BENIGN BREAST DISEASE

Question 1

Define benign breast disease

Answer 1

Breast tissue changes ranging from normal to abnormal, either in development, cyclical change or involution (shrinking down of an organ in old age) phases.

Question 2

LIST types of benign brest disease

Answer 2

o Fibrocystic change
o Breast cysts
o Fibroadenomas -results from hypertrophy of abreast lobule
o Sclerosing adenosis - aberration of normal involution
o Intraductal papillomas - a small, benign tumour that forms in a milk duct
o Duct ectasia - when central ducts become dilated with ductal secretions. These secretions may leak into periductal tissues and cause an inflammatory reaction (periductal masititis)
o Periductal mastitis
o Fat necrosis

Question 3

Explain the aetiology of benign breast disease

Answer 3

• Related to changes in hormone levels

* Fat necrosis occurs secondary to TRAUMA

Question 4

Explain the risk factors of benign breast disease

Answer 4

o May be less common in patients on the OCP

o SMOKING is a risk factor for periductal mastitis

Question 5

Summarise the epidemiology of benign breast disease

Answer 5

• VERY COMMON
• Diffuse fibrocystic changes are very common (60% of women)
• Fibroadenomas are more common in 15-35 yrs

Question 6

Recognise the presenting symptoms of benign breast disease

Answer 6

• History of breast discomfort or pain (may be cyclical)
• Swelling or lump
• Nipple discharge

NOTE: if bloody nipple discharge –> malignancy should be suspected

Question 7

What do you ask a patient to asses risk factors for breast cancer?

Answer 7

Family history of breast cancer
Exposure to oestrogens:
- age of menarche
- menopause 
- number of kids
- breastfeeding
- use of OCP/HRT

Question 8

Recognise the signs of benign breast disease on physical examination

Answer 8

• Focal or diffuse nodularity of breast

Question 9

Recognise the signs of FIBROADENOMA on physical examination

Answer 9

Smooth
Well circumscribed
Mobile lumps

(known as a ‘breast mouse’)

Question 10

Recognise the signs of DUCT ECTASIA on physical examination

Answer 10

YELLOW GREEN DISCHARGE

Question 11

What is duct ectasia?

Answer 11

A condition in which central ducts become dilated with ductal secretion
due to a blockage of the lactiferous ducts

Question 12

Identify appropriate investigations for benign breast disease

Answer 12

TRIPLE ASSESMENT
o Clinical Examination

o Imaging
• Mammography (twoMview)
NOTE: benign lumps are less likely to be calcified
• Ultrasound - in younger patients (< 35 yrs)

o Cytology/Histology
• Fine Needle Aspiration - sent for cytological analysis
• Excision Biopsy - sent for histological analysis

Question 13

Generate a management plan for benign breast disease

Answer 13

• Conservative
o Symptomatic treatment (e.g. analgesia for mastalgia)
o Fibroadenomas may be treated conservatively

• Surgery
o Removal or excision biopsy of a breast lump
o Wide local incision if there is any suspicion of the lump not being benign
o Microdochectomy (surgical removal of a lactiferous duct) - performed for
intraductal papillomas
o Hadfield’s Procedure (surgical removal of ALL lactiferous ducts under the nipple) - is used for duct ectasia

Question 14

Identify possible complications of benign breast disease

Answer 14

• Pain

* Recurrence

Question 15

Summarise the prognosis for patients with benign breast disease

Answer 15

• GOOD

* However, recurrence is common

Question 16

How do fibroadenomas form?

Answer 16

Results from hypertrophy of abreast lobule

Question 17

What is sclerosing adenosis?

Answer 17

Aberration of normal involution

Question 18

What are intraductal papillomas?

Answer 18

A small, benign tumour that forms in a milk duct

Question 19

What is duct ectasia?

Answer 19

When central ducts become dilated with ductal secretions. These secretions may leak into periductal tissues and cause an inflammatory reaction (periductal masititis)

Question 20

What is a risk factor for periductal mastitis?

Answer 20

Smoking

Question 21

What features of malignancy shouldn’t be found on examination for benign breast disease?

Answer 21

o Dimpling
o Peau d’orange
o Enlarged axillary lymph nodes