Makindo Medical Notes

Breast fibroadenoma is a common benign breast tumor, especially in young women. Regular monitoring and appropriate management can alleviate anxieties and ensure optimal breast health.

About Breast Fibroadenoma

Breast Fibroadenoma is the most common benign breast tumor, predominantly affecting females between the ages of 15 and 30. These non-cancerous lumps are composed of both glandular (fibro-) and connective (adenoma) tissues. While fibroadenomas are generally harmless, their presence can cause significant anxiety due to concerns about breast cancer. Breast fibroadenomas are benign masses that can cause emotional distress and concerns about breast cancer risk. There is a small increase in the risk of developing breast cancer in individuals with fibroadenomas, particularly complex fibroadenomas.

Aetiology

• Fibroadenomas develop from an imbalance between the proliferative and involutional processes of the breast tissue, often influenced by hormonal factors. They are categorized based on their complexity and histological features.
• Composition: Contain both glandular and stromal (connective) tissue.
• Classification:
  • Simple Fibroadenomas: Well-circumscribed, mobile, and typically solitary.
  • Complex Fibroadenomas: Have additional features such as cysts, calcifications, or sclerosing adenosis, and may carry a slightly higher risk of malignancy.

Clinical Presentation

• Demographics: Most common in females aged 15-30 years.
• Natural History: Tend to shrink after menopause due to decreased hormonal stimulation.
• Physical Characteristics:
  • Firm or rubbery consistency.
  • Well-defined, smooth, and round or oval shape.
  • Mobile within the breast tissue, often described as feeling like a marble.
  • Non-tender in most cases.
  • Can be single or multiple.
• Associated Features: Generally no associated worrying features such as skin changes or nipple discharge.

Differential Diagnosis

• Cyst: Fluid-filled sacs within the breast that are typically soft and may be tender.
• Breast Cancer: Malignant masses may present as hard, fixed lumps with irregular borders and may be associated with skin or nipple changes.
• Phyllodes Tumor: Rare, fast-growing breast tumors that can be benign or malignant, often larger and firmer than fibroadenomas.
• Fat Necrosis: Benign condition resulting from breast trauma, presenting as firm lumps that may mimic malignancy.
• Intramammary Lymph Nodes: Normal lymph nodes within the breast that can become enlarged and palpable.

Investigations

• Clinical Examination: Physical assessment to evaluate the size, consistency, mobility, and other characteristics of the lump.
• Ultrasound: Used to differentiate between solid and cystic masses. Cystic lesions are rarely cancerous and can be aspirated if needed.
• Mammography:
  • Useful in older women or those at higher risk for breast cancer.
  • Helps in identifying calcifications and other features suggestive of complex fibroadenomas.
• Biopsy:
  • Indicated if the mass has atypical features on imaging or if there is suspicion of malignancy.
  • Types include Fine Needle Aspiration (FNA), Core Needle Biopsy, or Excisional Biopsy.

Management

• Reassurance: Generally the treatment of choice for small, asymptomatic fibroadenomas. Regular follow-up and monitoring to detect any changes in size or characteristics.
• Observation:
  • Periodic clinical and imaging evaluations to monitor for growth or changes.
• Conservative Management:
  • Minimize unnecessary interventions in stable, uncomplicated cases.
• Excision:
  • Small lesions may be excised under local anesthesia, especially if they cause discomfort or anxiety.
  • Surgical excision is recommended for large fibroadenomas (>5 cm), those that are rapidly growing, or if there is uncertainty about the diagnosis.
  • Excisional biopsy also serves a diagnostic purpose by providing definitive histological evaluation.
• Patient Education and Support:
  • Inform patients about the benign nature of fibroadenomas and the low risk of malignancy.
  • Address any anxieties and provide psychological support if needed.

Prognosis

• The prognosis for individuals with breast fibroadenomas is excellent. These benign tumors do not typically pose a threat to life and can be managed effectively with appropriate interventions:
• Benign Nature: Fibroadenomas are non-cancerous and do not increase the risk of breast cancer significantly, especially simple fibroadenomas.
• Natural Course: Many fibroadenomas regress spontaneously, particularly after menopause.
• Recurrence: There is a possibility of new fibroadenomas developing in the same or contralateral breast.
• Complications: Rarely, complex fibroadenomas may require more intensive monitoring due to a slightly increased risk of malignancy.

References

• American Cancer Society. Fibroadenoma of the Breast. Available at: https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/fibroadenoma.html
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Breast Cysts and Fibroadenomas. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/breast-cysts-fibroadenomas
• Kaufman, C. A., & McLaren, R. A. (2014). Clinical Anatomy of the Breast. Elsevier Health Sciences.
• Jones, T. H., et al. (2018). Breast Fibroadenoma: Clinical Presentation and Management. J Clin Diagn Res. 2018;12(9):OC15-OC19.
• Le, M. L., et al. (2017). Management of Fibroadenomas in Young Women. Obstet Gynecol Clin North Am. 2017;44(1):93-108.
• Gilbert, A., et al. (2020). Breast Masses: Diagnostic and Management Strategies. Radiographics. 2020;40(3):896-918.
• American College of Radiology (ACR). Breast Imaging Reporting and Data System (BI-RADS). Available at: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads