Complex fibroadenoma?
hi ladies!
I have a question. About 3 years ago I had a biopsy done for a lump. It turned out to be a fibroadenoma. I was 30 at the time. Fast forward to now I had too get my pathology reports for another reason and I see that that fibroadenoma also had usual ductal hyperplasia and apocrine metaplasia (sp?). So I Googled these two things and got all worried. Does that make it a complex fibroadenoma? Should I have had this thing removed....OR should I now? I had a breast MRI 5 months ago and it was normal. I have also had several ultrasounds since that biopsy and the fibroadenoma has gotten smaller. I have only asked my radiologist about this and she said it's a common finding and not to worry. BUT...of course I'm worried. Am is missing something. Is it really ok to leave there? When I had the biopsy three years ago I asked the radiologist who called with the results if I should have it removed, if it could ever turn into cancer and she said no but she also didn't even mention the usual ductal hyperplasia or the apocrine metaplasia she just said it's a fibroadenoma...no worries. Please let me know own if any of you know anything about this. Thank you!!!
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RubyRed,
There's an expression.... "Don't borrow trouble".
Why were you worried when you googled "usual ductal hyperplasia" and "apocrine metaplasia"? Neither of these conditions confers any increase in breast cancer risk. So what were you reading that concerned you?
How does hyperplasia affect your risk for breast cancer? "Mild hyperplasia of the usual type: This does not increase the risk for breast cancer."
Breast Apocrine Metaplasia "Apocrine Metaplasia is a particular kind of cellular change associated with a variety of breast cystic disorders. It is a completely benign condition which in itself does not increase risk for subsequent breast cancer."
You have a fibroadenoma. That's a common, almost-always harmless lump. Unless they are very large or causing pain, fibroadenomas in younger women are usually left in the breast. Part of the reason why surgery is not recommended is because sometimes fibroadenomas actually shrink and disappear on their own. Surgery, on the other hand, comes with risks and can result in scarring which can impact future mammograms.
Your fibroadenoma is in fact getting smaller on it's own. That's great!
Your fibroadenoma included usual ductal hyperplasia and aprocrine metaplasia. Those are both harmless, common, fibrocystic conditions. 60% of women have fibrocystic breasts, which means that 60% of women have these types of harmless conditions, although most women would never know this unless they had a biopsy. About 50% of fibroadenomas are associated with other benign conditions such as these, so there is nothing unusual or concerning there. It happens that fibroadenomas are made up of much of the same stuff as normal breast tissue, so any condition that can be found in breast tissue can also be found within a fibroadenoma.
With these associated conditions, it does mean that your fibroadenoma might be classified as a complex fibroadenoma (or maybe not, since your associated conditions are not proliferative changes). There is debate as to whether complex fibroadenomas increase breast cancer risk. A recent study found that any increased risk is in fact associated with the risk from these other conditions, not from the fact that the patient has a complex fibroadenoma. For example, if your fibroadenoma included atypical ductal hyperplasia or sclerosing adenosis, two conditions that do confer an increased risk of breast cancer, then your risk would be higher - however not because of the complex fibroadenoma but because of these other conditions that are contained within the fibroadenoma. And in your case, what this study is saying is that since usual ductal hyperplasia and aprocine metaplasia do not increase breast cancer risk, it means that your complex fibroadenoma, which contains these harmless conditions, does not increase your breast cancer risk.
Complex Fibroadenoma and Breast Cancer Risk: A Mayo Clinic Benign Breast Disease Cohort Study
So, back to where I started, don't borrow trouble!
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Bessie,
Thank you for such a detailed reply!! Your info is so helpful to me. I guess I worried because I read that usual ductal hyperplasia raises BC risk by 1.5-2x. I also filled out the Tyrer Cuzic model and it took my risk from 12% as a base risk (whish is where everyone starts with this model) and raised my risk to 26% just by adding the usual ductal hyperplasia....that really sounded like it was wrong so I took it with a grain of salt. Some sites also say that complex fibroadenomas should be removed but it just wasn't all adding up to me. Your explanation really makes much more sense. Thanks know you for sharing your knowledge and quick reply. It's easy to get caught up in this and I always want to be sure that I'm doing the right most informed thing.
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