Dear Alice,

I am interested in your response to the question about breast lumps because I had a fibroadenoma removed about two years ago while I was pregnant. The surgeon said at the time that there was no evidence of increased risk of breast cancer for those with these kinds of lumps, but I subsequently heard a report on NPR on a study which did find some increased risk in women who have had fibro-adenomas. Are you familiar with this study, and can you tell me what the increased risk is?

— Attentive listener

Dear Attentive listener,

Kudos to you for staying up to date on your health knowledge! Fibroadenomas are a fairly common type of breast lump, though it’s unclear why they develop in the body. Like many other lumpy breast concerns, these growths are benign (non-cancerous) — current scientific evidence has found that the majority of fibroadenomas aren’t associated with an increased risk of cancer, at least not by themselves. Ultimately, various genetic risk factors and a family history of breast cancer contribute more significantly to an individual’s overall breast cancer risk.

Fibroadenomas come in all shapes and sizes, and it’s not particularly unusual to develop this type of lump in one or both breasts. Specifically, fibroadenomas can be classified as two main types: simple and complex. 

  • Simple fibroadenomas are usually small, painless, and can be freely moved around the breast tissue during an exam. They’re well-defined lumps made of fibrous and glandular tissue that may feel like a small marble. These simple fibroadenomas aren’t associated with an increased risk of breast cancer. 
  • Complex fibroadenomas, on the other hand, may be composed of any combination of dense, abnormal cysts or scar tissue, are typically larger, and usually affect older individuals. These complex lumps may be associated with a slight increase in developing breast cancer. However, this risk is typically elevated only in conjunction with risk factors such as having a family history of breast cancer. A medical professional can distinguish between the two types by ordering a breast biopsy (a procedure in which a few cells from the lump are removed and analyzed in a lab) and then make subsequent recommendations for treatment based on the results.  

In many cases, simple fibroadenomas don’t require treatment. Some people, however, will still elect to get them removed, especially if they’re painful or cause discomfort. They may be caused by hormonal changes during the reproductive years, including pregnancy (as you mentioned), the initiation of estrogen therapy, or menopause. These lumps often grow and shrink and sometimes resolve on their own given enough time. Other times, a fibroadenoma can grow large enough to change the shape of the breast, but this is fairly uncommon.

Individuals with complex fibroadenomas or additional risk factors for breast cancer may also have the lumps removed as a precautionary measure. Some disadvantages of surgical removal to consider may include the general risks associated with surgery, as well as scarring or changes in the shape and texture of the breast. Your health care provider will recommend a course of action after carefully weighing the risks and benefits for your specific situation at that particular time. Whatever the course of treatment, it's also critical that any follow-up care or screenings be completed as recommended. 

Attentive Listener, this is all to say, it’s probably wise to take any single source of information (no matter how reputable or distinguished) with a lump of salt. Keeping an ear to the ground is an essential part of being your own health advocate! Medicine is constantly evolving, and recommendations are made with the soundest body of evidence available at the time — but even then, not every study will come to the same conclusion. Staying up-to-date on new research by reading up on reliable sources, being critical of research methods, seeking a second opinion, or asking more questions are great strategies for sorting through the details of treatment decisions.

If you’re interested in learning about the most recent developments in cancer research, you may find more information from the National Cancer Institute or the Cancer category of the Go Ask Alice! archives. If you find that you still have more questions, consider making an appointment with your health care provider to talk about the best ways to manage your health!

Alice!

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