It’s Not Breast Cancer - What is it?

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Dr. Falkowski, Associate Medical Director at Acupath Laboratories, on Fibroadenomas and the pathology behind the good news.

About 40% of women will discover a breast lump at some point in their lives. The American Cancer Society says that most breast masses (approximately 80% according to WebMD) are benign; that is, they are not malignant: do not grow uncontrollably or spread, and are not life-threatening. So while breast cancer is the second most common cancer among American women, if a woman discovers a lump or detects an uncharacteristic breast change, there’s still a good deal of reason for optimism.

“Although a lump doesn't necessarily mean cancer, what women do immediately after that discovery makes all the difference,” cautions Dr. Olga Falkowski, a board-certified pathologist and Associate Medical Director of Acupath Laboratories, Inc. A medical examination and an accurate pathological diagnosis is the only way to be absolutely certain.”

Benign breast lumps, called fibroadenomas are breast tumors that are made of glandular and fibrous breast tissue. As the most common type of tumors found in American women, fibroadenomas are usually single lumps that feel firm, round, smooth, rubbery, and are movable. Statistics say that 10 - 15% of women have several lumps that may affect both breasts, and that occurrence of multiple or complex fibroadenomas, may raise a woman’s risk of breast cancer slightly.

There are several common causes of benign breast lumps, including normal changes in breast tissue, breast infection or injury, and medicines that may cause lumps or breast pain. Breast tissue changes during a woman's entire life. It is particularly sensitive to changing estrogen and progesterone hormone levels during the menstrual cycle.

Fibroadenomas typically occur in females during their reproductive years and rarely appear in post-menopausal women. Young women who have not gone through menopause often have more dense tissue in their breasts. “Because dense tissue has more glandular and connective tissue and less fat tissue,” says Dr. Falkowski, “mammograms are harder to interpret, making careful expert diagnosis especially important.” In most cases, a biopsy is needed to get a definitive diagnosis.

Other diagnostic tests include:

  • Ultrasound scan. A technique that uses sound waves to display a two-dimensional image of the breast, showing whether a lump is solid or fluid-filled (cystic).
  • Fine-needle aspiration biopsy. A minor procedure wherein fluid or cells are drawn out of the lump through a small needle (aspirated).
  • Core biopsy. A procedure wherein a larger piece of tissue is withdrawn from the lump through a larger needle.
  • Incisional biopsy. A biopsy in which only a sample of the suspicious tissue is cut into (incised) and removed for purposes of diagnosis. An incisional biopsy is in contrast to an excisional biopsy in which an entire lesion, usually a tumor, is removed.
  • Excisional biopsy. A surgical procedure wherein the entire lump is removed.

If a biopsy indicates that the lump is a fibroadenoma, the lump may be left in place or removed, depending on the will of the patient and the size of the lump. If left in place, it should be monitored over time through the use of mammograms, physical exams and ultrasounds. If the lump is left in place it has to be carefully observed. It may need to be removed at a later time if it changes or grows. In very rare cases, the lump may become malignant and may need further treatment. Because fibroadenomas rarely appear in post-menopausal women, unless the women is on estrogen therapy; any new lump should be should be considered malignant until proven otherwise.

Olga Falkowski, M.D. is Board-certified in anatomic and clinical pathology by the American Board of Pathology, and serves as the Unit Chief of Breast Pathology and the Associate Medical Director of Acupath Laboratories, Inc.

Acupath Laboratories, Inc. is a Plainview, New York, specialty medical lab engaged in leading-edge molecular and cytogenetic analysis.

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