From the Guidelines
Benign breast disease can be broken down into three broad categories: nonproliferative lesions, proliferative lesions without atypia, and proliferative lesions with atypia, to simplify management and risk assessment for general surgery oral boards. These categories help determine the risk of developing breast cancer, with nonproliferative lesions carrying the lowest risk, and proliferative lesions with atypia carrying the highest risk 1. The key characteristics of each category are:
- Nonproliferative lesions: include benign calcifications, fibrocystic changes, fibroadenomas, lipomas, fat necrosis, and nonsclerosing adenosis, with no increased cancer risk 1.
- Proliferative lesions without atypia: include usual ductal hyperplasia, sclerosing adenosis, complex fibroadenomas, radial scars/complex sclerosing lesions, papillomas, and papillomatosis, with a moderate increased cancer risk 1.
- Proliferative lesions with atypia: include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ (LCIS), and flat epithelial atypia, with a high increased cancer risk 1. Management of benign breast disease varies by type, with non-proliferative lesions typically requiring reassurance and symptomatic treatment only, while proliferative lesions with atypia require surgical excision to rule out malignancy, followed by consideration of chemoprevention 1. It's essential to remember that any solid mass requires triple assessment: clinical examination, imaging (mammogram/ultrasound), and tissue sampling (FNA or core biopsy) to exclude malignancy. Risk assessment should also include family history, as this can multiply the baseline risk 1. By categorizing benign breast disease in this way, general surgeons can provide appropriate management and counseling to patients, reducing the risk of morbidity, mortality, and improving quality of life.
From the Research
Benign Breast Disease Classification
- Benign breast diseases can be categorized into several groups, including:
- Developmental abnormalities
- Inflammatory lesions
- Epithelial and stromal proliferations
- Neoplasms 2
Key Points to Remember
- Benign breast diseases are a heterogeneous group of lesions, making diagnosis and management challenging 2
- Understanding the relationship between benign breast lesions and the development of subsequent breast cancer is crucial 2
Diagnosis and Management
- Accurate diagnosis and management of benign breast diseases are essential to prevent unnecessary interventions and to identify lesions that may increase the risk of breast cancer 2