When a diagnosis contains the word “benign,” we are accustomed to thinking that everything is fine. However, there is such a thing as Benign Breast Disease (BBD), a term given to a wide variety of changes in the breast that are seen in an image of the breast and by a pathologist after a biopsy. These changes can range from benign cysts to pre-cancerous changes in the cells of the breast and may require further action or decision making by the patient. In order to help women understand what benign breast disease can entail and how to respond, Mary Daly, MD, PhD, FACP, Chair of the Department of Clinical Genetics, and Beth Stearman, MPH, Senior Project Manager, Risk Assessment Program, have published a booklet: Benign Breast Disease: What It Means For Me. Below are answers to frequently asked questions about BBD.
As always, please feel free to leave comments or questions here, or to contact your oncologist.
How is benign breast disease (BBD) diagnosed, and how common is it?
Benign breast disease is usually diagnosed after a patient has had a biopsy following an abnormal mammogram or MRI. More than 700,000 new cases of BBD are diagnosed each year, and most of them are just as the name suggests – benign. A diagnosis of BBD is more than three times more common than breast cancer. However, 30 percent of BBD cases are associated with an increased risk for future breast cancer.
How do you know if you’re part of the 70 percent with harmless changes or if you’re part of the 30 percent who have an increased risk of breast cancer?
Women diagnosed with BBD because of fibroadenomas and cysts – the most common forms of BBD – do not have an increased risk for breast cancer. In fact, both of these findings are not thought to be related to breast cancer.
Roughly 26 percent of women diagnosed with BBD, however, are diagnosed with other conditions such as sclerosing adenosis, intraductal papillomas or hyperplasia, which are all associated with a mildly increased risk for breast cancer.
Another 4 percent of women diagnosed with BBD have either atypia (atypical lobular or ductal hyperplasia) or lobular carcinoma in situ (LCIS), placing them at a highly increased risk for breast cancer.
If you have had a breast biopsy showing any of these types of changes, you may wish to consult with staff in our Risk Assessment Program. These professionals can help assess whether you have an elevated risk based on personal history of BBD, your family history of breast cancer, and other risk factors which might help in your decision making.
If you are diagnosed with a condition that either mildly or highly increases your risk for breast cancer, what are your options?
There is a range of health care choices for women with BBD, including screening, lifestyle changes, chemoprevention and risk-reducing surgery. We recommend an annual mammography routine starting at age 40. We also encourage all women to maintain a healthy lifestyle through a combination of regular physical activity, a diet rich in fruits and vegetables, and low in alcohol. In addition to these recommendations, you may have an option to use chemopreventive agents (medicines or natural products to prevent the development of cancer) such as tamoxifen for pre-and postmenopausal women; or raloxifene for women who are postmenopausal. Occasionally, a woman with BBD may make a personal decision to have both breasts removed (a bilateral prophylactic mastectomy). This decision is usually made when there is a very strong family history of breast cancer and/or a personal history of multiple breast biopsies.
How does one choose her own course of action for a diagnosis that is not cancer but an increased risk for cancer?
Each woman’s decision regarding her treatment plan is a personal one; what makes sense for a friend or loved one may not make the most sense for you. In the Risk Assessment Program at Fox Chase, we have put together a guide that may help some women organize their questions and feelings on whether or not to pursue chemoprevention or risk-reducing surgery. The guide, Benign Breast Disease: What It Means For Me, offers various worksheets, allowing each woman to fill in what she’s learned about her diagnosis and her personal risk factors. This tool is just one step in the decision-making process, but can help women with BBD formalize their thoughts and facilitate a conversation with their health care providers.
We understand that the decision-making process with BBD can be stressful for women, as they are not sure how to interpret the increased risk for cancer or whether to take action. For this reason, we try to anticipate the questions and offer as much personalized support as possible.
Mary B. Daly, MD, PhD, FACP
Beth J. Stearman, MPH
Download the booklet Benign Breast Disease: What It Means For Me here.