Questions and answers

Fibroadenomas are the most common benign changes in the female breast. Even though the diagnosis is no reason for concern at the time, many women still ask several questions about these benign lumps.

What is a fibroadenoma?

First of all, you can put your mind at rest: A fibroadenoma can be irritating under certain circumstances, but is just a benign lump in the female breast. During palpation of the breast, you can feel that this lump is freely movable (see also Self investigation).

A fibroadenoma is typically firm and smooth, and has a definite margin. The size can vary greatly – anything is possible, from less than 1 cm to over 15 cm in diameter.

How common are fibroadenomas?

If you have a fibroadenoma, you are not alone: Approximately 10 to 100 women develop these kind of lumps. Fibroadenomas are therefore the most common benign changes in the breast. At the time of diagnosis, most women are between 15 and 35 years old. However, fibroadenomas also commonly occur between 45 and 55 years of age.

How do I recognise a fibroadenoma?

Many women have no initial symptoms, but instead discover a lump by chance or during a self examination of the breast. Sometimes the fibroadenoma is only noticed during a routine examination by the gynaecologist or during a mammogram.

Pain is rare with fibroadenomas: even when you press on them, most lumps do not hurt. If pain does occur, this is no cause for concern. A fibroadenoma can be palpable or even sensitive to pain, depending on its size and position in the breast. This particularly applies to the time before the period when the breast swells.

If the fibroadenoma is already very big, sensitivity and a feeling of tension in the breast are often more marked. It may also happen that the lump deforms the breast because the skin bulges outward at this point.

How does a gynaecologist recognise a fibroadenoma?

A gynaecologist first makes a provisional diagnosis. In addition, they will examine the breast carefully and then palpate the breast and the armpits. If they notice any changes, they may perform an ultrasound investigation and possibly also a mammogram. A tissue sample, also known as a biopsy, is important so that the doctor can say with certainty that it is a benign lump.  

How fast does a fibroadenoma grow?

It is difficult to predict how a fibroadenoma will develop. Often, there is a growth spurt and then a long period without any further changes. Sometimes a fibroadenoma may also disappear spontaneously. The growth is heavily influenced by the female hormone oestrogen. This also explains why, for example, fibroadenomas often get suddenly bigger during pregnancy. 

Must a fibroadenoma be treated?

Not every fibroadenoma must necessarily be treated. However, it is important that you visit your gynaecologist for follow-up examinations. Women younger than 35 years without  a genetic risk of breast cancer in the family and with a very small fibroadenoma are usually recommended to wait and attend regular follow-up examinations. If the fibroadenoma grows very fast, it may have to be removed. However, there are several other factors that could prompt treatment. Removal of the lump is often recommended before pregnancy to prevent the problems that occur with the often increased growth. Treatment may also be prompted by psychological stress in some cases, due to changes in breast shape or problems in everyday life. The decision for or against therapy must be made on an individual basis. Discuss this with your gynaecologist. (See also Treat or wait – what is right for me?

How is a fibroadenoma treated?

The usually method of removing a fibroadenoma is still surgery. A small cut is made under general anaesthesia and the lump is completely removed. There are also various methods for treating very small fibroadenomas that require smaller incisions. These are called minimally invasive.

The alternative is to treat the fibroadenoma using echotherapy. During this non-invasive technique, the lump is treated with ultrasound. The treatment occurs on an outpatient basis under local anaesthetic. No scars are left behind. (See also What is echotherapy?)

Is a fibroadenoma really not dangerous?

It is initially worrying for any woman when she discovers a lump in her breast. When it is identified as a fibroadenoma, however, then the first priority is to give the patient the all-clear signal: The chances that a malignant tumour could develop from this lump are extremely low: at present, only one out of every 1,000 fibroadenomas undergoes these changes. [1,2,]  In other words, the risk of a woman with a fibroadenoma developing breast cancer is exactly as high or low as a woman without one. Only women with multiple or complex fibroadenomas have a slightly increased risk [3,4].

[1] Buzanowski-Konaky K, Harrison EG Jr, Payne WS: Lobular carcinoma arising in fibroadenoma of the breast. Cancer 1975; 35(2):450-456.
[2] Dupont WT, Page DL, Parl FF, Vnencak-Jones CL et al.: Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med 1994; 331:10-15.
[3] Sklair-Levy M, Sella T, Alweiss T et al.: Incidence and management of complex fibroadenomas. AJR Am J Roentgenol. 2008; 190(1):214-18.
[4] Worsham MJ, Raju U, Lu M et al.: Risk factors for breast cancer from benign breast disease in a diverse population. Breast Cancer Res. Treat. 2009; 118(1):1-7.

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