The incidence of breast fibroadenoma is high, and surgical resection is recommended in the following four situations!

Author: Luo Bin, Chief Physician of Thyroid and Breast Surgery, Beijing Tsinghua Chang Gung Hospital, Tsinghua University

Audit:

Breast fibroadenoma is a benign lesion. Its incidence rate currently ranks third among breast diseases. It is common in young women around 20 years old, but can also occur at any age. However, postmenopausal women account for less than 5% of all fibroadenomas.

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Breast fibroadenoma is related to the imbalance of estrogen and progesterone, but the exact cause is still unclear. In young women, estrogen and progesterone levels fluctuate greatly, so the incidence rate is high. In addition, the earlier the menarche, the higher the chance of fibroadenoma.

Current research has not shown that taking short-acting or temporary contraceptives will increase the incidence of breast fibroadenoma, nor has there been any evidence that breast fibroadenoma is related to genetics.

1. How are breast fibroadenomas generally discovered?

Breast fibroadenoma is not an inflammation but a benign tumor, so it will not show redness, swelling, heat or pain. A small number of breast fibroadenomas may be mildly tender.

Generally, when you self-examine your breasts, you will feel one or more smooth, movable, and clearly defined lumps on your breasts, which are usually no larger than 2 cm. Fibroadenomas smaller than 1 cm are usually not palpable. They can also be found during physical examinations through B-ultrasound.

The border of breast fibroadenomas is relatively clear under B-ultrasound. They are similar to oval or nearly circular low-echo masses. Some are lobed, with relatively uniform echoes and capsules. 10%-20% of fibroadenomas are multiple or occur in both breasts.

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The diagnosis can be made based on age, characteristics of palpation and typical ultrasound findings, and a puncture is required for definitive diagnosis.

2. Will breast fibroadenomas grow and become cancerous?

Some breast fibroadenomas will grow slowly. After observing for 5 or 10 years, it is found that 10% or even 40% of breast fibroadenomas will gradually shrink or even disappear. In most cases, they will not grow larger.

Breast fibroadenomas may become malignant, but the probability is very low. Foreign studies have shown that the probability is between 1/1,000 and 2/10,000. Tianjin Cancer Hospital once published a research report showing that the probability of breast fibroadenomas becoming malignant is 3/10,000, so don't worry.

There are some signs and characteristics that may indicate malignant transformation. First, the age of people with malignant fibroadenomas is relatively old, with an average age of around 45 years old. Second, there is a tendency to grow larger during observation. The morphology changes under ultrasound. In this case, a puncture biopsy may be considered to confirm the diagnosis.

In general, breast fibroadenomas are benign diseases. As long as they do not grow and do not affect the appearance, they are actually harmless. Studies have shown that women with fibroadenomas have a 100% higher risk of developing breast cancer than the general population.

3. Does breast fibroadenoma need to be removed?

Most breast fibroadenomas will not grow larger. Smaller fibroadenomas, such as those below 2 cm, can be observed and do not require any treatment. Regular B-ultrasound examinations at the hospital are sufficient. In addition, you can feel any changes by touching them with your hands.

There are several situations in which surgical resection should be considered: 1. The fibroadenoma is relatively large, larger than 2 cm or 3 cm; 2. The fibroadenoma gradually grows during the observation process, for example, it was 1 cm last year and became 2 cm this year, and there is a trend of growth; 3. It is sometimes painful and causes discomfort; 4. You are very nervous, anxious, and worried. Surgical resection can be considered in the above four situations.

Breast fibroadenoma is common in women aged 20-30, who are at their peak fertility. Many patients worry about whether it will affect pregnancy?

It was previously recommended that fibroadenomas be treated before pregnancy, but studies have found that 75% of fibroadenomas do not grow or change during pregnancy.

If you are preparing for pregnancy and the fibroadenoma is only 1 cm or 2 cm in size, is not located below the nipple or areola, does not affect breastfeeding, and you do not have a strong desire for surgery, you can observe. If the fibroadenoma is larger than 2 cm and you are very concerned, and it tends to grow larger during the observation period, it is recommended that you remove it before pregnancy.

Fibroadenomas are characterized by multiple occurrences. Sometimes they will grow again after surgical removal, and sometimes they will grow again near the surgical site. This is called recurrence, and the recurrence rate can reach 10% or even 20%.

What should I do if it relapses? Still the same as above, if it is not large, has no tendency to grow, and does not cause any physical discomfort, it does not need to be treated and can still be observed.