Fibroadenomas need
not be so frightening

By Diane Prokop
Times Staff Writer

One Monday afternoon in September, three teenage girls sat in a doctor’s office, waiting their turn.
These young women weren’t waiting to get booster shots or back-to-school health exams; each was there to visit a surgeon specializing in breast oncology.
It’s always scary when a woman finds a lump or other abnormality in a breast. For a teenager it can be even more frightening, though it doesn’t need to be.
Fibroadenomas, which are benign breast tumors commonly found in young women, account for nearly 90 percent of all breast masses. The lumps, which are abnormal growths of glandular and fibrous tissues, feel like small, slippery marbles and are most prevalent in females ages 15 to 30.
The masses generally measure from 1 to 3 centimeters and carry only a very slight risk for future breast cancer.
Dr. Mary Daly, senior vice president of population science at the Fox Chase Cancer Center, explained a possible cause for fibroadenomas as immature breast tissue suddenly responding to estrogen and progesterone.
"The good news is that almost always, these turn out to be something benign. Just like older women, some have a lot (of growths) and some don’t have any. Some young women begin to experience these changes.
Others never do. A simplified way of thinking about it is that the cells are suddenly getting stimuli from hormones, preparing for full maturity. On a genetic basis, sometimes cells go awry," said Daly, who oversees programs in behavioral research, human genetics, epidemiologic and cancer research at Fox Chase.
Suspected fibroadenomas can be confirmed through ultrasound scans, mammograms and biopsies.
Because of their benign nature, fibroadenomas often are left untreated unless they cause tenderness or pain in surrounding breast tissue.
In those cases, outpatient surgical excision may be recommended. Tumors recur in about 20 percent of cases, according to the Web site microscopyu.com
Phyllodes tumors, which grow in the glandular and connective breast tissue, are not quite as common as fibroadenomas.
They are usually benign, but there still are times when they can be cancerous and spread.
"While they almost never spread, they are treated with surgical removal," Daly said.
Another non-cancerous breast condition occurring in young women is intraductal papillomas. These appear as a polyp projection usually close to the nipple and often present symptoms that include nipple bleeding, according to Daly.
The skin tag-like growths are associated with suspicious nipple discharge, as they often grow within a milk-producing duct. Additional papillomas also may be found on the breast and could be pre-cancerous.
Papillomas can be diagnosed by imaging the breast duct and are often treated by excision of the affected duct.
Awareness of these conditions can help young women become more aware of their bodies and more comfortable with breast self-exams.
While teenagers don’t usually want to hear about the self-exam, Daly believes that no one can do a better examination of a breast and its changes than its owner.
"We often don’t get them until they are twenty-five," Daly said of female patients.
She stressed the importance of girls and their parents being attentive to the parents’ histories on both sides of the family, so they can be more attuned and a bit more aggressive with any issue that might come up. ••
Reporter Diane Prokop can be reached at 215-354-3036 or dprokop@phillynews.com

It’s good to be informed . . .
The American Cancer Society offers these Guidelines for Early Detection:
Age 40 and older
• Annual mammogram
• Annual clinical exam
• Monthly self-exam (optional)
Ages 20 to 39
• Clinical exam every three years
• Monthly exam (optional)

To estimate your cancer risk via the Internet, visit:
• www.yourcancerrisk.harvard.edu
• http://cancer.gov/bcrisktool
To download cards with techniques for breast self-examination, visit http://www.komen.org/intradoc-cgi/idc_cgi_isapi.dll?IdcService=SS_GET_PAGE&ssDocName=DownloadBSECards

Age-specific probabilities of breast cancer*
Age % risk one in
20 .05 1,837
30 .43 234
40 1.43 70
50 2.51 40
60 3.51 28
70 3.88 26

* Among those free of cancer at beginning of age interval. Based on cases diagnosed 2002-04. "One in" numbers rounded up.
Source: American Cancer Society surveillance research, 2007