What Is Benign Breast Disease?

We hear the statistics often: 1 in 8 women will develop breast cancer in her lifetime, and the risk for breast cancer increases with age. But many people aren’t as familiar with noncancerous or benign breast disease, which comes with some of the same initial warning signs as breast cancer, such as a lump in the breast or a suspicious mammogram. “Women need to understand that not every palpable lump in the breast is an issue. However, it’s important when they notice anything to seek an evaluation by a health care provider who can discern the difference,” says Dr. Susan Hoover, surgical oncologist specializing in breast cancer at the Moffitt Cancer Center Department of Breast Oncology.

Benign breast conditions are common, and most women will experience some of them in their lifetime, according to the American Cancer Society.

While there are many types of benign breast diseases, here the most prevalent:

Simple or Complex Cysts

Cysts are fluid-filled sacs that can be found in many places in the body. In the breast, cysts may show up as swollen, painful or tender lumps that may worsen during a woman’s menstrual period.

A simple cyst is filled with water and doesn’t evolve into cancer. It often goes away on its own.

Complex cysts have both fluid and solid matter. “On an ultrasound, if a radiologist sees things within the cyst like flecks floating in the water, those start to move a cyst from simple to complex. And then the significance is whether the cyst has something growing in it that can be cancerous,” Hoover explains.

If the cyst is large and uncomfortable, your doctor may drain it with a needle and test it for breast cancer if it’s found to be suspicious.

Fibrocystic Breast Changes

For many women, breast tissue may become denser and it may have simple cysts within it. This combination is a benign breast condition that was once called fibrosis or fibrocystic breast disease. However, doctors now refer to the condition as fibrocystic breast changes.

Fibrocystic breast tissue may feel rubbery, firm or hard. It can lead to swelling or tenderness in the breast and may be influenced by hormonal changes that occur during the menstrual cycle.

Fibrocystic breast changes often resolve with time and do not usually require treatment. But many doctors will want to monitor the condition. “For the physician, it can be a problem because the patient comes in with a lump and you don’t know what it is,” Hoover says. “We typically order a mammogram and ultrasound to tell us if the lump is something of concern or not.”

If noncancerous breast lumps caused by fibrocystic breast changes cause you pain, the American Cancer Society suggests using over-the-counter pain relievers, wearing a supportive bra or applying a warm compress.

Ductal or Lobular Hyperplasia

Ductal and lobular hyperplasia are benign breast conditions that refer to an overgrowth of breast cells in the lobules (the milk glands) of the breast and the ducts of the breast (tiny tubes that deliver milk to the nipple). "Ductal and lobular designation depends on how these cells look under the microscope," Hoover notes.

Hyperplasia is categorized as usual or atypical:

Hyperplasia seldom shows up as a lump. It tends to be found in a routine mammogram and is diagnosed using a needle biopsy. In cases of atypical hyperplasia, doctors do a surgical biopsy and take a little bit more of the surrounding tissue.

Lobular Carcinoma in Situ

Lobular carcinoma in situ refers to abnormal cell growth inside the breast lobules that has not spread to surrounding tissue. It typically does not cause symptoms, and it may not show up on a mammogram. It is usually diagnosed between ages 40 and 50. "It's often found incidentally in a woman’s breast as a result of getting a breast biopsy performed for some other reason," Hoover says.

Although lobular carcinoma in situ includes the word "carcinoma," which means cancer, it is not a cancer. It’s a benign breast condition. The problem is that having lobular carcinoma in situ indicates that a person is at higher-than-average risk for having breast cancer now or in the future.

Treatment of lobular carcinoma in situ may involve needle biopsy, surgery to remove the affected tissue, alternating mammograms and breast MRI every six months as part of breast cancer surveillance and medication to ward off future cancer. “We typically offer tamoxifen, an anti-estrogen pill. We think these beginning breast formations are driven by estrogen. If we can make the estrogen load lower, there’s less estrogen floating around to bathe the breast cells and cause them to do things they’re not supposed to be doing,” Hoover says.

Fibroadenomas

Fibroadenomas are firm, smooth, rubbery or hard growths that often have a defined shape. These noncancerous breast lumps are “probably the most common in women in their 20s and 30s, but they can be found in women of any age. They tend to shrink after a woman goes through menopause,” explains Dr. Nicole Williams, assistant professor of medical oncology at the Ohio State University Wexner Medical Center.

“We usually image fibroadenomas. Depending on the size and how they look, we leave them alone,” Hoover notes.

Do These Conditions Elevate My Breast Cancer Risk?

For the most part, benign breast conditions aren’t cause for much concern, Williams says, but they should be checked out just to be sure they aren’t cancerous or masking a cancer elsewhere in the breast. In most cases, you’ll be offered a mammogram, and depending on the results of that, you may have an ultrasound or a biopsy.

However, lobular carcinoma in situ, complex cysts and hyperplasia with atypia can increase your risk of developing breast cancer. Atypical hyperplasia can elevate a woman’s risk for developing breast cancer at least four times that of the general population, according to the Mayo Clinic. Williams says that patients with lobular carcinoma in situ have “anywhere from seven to 12 times higher risk of developing invasive cancer in either breast.”

Risk Factors for Benign Breast Disease

As a rule, doctors don’t assign risk factors for benign breast disease. “Any woman with breasts is subject to benign breast disease,” Hoover points out. “There’s not a hard and fast rule that says if you’re 25, you’re at risk. It doesn’t work that way.”

However, Hoover says the same advice that applies to reducing breast cancer risk applies to overall breast health, including:

Remember: If you have any pain, tenderness or swelling in your breasts or find a lump, it’s best to get it checked out by your gynecologist. Most likely, it’s not breast cancer. Nearly 80 percent of all breast lumps are not cancerous, according to the Cleveland Clinic.

“That doesn’t mean you shouldn’t get it evaluated, and don’t be afraid,” Hoover advises. “The earlier we find something, the better we are at treating it.”