Fibroadenomas of the Breast

Fibroadenomas are common benign (non-cancerous) breast tumors made up of both glandular tissue and stromal (connective) tissue. 

Fibroadenomas are most common in women in their 20s and 30s, but they can be found in women of any age. They tend to shrink after a woman goes through menopause.

https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/fibroadenomas-of-the-breast.html

Long-Term Risk of Breast Cancer in Women with Fibroadenoma (Dupont et al., 1994)

Abstract

BACKGROUND

Fibroadenomas are benign breast tumors that are commonly diagnosed in young women and are associated with a slight increase in the risk of breast cancer. These lesions vary considerably in their histologic characteristics. We assessed the correlation between the histologic features of fibroadenomas and the risk of subsequent breast cancer.

METHODS

We conducted a retrospective cohort study of a consecutive series of patients with fibroadenoma diagnosed between 1950 and 1968. Follow-up data were obtained for 1835 patients (90 percent of those eligible). Fibroadenomas with cysts, sclerosing adenosis, epithelial calcifications, or papillary apocrine changes were classified as complex. The rate of subsequent breast cancer among the patients was compared with the rates in two control groups, women listed in the Connecticut Tumor Registry and women chosen from among the patients' sisters-in-law.

RESULTS

The risk of invasive breast cancer was 2.17 times higher among the patients with fibroadenoma than among the controls (95 percent confidence interval, 1.5 to 3.2). The relative risk increased to 3.10 among patients with complex fibroadenomas (95 percent confidence interval, 1.9 to 5.1) and remained elevated for decades after diagnosis. Patients with benign proliferative disease in the parenchyma adjacent to the fibroadenoma had a relative risk of 3.88 (95 percent confidence interval, 2.1 to 7.3). Patients with a family history of breast cancer in whom complex fibroadenoma was diagnosed had a relative risk of 3.72, as compared with controls with a family history (95 percent confidence interval, 1.4 to 10). Two thirds of the patients had noncomplex fibroadenomas and no family history of breast cancer and did not have an increased risk.

CONCLUSIONS

Fibroadenoma is a long-term risk factor for breast cancer. The risk is increased in women with complex fibroadenomas, proliferative disease, or a family history of breast cancer.

Dupont, W. D., Page, D. L., Parl, F. F., Vnencak-Jones, C. L., Plummer Jr, W. D., Rados, M. S., & Schuyler, P. A. (1994). Long-term risk of breast cancer in women with fibroadenoma. New England Journal of Medicine, 331(1), 10-15.

Article Long-Term Risk of Breast Cancer in Women with Fibroadenoma

Systematic review of fibroadenoma as a risk factor for breast cancer (El-Wakeel and Umpleby, 2003)

Abstract

Fibroadenoma (FA) is a common breast lesion occurring in 25% of asymptomatic women. Several studies considered FA as a risk factor for breast cancer, prompting a systematic review of the literature. We selected cohort and case–control studies. Seven studies satisfied the selection criteria. Dupont et al. (1994) and McDivitt et al. (1992) were considered to provide the strongest evidence, showing the relative risk for excised FA without hyperplasia in the range 1.48–1.7, with hyperplasia 3.47–3.7, and with hyperplasia and atypia 6.9–7.29, persisting for more than 20 years. Five studies by Levi et al. (1994), Ciatto et al. (1997), Moskowitz et al. (1980), Carter et al. (1988), and Levshin et al. (1998), were considered to provide weaker evidence, although they showed similar results. None of the results could be used to quantify the risks of excised, non-excised, and asymptomatic FA. More care should be taken in managing patients with complex FAs and FAs with hyperplasia with or without atypia. Core biopsy may be a better option in diagnosis of FAs. Regular screening may be advisable in patients with FAs and a family history of breast cancer in a first-degree relative. More rigorous research is needed in this area.

El-Wakeel, H., & Umpleby, H. C. (2003). Systematic review of fibroadenoma as a risk factor for breast cancer. The Breast, 12(5), 302-307.

Article Systematic review of fibroadenoma as a risk factor for breast cancer

Incidence of breast cancer in women with fibroadenoma (Levi et al., 1994)

Abstract

There is a general agreement that fibroadenoma is associated with a certain increase in breast cancer risk, but the risk estimates appear heterogeneous according to various studies. To provide further quantitative and population‐based estimates of breast cancer risk in women with histologically confirmed fibroadenomas, we linked data of 1,461 incident cases of fibroadenoma (median age, 37 years) to the Cancer Registry of the Swiss Canton of Vaud (about 600,000 inhabitants) over the period 1977–1991. After exclusion of 57 synchronous breast neoplasms, a total of 17 cases of breast cancer were observed vs. 10.9 expected (standardised incidence ratio, SIR, 1.6; 90% confidence interval: 1.1‐2.1). The SIR was similar in the short term (3–5 years) and in the medium‐long term (>5 years) following diagnosis of fibroadenoma. The cumulative risk of invasive breast cancer was 0.7% after 5 years and 2.2% after 12 years following diagnosis of fibroadenoma. This is not negligible on account of the young age of our cohort.

Levi, F., Randimrison, L., Te, V. C., & la Vecchia, C. (1994). Incidence of breast cancer in women with fibroadenoma. International journal of cancer, 57(5), 681-683.

Article Incidence of breast cancer in women with fibroadenoma

Management of breast fibroadenomas (Greeenberg et al., 1998)

Abstract

OBJECTIVE: To identify from the literature and clinical experience a rational approach to management of fibroadenomas of the breast.

METHOD: Recent literature on detection, diagnosis, and natural history of fibroadenomas was reviewed. Experience with over 4,000 women evaluated in the breast clinic at the Tel-Aviv Medical Center contributed to the management strategies suggested by review of the literature.

RESULTS: Fibroadenomas of the breast are common, accounting for 50% of all breast biopsies performed. Physical examination, sonography, and fine needle aspiration are effective in distinguishing fibroadenomas from breast cancer. Transformation from fibroadenoma to cancer is rare; regression or resolution is frequent, supporting conservative approaches to follow-up and management.

CONCLUSION: Age-based algorithms that allow for conservative management and that limit excision to patients whose fibroadenomas fail to regress are presented.

Greenberg, R., Skornick, Y., & Kaplan, O. (1998). Management of breast fibroadenomas. Journal of general internal medicine, 13(9), 640-645.

Article Management of Breast Fibroadenomas

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