What are the other Names for this Condition? (Also known as/Synonyms)
- Mammary Intraductal Papilloma
What is Intraductal Papilloma of Breast? (Definition/Background Information)
- Papillary neoplasms of the breast are tumors that occur in the milk ducts (ductal system) and may be benign or malignant. When they are benign, these tumors are known intraductal papillomas of breast; while malignant tumors are known as intraductal papillary carcinomas of breast
- Intraductal Papilloma of Breast is a benign tumor that can be present anywhere from near the nipple region to the lobular units (which are the terminating units of the milk duct) inside the breast. They are primarily of 2 broad types:
- Central Papilloma of Breast; affecting the central duct area
- Peripheral Papilloma of Breast; affecting the peripheral duct or lobular units
- Intraductal Papilloma of Breast can occur in women of all ages, though it is more commonly seen in young and middle-aged women. The cause of the condition is unknown, but the risk factors may include gender (women are affected more than men), the use of birth control pills, obesity, and one’s reproductive history
- The signs and symptoms of Intraductal Papilloma of Breast include the presence of a lump in the breast and discharge from the nipple. Small-sized tumors and peripheral papillomas may be asymptomatic and show no signs and symptoms
- Intraductal Papilloma 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 Intraductal Papilloma of Breast? (Age and Sex Distribution)
- Intraductal Papilloma of Breast represents approximately 10% of all benign breast tumor types
- The age of presentation is usually between 30-50 years; though it may be seen at any age
- All racial and ethnic groups are affected and no specific predilection is seen
What are the Risk Factors for Intraductal Papilloma of Breast? (Predisposing Factors)
The definitive risk factors for Intraductal Papilloma of Breast are not well-understood. However, the following risk factors increase one’s chances of getting breast tumors, and these include:
- Gender: Women have a higher risk for developing the condition than men
- 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 Intraductal Papilloma of Breast? (Etiology)
The exact cause of development of Intraductal Papilloma 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
Some reports indicate that Intraductal Papilloma of Breast may be associated with other types of adenomas occurring within the milk ducts.
What are the Signs and Symptoms of Intraductal Papilloma of Breast?
In most cases, peripheral papillomas and small papillomas may note present any signs and symptoms. In some cases, the signs and symptoms of Intraductal Papilloma of Breast may include:
- A benign lump in a single breast; some may be very small and missed during a mammogram screening
- The breast lump is generally painless
- The tumors can appear as firm or soft mass; larger tumors may be felt by touch
- Thickening or swelling of part of the breast; change in the size or shape of the breast
- Inversion of the nipple (pulling-in of nipple into the breast)
- Discharge from the nipple is seen with central papillomas
- Changes to the skin covering the breast or nipple area, including dimpling, irritation, redness, scaling, peeling, or puckering
- The condition can be bilateral and may affect both breasts
How is Intraductal Papilloma of Breast Diagnosed?
Intraductal Papilloma 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 definitively diagnose Intraductal Papilloma 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. A definitive diagnosis on a core biopsy may be difficult. Hence, a follow-up surgical procedure to obtain a larger breast biopsy specimen (such as through a lumpectomy) is often performed
- 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 Intraductal Papilloma of Breast?
There may not be any significant complications of Intraductal Papilloma of Breast.
- In some cases, the condition may cause emotional stress due to concerns of a malignancy
- Nipple retraction or puckering of nipple may result in cosmetic issues
How is Intraductal Papilloma of Breast Treated?
The following treatment methods for Intraductal Papilloma of Breast may be considered:
- A simple surgical excision and removal of the entire Intraductal Papilloma of Breast is normally sufficient treatment. It is the preferred treatment for papillomas
- 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 Intraductal Papilloma of Breast be Prevented?
Intraductal Papilloma 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 Intraductal Papilloma of Breast? (Outcomes/Resolutions)
- The prognosis of Intraductal Papilloma of Breast is generally excellent on a surgical excision and removal of the tumor
- In general, papillomas of breast are associated with an increased risk for breast cancer into the future. A healthcare provider will assess the risk depending on the combination of each individual’s risk factors
- Central papillomas have lower risk when compared to peripheral papillomas. However, the risk of breast cancer associated with central or peripheral papilloma depends on whether the reminder of the breast tissue has abnormalities such as sclerosing adenosis, radial scars, usual ductal hyperplasia, atypical ductal hyperplasia, etc.
- Therefore, periodic follow-up check-ups with screening is required
Additional and Relevant Useful Information for Intraductal Papilloma of Breast:
The following DoveMed website links are useful resources for additional information: