Breast lumps: dysplasia, fibroadenosis


A lump which develops in a young woman is less likely to be cancerous than one in an older, particularly post-menopausal woman. However, there are many causes of breast lumps at any age.
Unless a lump can be confirmed as being clearly benign by clinical diagnosis, mammography and fine needle aspiration, most surgeons will opt to remove it. Some women also prefer to have obviously benign lumps removed, and most surgeons will comply with this wish. The operation can normally be performed as minor day-case surgery under a local or general anesthetic.
Dysplasia simply means the changed structure of tissue. It is a benign condition which becomes apparent as hardening around the edges of the breast, often occurring in both breasts simultaneously. It is normally associated with age-related changes in the tissue rather than with any serious disease, although it can cause concern to a woman who suddenly discovers it. More localized lumps may be cysts.

Also known as chronic mastitis (a poorly descriptive term that is sometimes used), hyperplastic cystic disease, or benign mammary dysplasia, fibroadenosis is a general benign condition which usually occurs in women between the ages of 30 and 50. It can also develop around the time of the menopause, when it is due to hormone imbalance or to the start of hormone replacement therapy (HRT). Although its cause in younger women is unknown, the fact that its signs and symptoms are related to the menstrual cycle, and that it can be induced in men and animals given the female hormone oestrogen, has led to the suggestion that it may be related to hormone imbalance in this age group as well. It may be less common in women who have breast-fed their babies.

Fibroadenosis involves the presence of lumps, cysts and irregular breast tissue. Some degree of lumpiness of the breasts is normal in pre-menopausal women, especially during the last half of each menstrual cycle. However, one or several persistent lumps appearing before a period, and painful, tender breasts could indicate fibroadenosis. Occasionally there may be an associated clear or brownish discharge from the nipple, and the lymph nodes in the armpits may swell and become tender, although this is more common in duct ectasia.

Diagnosis and treatment
Diagnosis is usually straightforward, but investigations may be necessary to confirm that there is no malignancy. These include fine needle aspiration biopsy, mammography or ultrasonography. Fibroadenosis is not associated with breast cancer, and surgery to remove part or all of the tissue from a lump should only be necessary if the results of the investigations are inconclusive. A biopsy may also be done for women approaching the menopause, for which the chance of having a cancer is greater.
Although the lumpiness itself requires no special treatment, the breasts should be re-examined by a specialist after 2 or 3 months. This examination should be done during the first half of the menstrual cycle, when there is less normal irregularity of the breast.
If necessary, the associated symptoms of fibroadenosis, particularly cyclical breast pain, may be relieved by various hormones and 'anti'-hormones such as the drug danazol or tamoxifen, by evening primrose oil, and possibly, although there is no evidence to substantiate this claim, by a low-fat diet.
Fibroadenosis-like symptoms can also occur in women having HRT. If so, a lower dose of hormone preparation may be needed or the HRT may have to be stopped altogether.

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