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Benign abnormalities of the breast should put some women at high alert

A University of Michigan Health Minute update on important health issues.

Certain changes can increase risk for developing breast cancer

Ann Arbor, MI. -- Not all breast lumps are cancerous. In fact, a degree of “lumpy bumpiness” is normal for most women. But these benign lumps can sometimes put women at higher risk for breast cancer.

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“Over the course of many years of a woman’s reproductive lifespan, the breast tissue is simply prone to develop areas of irregularity in texture. This is the lumpy bumpiness of what we call fibrocystic changes in the breast,” says Lisa Newman, M.D., M.P.H., director of the Breast Care Center at the University of Michigan Comprehensive Cancer Center.

The breast is made up of different types of tissues, which are all influenced by hormones over the course of a woman’s menstrual cycle. These fluctuations can cause different types of lumps to form, such as a lump of benign tissue, called a fibroadenoma, or a fluid-filled cyst. These lumps can often be felt during a breast self exam.

While it’s important to have any suspicious change checked by your doctor, Newman says only about 5 percent to 10 percent of all mammograms performed will require additional tests because of fibrocystic changes. Of all the biopsies performed, only 15 percent will turn out to be cancer.

“The majority of biopsies we need to do because of mammographic abnormalities will in fact be completely benign,” Newman says. “However, there are some breast changes we find on microscopic evaluation that indicate a higher risk of developing breast cancer in the future.”

These changes are unusual – fewer than 10 percent of all breast biopsies. They include conditions called atypical ductal hyperplasia, atypical lobular hyperplasia or lobular carcinoma in situ.

“When we find these patterns, or if a woman knows that she has had this pattern found on a past breast biopsy, she should talk to her health care provider about whether she should consider taking a medication to reduce her breast cancer risk. This is why it’s so important for a woman to know exactly what was found in her breast tissue on that pathology report, even if her doctor told her the result was completely benign,” says Newman, associate professor of surgery at the U-M Medical School.

Women with these abnormal patterns who also have a family history of breast cancer are at even greater risk of developing breast cancer.

mammography Thanks to screening mammography, doctors are able to spot very small breast cancers in the early stages before they grow to the point of threatening a woman’s life. Every woman age 40 and older should have a yearly mammogram. Women who get screened regularly have a 30 percent lower risk of dying from breast cancer compared to women who do not have yearly mammograms.

“We need to counsel women about the proper ways to perform breast self-examination. We also need to educate women about findings in the breast that are true danger signs for breast cancer, vs. the signs that are a simple manifestation of normal lumpy bumpiness in the breast,” Newman says.

“The bottom line message to women is that being aware of your body and changes in your body is absolutely essential. Performing self-examination can be a very useful maneuver. If a woman notices a change she should talk to her health care provider,” Newman says.

Signs of benign breast disease

  • Pain or tenderness, usually in both breasts. Some women with fibrocystic changes experience no pain but notice lumps or nodules within the breast.
  • Lumps in one or both breasts and tenderness one to two weeks before the start of each menstrual period. Breast pain occurs most often in the upper, outer part of the breast.

Treatments for benign breast disease

  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen, to relieve pain and inflammation.
  • Diet changes such as reducing or eliminating caffeine.
  • Clothing modification, including wearing a bra with good support or changing the type of bra worn.
  • Evening primrose oil, 1,000 milligrams two to three times per day.

 

Written by Nicole Fawcett

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