When It's Not Breast Cancer: All About Benign Breast Disease

There are times when what someone finds in their breast—whether a lump, discharge, pain, or skin changes—isn’t cancer. Until a diagnosis is made, however, it can be a very anxious time for the patient and their loved ones, according to Heather Davis, CNP, Baystate Breast & Wellness Center in Springfield.

Ms. Davis’ role is to evaluate breast symptoms, but fortunately, most breast symptoms are not cancer.

“The first thing we will do is evaluate the situation,” says Ms. Davis. “We are the first point of care.”

First Step in Breast Care

When someone calls the Baystate Breast & Wellness Center with a new breast problem, they are assigned to one of the nurse practitioners, who takes their history, conducts an exam, and will order the appropriate breast imaging such as an ultrasound or a mammogram.

“We follow up on any abnormalities,” she says. “If it turns out to be cancer, we refer them to a breast surgeon. If not, we take care of the situation.”

She says evaluation often includes a biopsy, which may be the only way to know exactly what a breast lump is.

“If we find a fibroadenoma (a non-cancerous solid breast tumor), for instance, we will see the patient every six months for two years just to make sure it doesn’t change,” she says. “If it’s a large cyst, we’ll aspirate to relieve the pain or discomfort caused by the cyst.”

Plan for Care of Benign Breast Disease

If the findings are not cancerous, Ms. Davis and the care team explain the imaging and biopsy results and make a plan to address the underlying condition.

“Someone comes in with a mass and though the likelihood of it being cancer is low, we all want to be sure,” says Ms. Davis. “But it is the patient that carries the anxiety until the diagnosis is made. We do see the anxiety fall away if it isn’t cancer.”

Ms. Davis says most biopsies reveal a benign condition, but even so, she will follow a patient for two years after to make sure it doesn’t turn into cancer. “If it isn’t cancer and after two years there haven’t been any issues, the patient returns to their primary care for regular care,” she says.

Evaluating Breast Pain and Other Symptoms

The office gets a lot of referrals for pain, she explains. A lot of time breast pain is worse just before a woman gets her period and it subsides after. “That’s totally normal,” she says. “If there’s breast pain in just one area and it lasts a couple weeks or more, the patient should come in for an evaluation,” she says. “Anyone with a breast lump or discharge should be evaluated as well.”

For evaluation of breast pain, the provider will do an exam and decide if there is an indication for getting an ultrasound or mammogram, and then the provider will come up with a plan to manage the pain. Ms. Davis says addressing a patient’s anxiety is very important, because many times they are anxious worrying about cancer. Most breast pain is not caused by cancer. In addition to normal hormonal changes, other causes of breast pain include poorly fitted bras (i.e. not enough breast support), caffeine, and pain and inflammation in the chest muscles under the breasts.

Family History and Screening Recommendations

If an individual has a strong family history of breast cancer – parent, sibling – they should have breast exams with their PCP or OB/GYN once a year and should consider starting screening mammograms ten years earlier than the age when their family member was diagnosed with breast cancer, but not younger than age 30. For example, if a woman’s mother was diagnosed with breast cancer at age 45, she would start to have mammograms at age 35 instead of waiting to age 40 which is when most women start screening with mammograms. “It’s better to be safe,” she explains.

Non-Cancerous Possibilities

Dr. Holly Mason, Section Chief for Breast Surgery at Baystate Health, adds, “Many breast symptoms like lumps, pain, and discharge are not cancerous and can have a number of causes.”

These include:

• Cysts are fluid-filled sacs. They are typically painless and slow-growing and are smooth to the touch. Some go away on their own, others may become large and painful in which case they can be drained by a professional.
• Fibroadenomas: common non-cancerous solid breast tumors. Fibroadenomas are more common in young women and thought to be influenced by hormones.
• Fibrocystic breast changes: fluctuating hormone levels can make breasts feel lumpy, dense, and tender, especially before menstruation.
• Intraductal papilloma: Small growths that form inside the mammary duct near nipple and may cause discharge. Surgery may be recommended to remove the growths and reduce the risk of cancer.
• Mammary duct ectasia: People who have reached menopause are more prone to this. Milk ducts may swell, thicken, and sometimes become blocked. The nipple might turn inward or leak discharge. It does not increase cancer risk.
• Traumatic fat necrosis: Breast lumps form when scar tissue replaces breast tissue that has been damaged. It does not raise the risk of cancer and does not need treatment.
• Skin abscesses: pus-filled lumps caused by bacteria getting under the skin. They can be painful, squishy, and warm to the touch, and they may leak pus.
• Pseudoangiomatous Stromal Hyperplasia (PASH): benign mass caused by overgrowth of cells. PASH typically does not require treatment unless it forms a large and uncomfortable lump.
• Phyllodes tumors: rare tumors that grow in the breast’s connective tissues. Typically benign, but some can be malignant.
• Usual ductal hyperplasia (UDH): a benign condition where the cells lining the milk ducts multiply excessively. It does not typically cause symptoms, but, in some cases, small, painless lumps may form in the breast. The risk of cancer is very small and does not need treatment.
• Sclerosing adenosis: a benign condition characterized by the formation of scar-like tissue within the milk-producing glands, or lobules, of the breast. Currently no treatment is recommended.
• Atypical cells: abnormal cells in the breast that are not cancerous but may have an increased risk of developing into cancer in the future. The specific type of cells present determines what kind of imaging or treatment may be needed.

When to See a Healthcare Provider for Breast Concerns

If you have any of the following symptoms, contact your healthcare provider:

• There is a breast lump
• The breast or nipple looks red or swollen
• There is bleeding or clear nipple discharge
• There is persistent pain

Breast cancer may be the first thing a person thinks of when they feel a lump in their breast, but fortunately, most lumps are benign. Breasts are filled with glands, tissue, and fat. It is relatively common to develop a breast lump, cyst, or tumor in the breast, known as benign breast disease. They are not life-threatening, but some may increase the risk of developing breast cancer in the future. While most conditions are non-cancerous, the best way to know for sure is to see your healthcare provider.

Men can also get benign breast disease and breast cancer, but it is much less common. Symptoms are the same as in women, so any men with breast symptoms noted above should see a health care provider.