Benign Breast Conditions
Benign (non-cancerous) breast conditions are unusual growths or other changes in the breast tissue that are not cancer.
Having a benign breast condition can be scary at first because the symptoms often mimic those caused by breast cancer. You or your doctor might be able to feel a lump or see nipple discharge, or your mammogram might pick up something that requires further testing.
Any abnormal change in the breast can be a sign of cancer and needs to be checked out. However, many changes turn out to be benign. In fact, benign breast conditions are quite common — even more common than breast cancer.
Although benign breast conditions aren’t cancer, some can increase your risk of eventually developing breast cancer. Experts often group benign conditions into three categories, according to whether they raise breast cancer risk:
no increase in risk
slight increase in risk
moderate increase in risk
You and your doctor can develop a follow-up plan that suits your diagnosis. Conditions that carry “no increase” and a “slight increase” in breast cancer risk typically require no further action beyond the usual breast cancer screening recommendations for women at average risk.
For conditions that carry a “moderate increase” in breast cancer risk, your doctor might suggest you get more frequent screenings with mammography and/or other imaging tests such as an ultrasound or MRI (magnetic resonance imaging) scan. He or she also might recommend strategies for reducing your risk. If you have additional risk factors for breast cancer, such as a strong family history, this can influence your action plan. These decisions have to be made on a case-by-case basis. Your doctor can help you understand your lifetime risk of breast cancer.
This section includes information about some of the more commonly diagnosed benign breast conditions. (We have not included every possible diagnosis; there are many, many breast cell changes that are considered benign. See your doctor for more information.)
Signs and symptoms of benign breast conditions
There are many different types of benign breast conditions but they all cause unusual changes in breast tissue. Sometimes they affect the glandular tissue (the system of lobules and ducts that produce milk and carry it to the nipple). Or they can involve the supportive tissue of the breast, also called stromal tissue.
A benign breast condition can lead to a distinct growth or lump that sometimes can be felt through the skin. Or it can be something unusual picked up on a screening mammogram.
If you have symptoms, they’re often similar to those associated with breast cancer, such as:
pain, swelling, and/or tenderness in the breast
a lump that can be felt through the skin or nipple
redness or scaling on the nipple and/or skin of the breast
nipple pain or retraction (meaning part of the nipple looks like it is puckered or pulling inward)
discharge from the breast that is not milk (the color can range from clear to bloody to yellow, green, dark brown, or even black. Note: If you have discharge alone, even with no other symptoms, tell your doctor. Generally, yellow or greenish discharge is benign while discharge that is clear or tea-colored is more concerning. Any discharge should be checked out, though.)
All of these symptoms require further testing to rule out breast cancer as a possible cause.
Diagnosis of benign breast conditions
The tests and procedures used to diagnose a benign breast condition are often the same as those used to diagnose breast cancer. The goals of diagnosis are to:
make sure that the growth or other change detected is really benign
determine whether the condition is associated with any increase in cancer risk
Procedures could include:
A breast physical exam and medical history: Your doctor examines the breasts, paying close attention to the area or areas where there is a lump or other unusual change. He or she also takes a complete medical history, including your current and previous symptoms, general breast health, and any risk factors for breast cancer.
Imaging tests: The most commonly used tests are mammography, an X-ray examination of the breast; and ultrasound, which uses high-frequency sound waves to create images of the breast tissue. Ultrasound is a good tool for telling the difference between lumps that are fluid-filled (called cysts) and those that are solid (which can indicate cancer or another benign breast condition, such as fibroadenoma). A breast MRI, or magnetic resonance imaging scan, may also be done if other imaging tests don’t provide enough information.
Nipple discharge analysis: If you have nipple discharge, a sample can be taken and examined under a microscope for the presence of blood or other abnormal cells. In some cases, additional tests may be needed to figure out the cause.
Biopsy: Biopsy involves removing a tissue sample and examining it under a microscope. Typically you would have a core needle biopsy, which removes slivers of tissue, or an excisional biopsy, which removes abnormal tissue from the area.
Your testing plan will depend on your symptoms and what type of benign breast condition is suspected. Your doctor might not be able to tell you much until the test results come back. Waiting is hard, but remember that benign conditions are more common than breast cancer.
In most cases, today’s imaging techniques are advanced enough to tell the difference between a benign breast condition and cancer, notes Alan Stolier, M.D., a surgical breast oncologist with St. Charles Surgical Hospital and the Center for Restorative Breast Surgery in New Orleans. “If anything about the imaging is suspicious, we will go a step further with biopsy,” he says. “If we don’t recommend anything else be done, we have a high level of confidence it is benign.”
In some cases, he adds, your doctor might have you come back for another ultrasound or other imaging study within 6 months. This doesn’t mean he or she is concerned that the breast change could be cancer. Rather, it’s an extra precaution to make sure the area stays the same, and this often eases patients’ minds. However, most women don’t need to be followed with imaging studies in this way. Whatever your situation, don’t hesitate to ask your doctor for more information or seek a second opinion.
Benign breast conditions that do not increase breast cancer risk
Many benign breast conditions don’t increase your risk of developing breast cancer later on. Some of them cause symptoms, while others may be picked up on a routine screening mammogram or ultrasound. They include:
Some benign breast conditions are associated with a slight increase in the risk of developing breast cancer. All of these conditions involve an overgrowth of breast cells that closely resemble normal, healthy cells. The cells look fairly typical and are not abnormal (the technical term is “lesions without atypia”).
The increase in cancer risk is so slight that it generally doesn’t change recommendations about screening practices or follow-up. Your doctor may encourage you to pay closer attention to getting annual mammograms and adopting healthy behaviors that lower risk, such as exercising regularly, maintaining a healthy weight, and limiting alcohol. (See Risk and Risk Factors for more information.) However, your breast cancer risk is still considered to be similar to that of women at average risk.
In addition, your individual situation will be taken into account. You and your doctor can discuss your benign diagnosis in relation to any other well-defined risk factors you may have, such as family history or personal medical history. You can then decide if you need a different follow-up plan.
The following benign conditions are linked to a slight increase in cancer risk. Most would be diagnosed after you’ve had a biopsy of a suspicious area that showed up on an imaging study. Your doctor often will classify the condition based on the appearance of breast tissue under a microscope.
Benign breast conditions known as “atypical hyperplasias” are linked to a moderate increase in the lifetime risk of breast cancer. However, if you are diagnosed with atypical hyperplasia, your risk of being diagnosed with breast cancer in any given year remains low. The actual risk of developing breast cancer over a lifetime depends on other breast cancer risk factors as well as the age you were diagnosed with atypical hyperplasia.
“Hyperplasia” means that there is excessive growth of breast cells that are also “atypical,” meaning they have some, but not all, of the features of carcinoma in situ (an early form of breast cancer that stays inside the duct or lobule where it started). These cells aren’t cancer but they aren’t completely normal either. Sometimes they are also called neoplasias.
Thanks to the increased use of mammography screening, atypical hyperplasias are being diagnosed more often than ever before. An abnormal finding through screening would lead to biopsy and examination of the tissue.
If you’re diagnosed with atypical hyperplasia, keep in mind that these conditions are not breast cancer. They also don’t mean you will develop breast cancer one day. Instead, these conditions suggest a potential for moderate increased risk in both breasts, not just the breast where the cell changes were found. They give you good reason to pay closer attention to your breast health and perhaps work with a breast specialist. However, most women with atypical hyperplasias will never get breast cancer.
You and your doctor can discuss your diagnosis relative to any other breast cancer risk factors you may have — such as family history, personal medical history, or lifestyle — and your follow-up plan.
There are two main types of atypical hyperplasia:
Benign breast changes due to inflammation, infections, pregnancy, and more
There are other benign breast conditions that result from inflammation, infection, pregnancy, or simply other unusual changes. They can lead to the development of lumps, growths, irritated areas, unusual discharge, and/or pain. These conditions aren’t associated with increased risk of breast cancer. However, their symptoms often will lead you and your doctor to consider breast cancer as a possibility. You’ll often need additional imaging tests, such as ultrasound and mammography, and perhaps even a biopsy, to make sure the condition is truly benign.
Many benign breast conditions are linked to inflammation, pain, and infection. There can be areas of redness and swelling involving the nipple, areola, and/or skin of the breast. Such symptoms are usually not a sign of breast cancer. However, any breast changes that persist over time should be checked by a breast specialist. Infections usually get better quickly and completely resolve after a couple weeks’ treatment with antibiotics. If you have symptoms of inflammation and infection that won’t go away, you can ask your doctor to rule out a rare form of cancer known as inflammatory breast cancer (IBC). Inflammatory breast cancer is an uncommon but aggressive form of breast cancer that usually starts with redness and swelling in the breast rather than a distinct lump. Learn more about Inflammatory Breast Cancer.
Other benign breast conditions can cause unusual symptoms that require further investigation. Generally, these symptoms are not the same as those that occur with breast cancer.
If you’ve ever been pregnant or you’re close to someone who has, you know that pregnancy and breastfeeding lead to major changes in the breasts. Pregnancy-related hormones increase the volume and density of the breasts. The breasts not only get bigger but the tissue inside them becomes more glandular and less fatty — all part of the process of getting ready to produce milk after the baby is born. These tissue changes, along with the act of breastfeeding itself, make pregnancy and the postpartum period a prime time for developing benign breast changes.
Follow-up care for benign breast conditions
Usually, women with benign breast conditions linked to no increase or a slight increase in cancer risk don’t need additional follow-up besides routine screening with annual mammograms and clinical exams. If you had surgery to remove a growth, certainly you’ll have appointments to check on healing.
Your doctor may recommend a follow-up breast exam and imaging test (mammogram, ultrasound, and/or MRI, magnetic resonance imaging) within 6-12 months to check on the area. If you have a cyst, fibroadenoma, or other growth that didn’t need to be removed, your doctor may recommend checking on it with breast exams and ultrasound for the first couple of years as a precaution. Or you might go right back to annual screenings.
Closer follow-up might be needed if:
you have a benign condition linked to a moderate increase in breast cancer risk, such as atypical hyperplasia or lobular carcinoma in situ
you have a benign condition linked to a slight increase in breast cancer risk, but you also have some known breast cancer risk factors, such as family history
You and your doctor can work together to understand your level of risk and develop a plan that’s right for you. You also may wish to be followed by a breast specialist with expertise in benign breast conditions.
Your plan may include the following:
You and your doctor will develop a screening plan tailored to your situation. In some cases, you may simply proceed with monthly breast self-exams and yearly mammograms (age 40 and over) and clinical breast exams by your doctor. However, your doctor also may recommend:
starting mammograms before age 40
having additional screening tests such as ultrasound or MRI of the breast, which can aid with early detection
being screened more frequently (say, every 6 months instead of every 12 months), perhaps alternating the type of test you have each time — mammography and MRI, for example
Certain lifestyle changes can help you keep your risk of breast cancer as low as possible. Examples include:
maintaining a healthy weight
eating nutritious food
never smoking (or quitting if you do smoke)
avoiding or stopping hormone replacement therapy
If your benign breast condition and other risk factors put you at a moderately increased risk of developing breast cancer, your doctor may recommend anti-estrogen hormonal therapy. By blocking the effects of estrogen or lowering estrogen levels in the body, these medicines can reduce the risk of developing hormone-receptor-positive breast cancer. Examples include:
tamoxifen (brand names: Nolvadex, Soltamox)
raloxifene (brand name: Evista)
toremifene (brand name: Fareston)
exemestane (brand name: Aromasin)
anastrozole (brand name: Arimidex)
letrozole (brand name: Femara)
fulvestrant (brand name: Faslodex)
Tamoxifen is usually recommended for premenopausal or postmenopausal women; the other medications are generally used after menopause.
These medications have side effects, so you and your doctor can discuss whether the benefits in terms of risk reduction are great enough to justify taking them.
— Last updated on December 20, 2021, 6:45 PM