When most women feel a lump in their breast, thoughts immediately turn to cancer. While breast cancer is a scary possibile cause of changes to breast tissue, fibroadenoma is more likely. This common condition mostly happens during childbearing years. The lumps may be singular or multiple, in one breast or both. In the majority of cases, they are benign and not indicative of serious health issues.
What is a Fibroadenoma?
Fibroadenomas are breast lumps that many women describe as rubbery or stiff. For the most part, they are painless. In women, the tissue grows over the milk-producing glands, known as lobules, and ducts, resulting in a lump. When fibroadenoma develops in men, who do not have lobules, studies show hyperplasia or rapid cell reproduction may be the culprit. The exact trigger for both is unknown, but researchers suspect answers could lie in increased sensitivity to estrogen and progesterone.
Less than ten percent of women and men experience fibroadenomas, but that percentage could increase when accounting for undetected and unreported cases. The typical age range of those affected is 20 to 25 years, but it can occur as late as one’s 50s. Most cases are of a single, small lump, while about 20 percent present with multiple lumps scattered throughout the breast. In two-thirds of all cases, the masses stay the same size or decrease and disappear.
Types of Fibroadenoma
There are a few categories and subcategories of fibroadenomas. Between 60 and 90 percent are classified as “simple,” meaning they are homogenous and measure approximately one to three centimeters or between 0.4 and 1.2 inches. Juvenile fibroadenomas occur in adolescents between ten and 18 years. They grow quickly, and a majority of them dissipate without incident. Complex fibroadenomas have mixed composition under the microscope. They are lumps with both calcifications and cysts and tend to present in individuals over 40.
GFA or giant fibroadenoma is classified as a lump greater than five centimeters (a little less than two inches). However, they can grow so large that they deform the breast or cause visible asymmetry. One study showed that in almost two-thirds of patients with GFA, the average tumor size was about 10.2 centimeters or four inches and weighed about 7.2 ounces. At that stage, though they are still likely benign, the only treatment is removal.
From the Greek word for leaf, phyllodes tumors are rare fibroadenomas whose cells have a leaf-like pattern that branches out into the breast. These account for less than one percent of all tumors, and affect both genders, though they are much rarer in men than in women. Phyllodes tumors are classified as benign, borderline, or malignant, and mostly appear in people in their 40s and 50s. While they grow fast, they rarely metastasize (spread beyond the breast tissue).
Increased Risk of Breast Cancer
Most adenomas are benign and have no bearing on breast cancer risk. The diagnosis of a phyllodes tumor, however, will prompt the doctor to monitor a patient’s breast health more closely, because approximately 25 percent become malignant. There is some concern that complex fibroadenomas also double breast cancer risk, but studies have called this theory into question, showing instead that there is little risk of breast cancer from complex fibroadenomas. This does not rule out the possibility entirely, however.
The flood of estrogen, progesterone, and prolactin during pregnancy make fibroadenomas more likely to grow. The density of breast tissue during that time, however, makes them harder to detect. One example is the lactating adenoma, which is softer and disappears after childbirth. Sudden breast pain during the last trimester or birth could indicate fibroadenoma with infarction, a rare occurrence where an embolus or blood vessel blockage bursts, causing acute pain and a certain degree of necrosis. Despite these possibilities, fibroadenomas do not normally affect the ability to breastfeed.
For lumps that can be detected without x-ray or magnification tools, fibroadenoma diagnosis is a two-phase process. Breast mammography and ultrasound help doctors get a picture of the mass, especially in dense breasts. Evaluation, the next phase, involves aspiration with a fine needle. If this process removes fluid, the lump is a cyst. With a needle biopsy, tissue samples are collected and analyzed to determine its nature.
One way to treat a fibroadenoma is with a lumpectomy. This short procedure involves either general or local anesthesia. If the tumor is cancerous, the surgeon may check the margins — the edges of the removed tissue — and even remove some lymph nodes to check for metastasis. Internally, doctors can mark the incision with metal clips, which not only identify the area in future examinations but can also guide targeted radiation therapy.
A less invasive approach to removing fibroadenomas is cryoablation with local anesthesia. The doctor makes a three-millimeter incision. With the help of guided ultrasound, the cryoprobe needle and liquid nitrogen freeze and kill the tumor cells, which are eventually reabsorbed by the body. The whole procedure takes about 15 minutes. Since there is no tissue removal, the breast does not lose shape and pain and scarring are minimal.