Benign diseases are classified into two major categories based on the increased risk of breast cancer development or lack thereof. Nevertheless, they have common symptoms such as:
- Palpable changes
- Discharge from the nipple
- Breast pain, intense chest pain
- Change in the quality of the skin
- Benign diseases not associated with an increased risk of breast cancer development.
- Fibroadenoma: It is a benign, solid mass, well-described in ultrasound imaging, and can be solitary or multiple. It mainly occurs after the age of 30, and its size increases during pregnancy and hormone therapy. The frequency and size decrease during menopause. When the size is less than 2 cm and the imaging and clinical presentation do not raise suspicion of malignancy, a 6-month follow-up with clinical and imaging examination is recommended. When there is suspicion or a change in the clinical presentation, a fine-needle aspiration (FNA) biopsy and further cytological examination are recommended. In cases where, during the 6-month follow-up, there is a change in shape and size, surgical removal is necessary. If initially found to be larger than 2 cm or multiple, surgical removal is necessary. It is not clinically monitored during the months since the likelihood of transforming into cancer is high.
- Fibrocystic breast disease: It is a condition that predominantly occurs in premenopausal women. It mainly represents the dense structure of the breast parenchyma rather than a pathological condition. It often causes nipple discharge or intense breast pain. The disease manifests when multiple cysts obstruct or distend the central lactiferous ducts, resulting in intense breast pain. The management of mild mastalgia due to fibrocystic breast disease involves reducing the consumption of coffee and chocolate, abstaining from alcohol, and smoking, and avoiding stress as much as possible. If the pain is not relieved, pharmacological treatment with non-steroidal anti-inflammatory drugs may be necessary to reduce edema and inflammation.
- Ductal ectasia: It is a condition in which dilation of the ducts beneath the nipple is accompanied by the secretion of a yellowish-brown fluid. It is often seen in smokers and generally does not require treatment. However, it is necessary to differentiate it from nipple discharge due to intraductal carcinoma.
- Breast cysts: It is a common condition, especially in women aged 30-40, who are smokers. Cysts can be solitary or multiple and may also be caused by trauma. A sudden increase in their size can cause intense and sudden breast pain. When the cysts communicate with lactiferous ducts, the pain is accompanied by greenish-brown or dark brown nipple discharge. The therapeutic approach to cysts varies depending on their size and content.
- In cysts smaller than 1.5 cm when the ultrasound shows no solid components, clinical and imaging follow-up every 6 months is recommended.
- When the size is larger than 1.5 cm, FNA (Fine Needle Aspiration) biopsy and cytological examination are recommended for clarification.
- If there is a recurrence after biopsy or if the ultrasound, mammography, or clinical examination raise suspicions about the nature of the cyst, surgical removal and histological examination are required.
- Resource ducts: Resource ducts, single or multiple, mainly manifest as nipple discharge. It can be bloody or yellow-brown, spontaneous, or only caused by pressure and massage on the nipple. Usually, resource ducts remain small and do not require treatment, only monitoring. However, if nipple discharge changes in consistency or becomes more pronounced, further investigations are necessary. This includes repeat cytological examination of the discharge, clinical imaging examinations, and ultrasound to assess any increase in size. In such cases, surgical removal (duct excision) and histological examination are required.
- Inflammations: Mastitis and breast abscesses are more common in lactating mothers but can occur in the general population as well. Differential diagnosis with inflammatory breast cancer is crucial. The most common pathogens causing inflammation are Streptococcus and Staphylococcus aureus. Prompt and effective treatment is necessary to prevent the spread of inflammation to the entire breast, which can lead to severe clinical consequences such as significant swelling, fever, and pain, followed by fat necrosis, cyst formation, and abscesses.
- Adenosis: It is a rare benign lesion that is primarily diagnosed through mammography. Monitoring is recommended, but if there are changes in size or mammographic appearance, surgical removal and histological examination are necessary.
- Galactocele: It is a condition that occurs mainly after weaning. It consists of cystic formations containing milk. Treatment involves aspiration to drain the contents and confirming the initial diagnosis by collecting milk.
- Diabetic mastopathy: It occurs in women who have type 1 diabetes. A palpable mass in the breast is the typical clinical presentation. Surgical removal and biopsy are necessary to differentiate it from breast cancer. If the biopsy confirms its benign nature, clinical monitoring is sufficient, as the condition may recur, but the possibility of developing cancer cannot be ruled out.
- Benign conditions associated with an increased risk of breast cancer development:
- Complex fibroadenomas: In cases where fibroadenomas contain sclerosing adenosis, cysts larger than 3 cm, or other complex changes in imaging, they are associated with an increased risk of developing breast cancer. Surgical removal and histological identification of their benign nature are recommended.
- Phyllodes tumors: These are tumors that resemble fibroadenomas but often have leaf-like projections and cystic components. They are considered intermediate-grade tumors as they grow rapidly in size and often exhibit increased vascularity. Their progression to malignancy (sarcoma) is common, making surgical removal necessary. They also tend to recur, which categorizes them as intermediate-grade lesions.
- Sclerosing adenosis: It is characterized by palpable hardness, usually accompanied by pain. Histologically, it presents with lobular hyperplasia in a background of increased fibrous tissue. Mammography typically shows scattered microcalcifications bilaterally. Surgical biopsy is necessary to exclude breast cancer.
- Atypical ductal hyperplasia (ADH): ADH refers to abnormal cell growth in the breast ducts, which carries an increased risk of developing breast cancer. Surgical excision is recommended to ensure complete removal and further evaluate the lesion for any potential malignancy.
- Lobular carcinoma in situ (LCIS): LCIS is a non-invasive condition characterized by abnormal cell growth in the lobules of the breast. Although it is not considered a precursor to invasive breast cancer, it is associated with an increased risk of developing breast cancer in either breast. Close monitoring and risk reduction strategies are recommended.
