Understanding Biopsy Results
The breast biopsy diagnosis may reveal that a breast abnormality is benign, or non-cancerous. This is good news.
Most benign breast lumps are caused by fibrocystic [FI-bro-SIS-tic] changes in the breast, which are a normal part of the menstrual cycle. These lumps generally consist of fluid-filled cysts formed within the breast tissue and do not increase your chance of getting breast cancer. Breast swelling and tenderness can be associated with fibrocystic changes. In addition, your breast may feel lumpy and occasionally present a cloudy discharge from the nipple.
Fibroadenomas [FI-bro-ad-eh-NO-mas] and intraductal papillomas [pa-pi-LO-mas] are two other types of benign breast lumps and abnormalities. Fibroadenomas generally consist of smooth, rubbery or hard lumps that move easily within the breast tissue. These abnormalities very rarely develop into breast cancer and are most commonly found in teenagers and African American women. Intraductal papillomas are wart-like lumps that form within a milk duct. They sometimes cause nipple discharge.
Your doctor will advise you on the proper course of action regarding a benign breast lump or abnormality. Occasionally, the decision is made to remove the cyst either through a surgical or minimally invasive procedure. Regardless of this decision, you will want to continue to perform a monthly breast self-exam and get an annual breast exam and mammogram.
Fibroadenomas (Non-Cancerous Breast Lumps)
Not all breast lumps are malignant (or cancerous). There is such a thing as benign (or non-cancerous) breast disease. The most prevalent, non-cancerous breast lumps are known as fibroadenomas [FI-bro-ad-eh-NO-mas].
Fibroadenomas are usually solid, round, non-cancerous tumors that feel like a marble within the breast. They can range in size from microscopic to several inches across and you or your doctor can feel them during a breast exam. Fibroadenomas may require removal if they cause pain, continue to grow or change in shape. Many doctors recommend removing them to ensure they are not cancerous. Sometimes, new fibroadenomas may develop even after your doctor removes old ones.
Fibroadenomas occur in about 10 percent of all women and account for about half of the 1.6 million breast biopsies doctors perform each year in the US. They are common among girls in their teens and women in their twenties and thirties, but may occur at any age. According to the National Institutes of Health (NIH), fibroadenomas occur twice as often in African-American women.
Detection, Diagnosis and Treatment
Most women detect fibroadenomas during a self-breast examination or your doctor may detect them during a clinical breast examination. Removing the lump may be necessary. In the past, most fibroadenomas were removed using an open surgical biopsy method. Open surgical removal of fibroadenomas may involve the removal of nearby breast tissue which can cause scarring and breast disfigurement. This method also requires stitches and an incision 1 to 2 inches long.
Nowadays, doctors can use a Mammotome breast biopsy device in the management of fibroadenomas with minimal scarring, no stitches and immediate recovery. Using this method, the incision is the size of a match head and the procedure may be performed in the doctor’s office.
Review the chart below to see the differences between managing benign breast disease (fibroadenomas) using a Mammotome breast biopsy device versus Open Surgery.
Patient Satisfaction Data
Women with benign, non-cancerous breast lumps can now receive care in a doctor’s office with a minimally invasive device such as a Mammotome breast biopsy device, rather than having the lump removed by surgery in an operating room. A study on management of benign disease with one of Mammotome’s breast biopsy devices reveals very high patient satisfaction.
In this study, 236 patients underwent a biopsy procedure using the Mammotome Breast Biopsy System, 179 had a six-month follow-up and 83 completed a satisfaction survey.*The study concluded:
- 99% of patients would inform other women about the
- 96% of patients were satisfied with the incision appearance
- 94% of patients would be willing to have a similar procedure in the future
- 94% of patients had no palpable evidence of the initial lesion at their six-month follow-up
If It’s Breast Cancer
It’s tough to prepare yourself for the “C” word. You may feel angry, afraid, dejected or overwhelmed. All of these responses are normal. But a breast cancer diagnosis is not a death sentence. In fact, if caught and treated early, your chances of surviving breast cancer are very good. Millions of breast cancer survivors can attest to this.
This doesn’t mean that a battle with breast cancer will be easy. Breast cancer can be life threatening, and dealing with it is often physically, mentally and emotionally draining. But by leaning on your support group and understanding your breast cancer treatment options, you will find the confidence to face breast cancer head on.
Types of Breast Cancer
The term “breast cancer” actually describes a variety of cancers that occur within the breast. The different breast cancer types are generally categorized by two factors – where the cancerous cells are located and whether the cancer is prone to spreading.
Breast cancer that occurs in the milk ducts of the breast is called ductal carcinoma [DUK-tal kar-sin-OE-ma]. The breast cancer that forms in the lobules where breast milk is made is called lobular carcinoma [LOB-u-lar kar-sin-OE-ma].
Carcinomas that do not spread outside of the duct or lobule are called in situ [in SY-too] cancers, which mean “in place.” If ductal or lobular carcinoma spreads into nearby tissue, it is said to be invasive, or infiltrating. Understanding breast cancer types, size and spread will help you and your doctor select a breast cancer treatment option that is appropriate for you.
Ductal carcinoma is the most common form of breast cancer. It develops in the ducts that carry the milk from the lobules (milk glands) to the nipple. Ductal carcinomas can be either in situ or invasive breast cancer.
Ductal Carcinoma In Situ (DCIS)
In ductal carcinoma in situ, cancer cells are present inside the milk ducts but they have not yet spread through the walls of the ducts into the fatty tissue of the breast. For this reason, nearly 100% of women diagnosed at an early stage can be cured. The best way to monitor and identify ductal carcinoma in situ is with a yearly mammogram. Left unchecked, it may develop into invasive breast cancer.
Invasive Ductal Carcinoma (IDC)
Invasive ductal carcinoma accounts for nearly 80% of breast cancers. It also begins in a milk duct, but unlike ductal carcinoma in situ, it invades the fatty tissue of the breast. This invasive carcinoma has the potential to metastasize [meh-TAS-ti-size], or spread to other parts of the body through the bloodstream or lymphatic system. It is important to detect and treat invasive ductal carcinoma before it has had time to metastasize and spread to other organs.
Lobular carcinoma is found in the milk-producing glands of the breast. It is far less common than ductal carcinoma, but it can present itself in both breasts more often than other types of breast cancer. Lobular carcinoma can be either in situ or invasive breast cancer.
Lobular Carcinoma In Situ (LCIS)
Technically, lobular carcinoma in situ is not even a cancer. Sometimes called lobular neoplasia [LOB-u-lar nee-o-play-zee-uh], it is classified as pre-cancerous growth that begins in the milk-producing glands. Lobular carcinoma in situ does not penetrate through the wall of the lobules, and most researchers believe it does not usually become an invasive breast cancer. However, women who develop lobular carcinoma in situ have a higher future risk of developing invasive breast cancer in the same or opposite breast. If you have been treated for a lobular carcinoma in situ, you will want to have a physical exam two or three times a year, in addition to an annual mammogram.
Invasive Lobular Carcinoma (ILC)
Similar to invasive ductal carcinoma, invasive lobular carcinoma has the potential to metastasize and spread to other parts of the body. It begins in the milk-producing glands, where it extends into the fatty tissue of the breast. About 10% to 15% of breast cancers are invasive lobular carcinomas. Invasive lobular carcinoma also can be more difficult to detect by mammogram than LCIS, making it important to have mammograms annually.
Inflammatory Breast Cancer
This rare type of invasive breast cancer accounts for about 1% of all breast cancers. Inflammatory breast cancer makes the skin of the breast look red and feel warm, as if it were infected. The skin develops a thick, pitted appearance that doctors often describe as resembling an orange peel. Sometimes the breast develops ridges and small bumps that look like hives. Cancer cells blocking lymph vessels or channels in the skin over the breast cause these symptoms.
This special type of invasive breast cancer has a relatively well-defined boundary between the tumor tissue and normal tissue. This prevents rapid spreading of the cancer, and it often can be treated more effectively compared to other types of invasive breast cancer. Medullary carcinomas [MED-u-lair-ee kar-sin-OE-ma] account for about 5% of breast cancers.
Mucinous carcinoma [MYOO-sin-us kar-sin-OE-ma] is another rare type of invasive breast cancer. It is formed in the breast by mucus-producing cancer cells which spread the disease into the surrounding breast tissue. This type of breast cancer is treatable and offers a higher rate of recovery compared with other types of invasive breast cancer.
Paget’s Disease of the Nipple
This type of breast cancer starts in the milk ducts and spreads to the skin of the nipple and areola (the dark circle around the nipple). The nipple and areola will often appear crusted, scaly and red. The patient may experience burning, itching or notice some bloody discharge from the nipple.
Paget’s Disease is a rare form of breast cancer, occurring in only 1% of all cases. It can be associated with in situ carcinoma as well as invasive carcinoma. If no lump can be felt in the breast tissue and the biopsy shows the growth to be in situ and not invasive, treatment for Paget’s Disease is very effective.
This rare breast tumor forms from the stroma [STROM-ah] (connective tissue) of the breast, in contrast to carcinomas which develop in the ducts or lobules. Phyllodes [FI-lodes] tumors are usually benign, but on rare occasions have been found to be malignant (cancerous with the potential to metastasize). These occurrences are extremely rare, with fewer than 10 women dying each year as a result of this breast cancer.
Phyllodes tumors do not respond to hormonal therapy and are less likely to respond to other breast cancer treatments such as chemotherapy or radiation therapy. As a result, benign phyllodes tumors are treated by removing the mass and a narrow margin of the surrounding breast tissue. Malignant phyllodes tumors are removed in the same manner with a wider margin of breast tissue, or by mastectomy.
Tubular carcinoma [TOOB-u-lar kar-sin-OE-ma] is similar to invasive ductal carcinoma (IDC) and accounts for approximately 2% of all breast cancers. However, the treatment for tubular carcinoma is more effective than that of other invasive breast cancers.
Before you begin any treatment, your doctor will review your pathology report and discuss the breast cancer treatment options available. The type of breast cancer treatment or treatments that are recommended will be based on the following factors:
• How small or large is the tumor
• Where the tumor is found in the breast
• If the tumor is invasive or in situ
• If cancer is present in the lymph nodes
• If cancer is found in other parts of the body
Be sure to ask your doctor if you have any questions or concerns about the breast cancer treatment option that is being recommended. It is a decision you and your doctor will make together, and it is important to know exactly what to expect with a procedure before you begin any form of treatment.
In a lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed as well. The lumpectomy breast cancer treatment procedure is usually followed by radiation therapy to destroy any cancer cells that may remain in the area.
In a partial mastectomy [MAS-TEC-toe-mee], the surgeon removes the breast cancer and a larger area of normal breast tissue around it. In many cases, the lymph nodes under the arm are also removed. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. This breast cancer treatment procedure is usually followed by radiation therapy to destroy any cancer cells that may remain in the area. A partial mastectomy is also referred to as segmental mastectomy or quadrantectomy.
This type of breast surgery actually removes the breast. Some of the lymph nodes under the arm may also be removed. A total mastectomy is sometimes referred to as a simple mastectomy.
Modified Radical Mastectomy
In a modified radical mastectomy, the surgeon removes the breast, most of the lymph nodes under the arm and often the lining over the chest muscles.
In most cases, breast sparing surgery is followed by radiation therapy. Some patients undergoing mastectomy may also require radiation therapy. High-energy radiation is used to kill cancer cells that may be present in the remaining breast tissue. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (implant radiation).
Chemotherapy and Hormone Therapy
Depending on the particular clinical factors of breast cancer patients, chemotherapy may be recommended. Chemotherapy drugs are designed to travel throughout the body and kill or slow the growth of cancer cells. For women who have cancer that has spread beyond the breast, hormone therapy is often recommended.
Sentinel Node Biopsy
Sentinel node biopsy is a technique used to determine the status of the axillary lymph nodes without performing a full axillary dissection. The tumor site is injected with a radio-isotope and/or blue dye. This is tracked into the sentinel node, which is the first lymph node in the body to come in contact with cancer cells as they leave the primary tumor. The sentinel node is then removed.
If there is no breast cancer found in the sentinel node, no further nodes may need to be removed. If breast cancer is found, then more lymph nodes will need to be removed. Minimal node removal can save a woman from a condition known as lymphedema, a painful swelling of the arm.
After a mastectomy, some women decide to have breast reconstruction. This is done either at the same time as the mastectomy or in a later surgery. It is best to consult with a plastic surgeon before the mastectomy, even if breast reconstruction will be considered at a later date.
Either implants or tissue flaps can be used to rebuild the breast. Tissue flaps involve using muscle, fat and skin from another part of the body to reconstruct the breast. The tissue is shaped and inserted in the chest to form a breast.
Our Mission & Vision
Advancing Cancer Diagnostics, Improving Lives
Enabling clinicians to efficiently provide patients a highly confident diagnosis within 24-hours from biopsy