Breast fibroadenomas are at least ten times more common than breast cancer. They are benign tumors in the breast which present as smooth mobile swellings to the patient. Often they are spherical or oval in shape. They can be tender to touch at times. In recent years, thanks to the popularity of screening ultrasound scans and mammograms, a lot of fibroadenomas present as non-palpable (cannot be felt) lesions detected by imaging techniques. “How to treat a breast fibroadenoma” is a common question posed to many patients and their attending doctors.
While some controversies remain, most surgeons will advise establishing a diagnosis by means of “fine needle aspiration cytology” under ultrasound guidance (involving a radiologist to image the mass and putting a fine needle in it and get cells out for examination by a pathologist). Even though the test is not 100% fool-proof in excluding cancers, the chance of missing the diagnosis of breast cancer is very low. Bearing the small chance in mind, the surgeon can then advise on further treatment on the basis of the working diagnosis of “a benign breast tumor, likely fibroadenoma”.
If the fibroadenoma is small (say, less than 1 cm in its largest dimension), non-palpable and not associated with symptoms, the surgeon may advise that this can be observed rather than removed. If the fibroadenoma is large (more than 2cm in its largest dimension), palpable and associated with tenderness, removal is often advised. The borderline situations between the two are treated in consultation with the patient, taking into account the patient’s preference, level of anxiety caused by the mass, presence or absence of family history of breast cancer and other factors that may come into the picture.
The author has a specific word of warning regarding leaving large or growing fibroadenomas behind for further observation. Some fibroadenomas can grow to a size of over 5cm in their largest dimension. The patient’s concern, besides the issue of malignancy, will be about asymmetry between the breasts and the cosmetic outcome of the surgical incision when the mass is removed surgically. Also, there are instances in which the supposed growing fibroadenoma is in fact a “phyllodes tumor”, a predominantly benign tumor with a slight malignant potential (about 90% of phyllodes tumors are benign and about 10% are malignant). Phyllodes tumors are best excised early. In addition to these, the attending surgeon should at no time forget the possibility of a false-negative (missing the diagnosis of cancer) cytology test.
by Benson Yeung