Breast cancer is common. The average risk for a woman to develop breast cancer is 1 in 8. That being said, not all breast masses are cancer. In fact, there are more non-cancerous breast masses biopsied than cancerous masses. Understanding the type of mass present in the breast after a biopsy can go a long way toward alleviating concerns related to future increased breast cancer risk for you and your family members. Sometimes women believe they have a family member who has had breast cancer because they had a “lump removed”. However, many times the family member had undergone a breast biopsy and was found to have a non-cancerous mass. It is important to clarify this point with your family to reduce unnecessary stress that accompanies the knowledge of breast cancer family history.
The most encountered benign (non-cancerous) biopsy results fall into these categories which are each discussed in more detail in the linked articles:
- Fibrocystic change (also referred to as fibrocystic breast disease)
- Benign breast cysts
- Fibroadenoma
Additional benign breast masses that often do not require a biopsy to make the diagnosis include lipoma and hamartoma.
MOST non-cancerous masses do not increase your lifetime risk of developing breast cancer. If fibrocystic change, benign breast cysts, or fibroadenoma are diagnosed on biopsy, the personal and family risk of developing breast cancer is not increased.
However, like most things in medicine, this is not an all-or-none situation. Some non-cancerous conditions of the breast ARE associated with an increased risk of developing breast cancer. If the biopsy results include the word “atypia”, “atypical”, or “LCIS” then your lifetime risk of developing breast cancer is increased. This is true even if one of the non-cancerous conditions is also present. For example: if the biopsy results show fibroadenoma with atypia, the atypia trumps fibroadenoma, increasing the personal lifetime risk of breast cancer. If one of the above results that increases lifetime risk of breast cancer are found at the time of biopsy, a surgical consultation will be recommended to discuss if a surgical excisional biopsy is also needed.
Pathology reports can be confusing. If you read your pathology report it will not always be clear that the biopsy results are benign. There are often many complicated descriptions of the actual cell types present in the biopsy samples. To the trained professional this will classify the biopsy results into a benign category, but it may not be readily apparent to you as a patient reading your pathology report. The breast radiologist and your primary care provider will guide you concerning any follow-up recommendations.
Benign pathology of the breast without atypia usually does not need to undergo surgery. However, there are times when surgery may still be considered or needed. First, if the radiologist does not feel the benign pathology results match what is seen on imaging, they will call the pathology results “discordant” and recommend a surgical excision for complete pathologic evaluation of the finding. Additionally, women with large fibroadenomas may undergo surgical removal of the mass for cosmetic reasons. As long as atypia is not found on the surgical specimen, the personal and family risk of breast cancer is not increased.
Imaging follow up recommendations after a benign breast biopsy will vary depending on the age of the patient, the pathology results, and the specific breast imaging findings. We will inform both the patient and the primary care provider of the imaging follow-up recommendations by including them in the biopsy report along with the pathology results.