The vast majority of women presenting with breast symptoms will have an underlying benign etiology. Only 1 in 10 of all women referred to a specialist breast clinic will have breast cancer. After establishing a firm diagnosis of benign disease, reassurance and an appropriate plan of management will need to be instituted. Benign disorders of the breast represent a large proportion of the workload at a specialist breast clinic; therefore, it is important to carefully distinguish these disorders from premalignant and malignant disease of the breast.
Understandably, they are a source of considerable anxiety for the patient and a potential source of medicolegal problems. A clear understanding of benign disease of the breast is therefore essential.
To ensure uniformity and consistency amongst all members of the specialist breast team, appropriate management protocols are advisable in clinical practice.
Our unit has developed management protocols based on available scientific evidence and has adopted a multidisciplinary approach in the management of patients involving surgeons, radiologists and pathologists.
The majority of patients with benign breast disease are premenopausal.
With the advent of hormone replacement therapy (HRT), an increasing number of postmenopausal women now present with a similar spectrum of disorders. The simplest approach to benign breast disease is to regard this group of disorders as an aberration of normal development and involution (ANDI).
This outlook facilitates an easier understanding of these disorders and consequently makes it easier to reassure patients and treat them appropriately.
A.D. Purushotham, P. Britton and L. Bobrow
A prospective study of benign breast disease and the risk of breast cancer. JAMA 2002
- Roberts MM, Elton RA, Robinson SE et al. Consultations for breast disease in general practice and hospital referral patterns. Br J Surg 1987; 74:1020-1022.
- Cochrane RA, Singhal H, Monypenny IJ et al. Evaluation of general practitioner referrals to a specialist breast clinic according to the UK national guidelines. Eur J Surg Oncol 1997; 23:198-201.
- Hughes LE, Mansel RE, Webster DJT. Aberrations of normal development and involution (ANDI): A new perspective on pathogenesis and nomenclature of benign breast disorders. Lancet 1987; 2:1316-1319.
- Minton JP, Foecking MK, Webster DJ et al. Response of fibrocystic disease to caffeine withdrawal and correlation of cyclic nucleotides with breast disease. Am J Obstet Gynecol 1979; 135:157-158.
- Boyd NF, McGuire V, Shannon P et al. Effect of a low-fat high-carbohydrate diet on symptoms of cyclical mastopathy. Lancet 1988; 2:128-32.
- Horrobin DF. The effects of gamma-linolenic acid on breast pain and diabetic neuropathy: possible noneicosanoid mechanisms. Prostaglandins Leuko Essent Fatty Acids 1993; 48:101-104.
- Gateley CA, Miers M, Mansel RE et al. Drug treatments for mastalgia: 17 year experience in the Cardiff mastalgia clinic. J R Soc Med 1992; 85:12-15.
- Chamners GC, Asch RH, Paurstein CJ. Danazol binding and translocation of steroid receptors. Am J Obstet Gynecol 1980; 136:426-429.
- Hinton CP, Bishop HN, Holliday HW et al. Double blind controlled trial of danazol and bromocriptine in the management of severe cyclical breast pain. Br J Clin Pract 1986; 40:326-330.
- O'Brien PMS, Abukhalil IEH. Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol. Am J Obstet Gynecol 1990; 180:18-23.
- Fentiman IS, Caleffi M, Brame K et al. Double-blind, controlled trial of tamoxifen therapy for mastalgia. Lancet 1986; 1:287-288.
- Konstostolis E, Stefanidis K, Navrozoglou I et al. Comparison of tamoxifen with danazol for treatment of cyclical mastalgia. Gynecol Endocrinol 1997; 11:393-397.
- Clayton RN. Gonadotrophin releasing hormone from physiology to pharmacology. Clin Endocrinol 1987; 26:361-384.
- Mansel RE, Dogliotti L. A European multi-center trial of bromocriptine in cyclical mastalgia. Lancet 1990; 335:190-193.
- Pasqualini JR, Cortes-Prieto J, Chetrite G et al. Concentrations of estrone, estradiol and their sulfates, and evaluation of sulfatase and aromatase activities in patients with breast fibroadenoma. Int J Cancer 1997; 70:639-643.
- Noguchi S, Yokouchi H, Aihara T et al. Progression of fibroadenoma to phyllodes tumour demonstrated by clonal analysis. Cancer 1995; 76:1779-1785.
- Cant PJ, Madden MV, Coleman MG et al. Nonoperative management of breast masses diagnosed as fibroadenoma. Br J Surg 1995; 82: 792-794.
- DuPont WD, Page DL, Parl FF et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med 1994; 331:10-15.
- Heywang-Kobrunner SH, Schreer I, Dershaw DD. Diagnostic Breast Imaging: Mammography, sonography, magnetic resonance imaging and interventional procedures. Stuttgart; New York: Thieme, 1997; 169.
- Tohno E, Cosgrove DO, Sloane JP. Ultrasound Diagnosis of Breast Diseases. New York: Churchill Livingstone, 1994; 78-88.
- Zurrida S, Bartoli C, Galimberti V et al. Which therapy for the unexpected phyllodes tumour of the breast? Eur J Cancer 1992; 28:654-657.
- Bruzzi P, Dogliotti L, Naldoni et al. Cohort study of association of risk of breast cancer with cyst type in women with gross cystic disease of the breast. BMJ 1997; 314:925-928.
- Dixon JM. Breast cancer risk with cyst type in cystic disease of the breast. BMJ 1997; 315:545-546.
- Murad T, Contesso G, Mouriessa H. Nipple discharge from the breast. Ann Surg 1982; 195:259-264.
- Dixon JM. Periductal mastitis/duct ectasia. World J Surg 1989; 13:715-20.
- Carter D. Intraductal papillary tumors of the breast. Cancer 1977; 39:1689-1692.
- Andersen JA, Gram JB. Radial scar in the female breast: A long-term follow-up study of 32 cases. Cancer 1984; 53:2557-2560.
- Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985; 312:146-151.
- Jensen RA, Page DL, Dupont WD et al. Invasive breast cancer risk in women with sclerosing adenosis. Cancer 1989; 64:1977-1983.
- Dupont WD, Parl FF, Hartmann WH et al. Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer 1993; 71:1258 -1265.
- Palli D, Del Turco MR, Simoncini R et al. Benign breast disease and breast cancer: A case-control study in a cohort in Italy. Int J Cancer 1991; 47:703-706.
- London SJ, Connolly JL, Schnitt SJ et al. A prospective study of benign breast disease and the risk of breast cancer. JAMA 1992; 267:941-944.
- Braunstein GD. Gynecomastia. N Engl J Med 1993; 328:490-495.
- Parker LN, Gray DR, Lai MK et al. Treatment of gynecomastia with tamoxifen: A double-blind crossover study. Metabolism 1986; 35:705-708.
- McDermott MT, Hofeldt FD, Kidd GS. Tamoxifen therapy for painful idiopathic gynecomastia. South Med J 1990; 83:1283-1285.