What are the other Names for this Condition? (Also known as/Synonyms)
- Mammary Ductal Adenoma
- Mammary Sclerosing Papilloma
- Sclerosing Papilloma of Breast
What is Ductal Adenoma of Breast? (Definition/Background Information)
- Ductal Adenoma of Breast is a benign tumor of breast affecting the breast glandular tissue and the milk ducts. This tumor type is mostly observed in middle-aged and older women
- The cause of Ductal Adenoma of Breast is unknown, but the risk factors may include gender (women are affected more than men), the use of birth control pills, obesity, and Carney complex (a rare genetic condition)
- The signs and symptoms of Ductal Adenoma of Breast may include the presence of a lump in the breast and rarely, discharge from the nipple. Small-sized tumors may be asymptomatic and show no signs and symptoms
- Ductal Adenoma of Breast is treated through a surgical excision, per the healthcare provider’s recommendation. The prognosis is excellent with its complete removal, since it is a benign tumor. However, periodic checkups and screening mammograms are advised
Who gets Ductal Adenoma of Breast? (Age and Sex Distribution)
- The age of presentation of Ductal Adenoma of Breast is usually after 40 years, with increased frequency in women over 60 years
- However, Ductal Adenomas of Breast can be seen at any age
- All racial and ethnic groups are affected and no specific predilection is seen
What are the Risk Factors for Ductal Adenoma of Breast? (Predisposing Factors)
The definitive risk factors for Ductal Adenoma of Breast are not well-understood. However, the following risk factors increase one’s chances of getting benign breast tumors, and these include:
- Gender: Women have a higher risk for developing the condition than men
- Carney complex, a genetic disorder, is associated with ductal adenomas
- Obesity: Being overweight or obese increases the risk
- Alcohol consumption
- Menstrual cycle: Women who got their period before the age of 12 years, and those who reached menopause after age 55 have a higher risk. The longer the duration between menarche and menopause, the greater is the risk. This is due to hormonal influences during the reproductive period on the breast tissue
- Postmenopausal hormone therapy: Women taking hormone replacement therapy medications containing both estrogen and progesterone for menopause, have a higher risk
- Reproductive history: Having the first child after the age of 35, or never having a child
- Birth control pills
- Physical inactivity: A lack of physical exercise (leading a sedentary life) can increase one’s risk
- Not breastfeeding the child
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Ductal Adenoma of Breast? (Etiology)
The exact cause of development of Ductal Adenoma of Breast is currently not clearly understood.
- Studies have shown that such tumors may be caused by hormonal influence
- Certain gene mutations have also been reported in the tumors. Research is being performed to determine how these mutations contribute to the formation of the tumors
What are the Signs and Symptoms of Ductal Adenoma of Breast?
The signs and symptoms of Ductal Adenoma of Breast may include:
- The presence of solid well-formed lump in the breast that are painless
- More than a single tumor may be present
- Characteristics of the benign tumor may include smoothness, roundness, easy travel within the breast, firmness, and having a rubbery feel
- Discharge from the nipple, in rare cases
- The tumor may resemble malignancy on imaging studies
When a pathologist examines the tumor under a microscope, the tumor usually has irregular margins. The findings may resemble a breast cancer, and hence, a careful examination is necessary.
How is Ductal Adenoma of Breast Diagnosed?
Ductal Adenoma of Breast may be diagnosed in the following manner:
- Complete physical examination with comprehensive medical and family history evaluation
- Breast exam to check for any lumps or unusual signs in the breasts
- Mammogram: A mammogram uses x-rays to provide images of the breast. These benign tumors are identified as a mammogram mass, which may or may not be associated with microcalcification. The mammography findings may raise enough suspicion to warrant a tissue biopsy
- Galactography: A mammography using a contrast solution, mostly used to analyze the reason behind a nipple discharge
- Breast ultrasound scan: Using high-frequency sound waves to produce images of the breast, the type of tumor, whether fluid-filled cyst or solid mass type, may be identified
- Computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the breast
- Breast biopsy:
- A biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
- Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
- Sometimes, the pathologist may perform additional studies, which may include immunohistochemical stains and molecular studies to assist in the diagnosis
Biopsies are the only methods used to determine whether an abnormality is benign or cancerous. These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. There are different types of biopsies:
- Fine needle aspiration biopsy (FNAB) of breast mass: In this method, a very thin needle is used to remove a small amount of tissue. FNAB cannot help diagnose definitively Ductal Adenoma of Breast. It only helps determine if the tumor is malignant or benign. This can help the healthcare provider discuss and plan the next steps (with respect to diagnosis and treatment)
- Core needle biopsy of breast mass: A wider needle is used to withdraw a small cylinder of tissue from an abnormal area of the breast
- Open tissue biopsy of breast mass: A surgical procedure used less often than needle biopsies, it is used to remove a part or all of a breast lump for analysis
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Ductal Adenoma of Breast?
There may not be any significant complications of Ductal Adenoma of Breast. However, in some cases, the condition may cause emotional stress due to concerns of a malignancy.
How is Ductal Adenoma of Breast Treated?
The following treatment methods for Ductal Adenoma of Breast may be considered:
- A ‘wait and watch’ approach may be considered for asymptomatic tumors
- A simple surgical excision and removal of the entire Ductal Adenoma of Breast is normally sufficient treatment
- The surgical procedure performed is known as a breast lumpectomy. It is a surgical procedure to remove the breast lump, which may be done under a general anesthetic
- During the surgery, a small incision is made in the skin of the breast and a hollow probe that is connected to a vacuum, inserted
- The breast tissue is sucked through the probe, using vacuum, until the lump has been removed
- Follow-up care with frequent breast self-examinations and screening mammograms may be recommended by the healthcare provider
How can Ductal Adenoma of Breast be Prevented?
Ductal Adenoma of Breast is difficult to prevent, because it is most likely caused by abnormal or fluctuating reproductive hormone levels. Since prevention is generally not possible, it is important to be aware of the risk factors of breast lumps.
- The individual must regularly conduct breast self-exams, to ensure that no lumps are present
- Maintain a healthy body weight and exercise regularly
- Implement and follow a well-balanced diet; a high intake of fiber via fresh fruits and vegetables helps in a healthy lifestyle
- Drink alcohol in moderation; limit to one or (maximum) two drinks a day
- Limit combination hormone therapy used to treat symptoms of menopause. It is advised that individuals be aware of the potential benefits and risks of hormone therapy
What is the Prognosis of Ductal Adenoma of Breast? (Outcomes/Resolutions)
- The prognosis of Ductal Adenoma of Breast is generally excellent on a complete surgical excision and removal of the tumor
- Recurrence is not known to occur, if the tumors are removed completely
- Periodic follow-up check-ups with screening is required
Additional and Relevant Useful Information Ductal Adenoma of Breast:
The following DoveMed website links are useful resources for additional information: