues include fatty and fibrous connective tissue. Any changes in the glandular or
stromal areas may cause symptoms of benign breast conditions.
Some women experience changes to their breast tissue over their lifetime. These changes can include
an increase in the number of breast cells (hyperplasia) or the emergence of atypical breast cells
(atypical hyperplasia). In some instances, a portion of breast tissue that exhibits abnormal
characteristics can eventually develop into a cancerous tumor. That is why physicians carefully
monitor patients with abnormal breast cells, to ensure that if cancer develops at a later date, it
is detected and treated early. Some patients with atypical hyperplasia may also be recommended to
take the drug tamoxifen to help prevent breast
cancer. While the appearance of atypical hyperplasia increases the risk of breast cancer, not all
women with abnormal breast cells go on to develop breast cancer.
The following chart summarizes the typical progression of breast tissue from "normal" to "cancer:"
Courtesy of the American
Medical Association.
While many cases of breast cancer arise from the above sequence some breast tumors may skip one or more
intermediate steps (for example, cells may proceed from "normal" directly to
"carcinoma in situ"). In general, anything farther along than atypical
hyperplasia is usually classified as a cancer. Abnormalities beginning with
ductal carcinoma in situ (DCIS), usually require treatment as cancers.
The treatment of benign breast conditions varies depending on a number of
factors including the exact diagnosis, potential
for developing breast cancer, and a woman’s discomfort.
How
Are Benign Breast Conditions Detected?
Benign breast lumps are often first
detected by physicians during clinical breast examination,
routine mammogram or by patients practicing breast self-examination (BSE). Focal pain (pain confined to one spot in
the breast) or nipple discharge (other than milk) may also alert
a woman to have her condition checked by a doctor. Benign breast lumps are usually
confirmed by imaging tests (mammogram, ultrasound/sonogram), observing the lump over a
period of time, or doing fine needle aspiration
biopsy (FNAB), core needle biopsy (CNB)
or surgical biopsy.
Nipple Discharge
Nipple discharge, fluid coming from the nipple(s), is the third most common breast complaint for which
women seek medical attention, after lumps and breast pain. The majority of nipple discharges are associated
with non-cancerous changes in the breast such as hormonal imbalances or papillomas (see section below on
intraductal papilloma for more information). However, because a small percentage of nipple discharges
can indicate breast/nipple cancer, any persistent discharge from the nipple(s) should be evaluated by a physician.
Up to 20% of women may experience spontaneous milky, opalescent, or clear fluid nipple discharge. During
breast self-exam, fluid may normally be expressed from the breasts of 50% to 60% of Caucasian (White)
and African-American women and 40% of Asian-American women. Usually, a discharge that is clear,
milky, yellow, or green, and is noted from both nipples, is not associated with breast cancer. Bloody
or watery nipple discharge, especially if limited to one side and/or a single breast duct, is
considered abnormal; however, only around 10% of abnormal discharges are found to be cancerous.
Nipple discharge may be a concern if it is:
- Bloody or watery (serous) with a red, pink, or brown color
- Sticky and clear in color or brown to black in color (opalescent)
- Appears spontaneously without squeezing the nipple
- Persistent
- On one side only (unilateral)
- A fluid other than breast milk
Women should report persistent nipple discharge to their doctors for analysis. To examine nipple
discharge, a small amount of the fluid is placed on glass slides under a microscope to determine if cancer cells are present.
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