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Do I need a biopsy? Choosing the right treatment for fibroadenoma


Do I need a biopsy? Choosing the right treatment for fibroadenoma
Being diagnosed with a breast condition can be traumatic for anyone, especially if you have never even heard of the condition before.

If you have been diagnosed with a fibroadenoma, you are probably keen to find out more about the condition and what your options are for treatment. You might not even know if you need treatment or if you actually want it. In light of this we’ve compiled all the necessary information you need to soothe your mind. Here, we hope to inform you a little more about the condition and help you to understand whether a biopsy is the right course of action for you.

What is a fibroadenoma?

Firstly, you need to actually know what a fibroadenoma is. A fibroadenoma is an extremely common condition in which a lump or lumps are formed in the breast. These lumps are benign lumps which means they are non cancerous. The lumps will feel slippery to touch and are often compared to feeling like a marble under the skin.2 They vary in size: some are too small to feel, some can be several inches in length but most are around 1-3cm in size.1 Although the condition can often develop during puberty, fibroadenomas are most common in women in their early 20’s.1 Having said this, the condition can occur in women of any age.1 The lumps are generally painless but they can occasionally feel tender and sore, usually just before your period.1

What ‘s the difference between simple and complex fibroadenomas?

There is more than one type of fibroadenoma, but the most common type is the ‘simple fibroadenoma’. Simple fibroadenomas are usually around 1–3cm in size, smooth to the touch and does not increase the risk of developing breast cancer in the future.1 If you were to look at a simple fibroadenoma under the microscope it would look the same all over.1 Whereas in comparison, if you were to look at what is known as a complex fibroadenoma under a microscope, some of the cells have different features.1 These types of fibroadenoma can very slightly increase the risk of developing breast cancer in the future.1

There are other, less common variations of the conditions. These include giant and juvenile fibroadenomas: the names are given to fibroadenomas exceeding 5 cm and those that are found in younger or teenage girls, respectively.1

What causes this condition?

Although it is not explicitly known what causes a fibroadenoma, it is thought to be caused by an increased sensitivity to the hormone estrogen.3 Fibroadenomas are most common in women in their 20’s and 30’s, when generally women are at their most fertile.2 It is also believed that they can often enlarge during cycles of hormone therapy or when pregnant. Converse to this, they may shrink after menopause, when levels of estrogen decrease.3

Breasts consist of milk-producing glands called ‘lobules’ and tubes that carry milk to the nipple called ‘ducts’.1 These lobules and ducts are surrounded by glandular, fibrous and fatty tissue, which make up the majority of the breast.1 In essence, fibroadenomas occur when the glandular tissue and ducts grow over the lobule, condense, and form a solid lump.1

Fibroadenoma and biopsies

If you have found a lump in your breast, then it is possible that it is a fibroadenoma. If you haven’t already, then it is important to consult your doctor so they can diagnose the cause of the lump. When consulting your doctor, firstly they will ask for your medical history. After this, the doctor may ask your permission to physically examine your breast, and will always ask if you'd like a nurse present. They may further examine the affected area using a non-invasive imaging technique such as ultrasound, MRI or mammogram (x-ray). These tests can be sufficient in aiding a doctor with their diagnosis, however if still unsure, they may opt to perform a breast biopsy.

A breast biopsy is a diagnostic test by which a small sample of breast tissue is removed from a suspicious area, and then sent off to be examined in a lab by a pathologist. The main reason to perform a breast biopsy is to determine whether or not a breast lump is cancerous, however it may also be used to remove a fibroadenoma that has already been shown to be benign. Whilst physical examinations and imaging techniques are useful in determining the course of treatment, a biopsy is the only procedure that can definitely determine whether or not a breast lump is cancerous.4 In younger women, a fibroadenoma can often be diagnosed via breast examination and ultrasound. However, if the doctor is unsure a biopsy will be performed.

By and large, you will not need any treatment for a fibroadenoma. Most of them stay the same shape and may disappear of their own accord. However if the lump gets larger, is causing discomfort, or is changing the shape of the breast, then the doctor may opt for the fibroadenoma to be removed (a patient can also request for this).

If the fibroadenoma is large and entangled, the doctor may want to perform an operation called an excision biopsy to remove it, by which a small incision is made in the skin, and the fibroadenoma is surgically removed.4 This is usually performed under local or general anaesthetic, can leave a small scar and may leave the affected area tender or sore for a few days after the procedure.

Alternatively, you may be offered a vacuum assisted excision biopsy to remove the fibroadenoma. This procedure is a relatively new technique and offers a minimally invasive alternative in the removal of fibroadenomas. Performed under local anaesthetic, the procedure involves a small 'nick' being made in the skin, about the size of half a grain of rice, at the affected area. A probe is then inserted into the breast, guided with ultrasound, and a gentle vacuum draws tissue inside the probe, while a rotating knife cuts away and gradually removes the fibroadenoma.7 A vacuum assisted excision biopsy is the National Institute for Health and Clinical Excellence (NICE) recommended treatment option in the removal of fibroadenomas.6 Generally speaking, the procedure does not leave a scar, however the procedure can cause some bruising and pain for a few days after the excision.

To prevent this you should be as familiar as possible with their breasts and check them regularly, so if a lump does develop, you can take action as soon as possible. Although finding a lump in your breast may be worrying at first, between 80 and 85 percent of breast lumps turn out not be cancerous.4 Having said this, it is important to see your doctor if you do detect an abnormality. For more information on breast conditions and general breast health, explore our website.

References
  1. https://www.breastcancercare.org.uk/information-support/have-i-got-breast-cancer/benign-breast-conditions/fibroadenoma
  2. https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/fibroadenomas-of-the-breast.html
  3. http://www.mayoclinic.org/diseases-conditions/fibroadenoma/basics/causes/con-20032223 - causes
  4. NBCF (2016) Biopsy: The national breast cancer foundation. Available at: http://www.nationalbreastcancer.org/breast-cancer-biopsy (Accessed: 24 February 2017) - 80%
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497021/
  6. https://www.nice.org.uk/guidance/ipg156
  7. Mayo Clinic: Breast Biopsy, What you can expect. Available at: http://www.mayoclinic.org/tests-procedures/breast-biopsy/details/what-you-can-expect/rec-20236113