HEALTH TALK: Fibroadenoma

DEFINITION

Fibroadenomas are solid, noncancerous growths (benign tumors) that often occur in women during their reproductive years. A fibroadenoma is a smooth firm, rubbery or hard lump with a well-defined shape. It moves easily under your skin when touched and is usually painless. Fibroadenomas are more common in women in their 20’s and30’s.

Fibroadenomas are one of the most common breast lumps in premenopausal women. Fibroadenomas range in size from less than 1 centimeter to several centimeters in diameter. They can increase in size during pregnancy and breast feeding.

Treatment may include careful monitoring to detect changes in the size or feel of the fibroadenoma or surgery to remove it.

SYMPTOMS

Fibroadenomas are solid breast lumps or masses that usually are:

•    Round with distinct borders
•    Easily moved
•    Firm or rubbery
•    Painless
A fibroadenoma may feel like a marble within your breast when you put pressure on it. You can have one or many fibroadenomas. They usually grow to about 1 to 2 centimeters in size, but they can become even larger. One that measure 5cm or greater is referred to as a giant fibroadenoma.

WHEN TO SEE A DOCTOR

Normal breast tissue in healthy women often feels lumpy or modular. If you find any new breast lumps, however, or if a previously evaluated breast lump seems to have grown or otherwise changed, make an appointment with your doctor to get it checked out.

CAUSES

Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-feeding. Small ducts conduct the milk to a reservoir that lies just beneath your nipple. The support for this network is a deeper layer of connective tissue called stroma.  Fibroadenomas are made up of both glandular (lobular) tissue and connective (stromal) tissue. It’s always helpful to know a bit about your breast anatomy so you can better understand problems such as fibroadenomas or serious breast issues.

The cause of fibroadenomas is unknown. However, fibroadenoma development is probably related to reproductive hormones. Fibroadenomas occur in greater frequency during your reproductive years, can increase in size during pregnancy or wilh estrogen therapy, and tend to shrink after menopause. Incidentally, fibroids (leiomyomas) will cease to grow after menopause, but increase in size during pregnancy or with estrogen therapy.

COMPLICATIONS

Breast cancer risk may increase with some types of fibroadenomas.

SIMPLE  FIBROADENOMAS

Most fibroadenomas are simple fibroadenomas. These masses have distinct borders and uniform-looking cells. Simple fibroadenomas do not increase your risk of breast cancer, especially if you have no family history of breast cancer.

COMPLEX  FIBROADENOMAS

These fibroadenomas contain cysts, enlarged breast nodules (adenosis) or bits of dense, opaque tissue called calcifications. Complex  fibroadenomas don’t turn into breast cancer, but they do increase your risk of later developing breast cancer by a factor of about 2 to 3. However, your overall risk of developing breast cancer after being diagnosed with a complex fibroadenoma remains low.

TESTS AND DIAGNOSIS

Evaluation usually begins after you or your doctor has found a breast lump. The following tests or exams may then be done:

•    Clinical breast exam. Doctor physically examines the lump and checks for any other problem areas in your breasts. He or she will ask you questions about anything you’ve noticed about the lump, breast, or your menstrual cycle.

•    Mammography. This is a series of X-Rays to produce an image (mammogram) of your breasts. A fibroadenoma will usually have a characteristic appearance. To evaluate a suspected adenoma, mammograms are routinely performed for women aged 30 and older.

•    If you’re under 30, a breast ultrasound is most likely the test to be done, for technical reasons. It may also be done as follow-up to a mammogram, regardless of age. Ultrasound can tell is whether a mass is solid or fluid-filled (a cyst). Some doctors may decide to skip ultrasound and perform fine-needle aspiration instead.

•    Fine needle aspiration. A thin needle is inserted into the breast lump and doctor attempts to withdraw the contents of the breast lump. If no fluid comes out, the lump is solid and most likely a fibroadenoma. A sample of cells may be collected and sent for analysis to check for the presence of cancer (fine-needle aspiration biopsy)

•    Core needle biopsy. To distinguish between fibroadenoma and breast cancer, a biopsy may be recommended. A large needle is used to obtain several tissue samples from the breast lump to send for analysis.

TREATMENT

SURGERY

If it continues to grow and change the shape of your breast, surgery to remove a fibroadenoma may be recommended if one of the tests is abnormal. It may also be recommended if it makes you very anxious.

After a fibroadenoma is removed, one or more new ones may develop. You may need to have another surgery in such a case.

WHEN SURGERY ISN’T NEEDED

If doctor is pretty certain that based on the results of tests, your breast lump is a fibroadenoma and not cancer, surgery may be necessary.

For younger women – those who most commonly develop fibroadenomas – surgery might distort the shape and texture of the breast and leave scar tissue that complicates future breast exams. In older women – usually past their 30’s – fibroadenomas may stop growing or even shrink on their own.

If you decide not to have your fibroadenoma removed, continued monitoring is important to make sure it doesn’t grow larger. At any time you become overly anxious about the fibroadenoma, you can consider surgery.

See you next week.