Proliferative Breast Disorders

Proliferative Breast Disorders
This is the second category of breast disorders. They are associated with a slightly higher risk of developing breast cancer. Women with these problems have a 1.5-2 times higher risk of developing cancer in her lifetime compared to women who do not have this problem. The increase risk is slight so no special preventative measures are recommended.

Histologically these lesions are described as proliferative tissue without any atypical changes. The disorders that fall into this category are described below with fibroadenoma being the most commonly recognized.

A fibroadenoma is a firm mobile mass that is usually found on clinical examination. It tends to occurs in women ages 15-35. The tumor responds to estrogen stimulation as evidenced by the fact that it increases in size during pregnancy or in women on estrogen therapy and regresses during menopause. There can be one or multiple lesions and they may vary in size.

Ultrasound imaging usually reveals a dense solid tumor and histologically it is composed of glandular and fibrous tissue. Even though there are characteristic findings on imaging, biopsy to obtain a tissue sample is recommended when it is found for the first time to be certain of the diagnosis. The tissue sample can be obtained with a core biopsy using a local anesthetic or complete excision to remove the entire lesion. There are pros and cons of each. The histopathology will revealed if the cells are complex or simple. This information along with a family history or the presence of proliferative changes can indicate whether there is an increased risk of developing cancer in the future. If the tissue is simple then there isn’t an increased risk. Once a clear tissue diagnosis is obtained, then future occurrences can be managed appropriately.

Ductal hyperplasia
This is usually found on biopsy. Microscopic findings indicate an increased number of cells within the usual ductal space. The cell features are benign however the mere presence of these increased number of cells indicates a slight increased risk of breast cancer compared to normal.

These present as masses or nodules found on exam or mammographic imaging. They can sometimes cause nipple discharge. There can be a single papilloma or multiple. The papillary cells of a cyst wall overgrow and fill the lumen. These growths can contain cells that are atypical in appearance or even malignant cells that haven’t yet grown past the basement membrane layer: this is call in-situ. Because of this potential, any imaging that suggests the presence of a papilloma should be followed with surgical excision. The final histopathologic findings will dictate further management.

Sclerosing Changes
Sclerosing adenosis or complex sclerosing lesions may present as a mass or a suspicious finding on mammography. These lesions should be biopsied to have a clear histologic diagnosis. The complex lesions should undergo complete excision because of the potential to develop into cancer over time or an increased risk of cancer being found in the excised specimen.

The lesions in these groups require a biopsy or excision to determine the correct diagnosis. The reassuring point is that once the tissue is removed, you can rest easy that it is out and you have a clear answer on what caused the problems. Certainly there is risk of surgery, including scarring making future evaluation difficult and damage to the breast duct system. The risks are worth it to provide peace of mind and to ensure there isn’t a malignancy.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!

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You Should Also Read:
Benign Breast disorders
Breast Problems
Evaluating Your Breast

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