Even though fibroadenomas of the breast are ten times more common than breast cancer, the management of these can be associated with significant pitfalls. These tumors typically present as smooth mobile masses to the patient, often spherical or oval in shape. They are occasionally tender to touch. More often, they are asymptomatic and not detectable by touch alone, and are incidental findings on screening ultrasounds and mammagrams.
How to treat a breast fibroadenoma
The first priority in the process of management is to establish the diagnosis by means of a test called “fine needle aspiration cyotology” under guidance of ultrasound scanning. This test involves a radiologist who puts a fine needle into the breast mass to aspirate clusters of cells for examination under the microscope). The test is close to 100% accurate in confirming cancer and close to 98% accurate in excluding it. On the basis of the test result, the surgeon will advise on either observation of excision. Surgeons tend to advise excision of the tender and bigger fibroadenomas (greater than 2cm in its largest diameter) and observation of the asymptomatic, non-palpable (cannot be felt on physical examination) and small (less than 1cm in its largest diameter) fibroadenomas, especially when these are multiple in number. The fibroadenomas which are in-between the two extreme situations are treated in consultation with the patient, taking into account her preference, her level of anxiousness, presence or absence of family history of breast cancer and her wishes, as well as other factors that may come into the picture.
Possible pitfalls of observation for prolonged periods
Leaving large or growing fibroadenomas behind for prolonged observation can lead to problems. Some of these tumors grow to the size of 5cm or even more in their greatest diameter. The patient involved will be concerned about malignancy, as well as the issue of asymmetry between the breasts both before and after excision of the mass. There is also the possibly of misdiagnosis that the growing breast tumor is a cancer or a “phyllodes tumor”. The problem of misdiagnosing a cancer is obvious. Missing a phyllodes tumor is also hazardous. Phyllodes tumors are predominantly benign tumors with a slight malignant potential (10% of these exhibit some malignant behavior, even though they don’t tend to spread by lymphatic or blood circulation). Should any doubt subsequently arise following a decision has been made to observe a breast fibroadenoma, the surgeon will still have to be vigilant and prepared to change the course of action and remove the mass for definite diagnosis.
Benson Yeung - General Surgeon born in the sixties, grew up in Hong Kong, won numerous writing awards in primary and secondary schools, educated in ...
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