What are the other Names for this Condition? (Also known as/Synonyms)

• Benign Sclerosing Ductal Proliferation of Breast
• Complex Sclerosing Lesion of Breast
• Scleroelastotic Scar of Breast

What is Sclerosing Lesion of Breast? (Definition/Background Information)

• Sclerosing Lesion of Breast is a benign tumor of breast that can mimic a malignant tumor. These are mostly observed in young and middle-aged women
• The cause of Sclerosing Lesion 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 one’s reproductive history
• The signs and symptoms of Sclerosing Lesion of Breast may include the presence of many benign tumors affecting both breasts. Small-sized tumors may be asymptomatic and show no signs and symptoms
• Sclerosing Lesion of Breast is indicative of a higher risk for breast cancer into the future. The degree of risk is dependent upon factors such as age of the individual, type of the tumor, and size of the tumor
• Due to this, a complete excision and removal of the entire tumor is the recommended practice.  Sclerosing Lesion of Breast is a benign tumor, and hence, its prognosis is excellent
• Nevertheless, since these benign breast tumors are associated with an increased risk for breast carcinoma, periodic checkups and screening mammograms are strongly advised

Who gets Sclerosing Lesion of Breast? (Age and Sex Distribution)

• The age of presentation of Sclerosing Lesion of Breast is usually between 30-50 years; though it can be seen at any age
• All racial and ethnic groups are affected and no specific predilection is seen
• The incidence of the tumor varies around the world, since some diagnostic modalities used to detect this tumor are more sensitive than others

What are the Risk Factors for Sclerosing Lesion of Breast? (Predisposing Factors)

The definitive risk factors for Sclerosing Lesion 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 one's 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 Sclerosing Lesion of Breast? (Etiology)

The exact cause of development of Sclerosing Lesion 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 Sclerosing Lesion of Breast?

The signs and symptoms of Sclerosing Lesion of Breast may include:

• The presence of benign lumps in the breast; frequently, both breasts are affected
• The breast lump is generally painless
• More than one tumor may be present; the irregular shape of the lesions may resemble a carcinoma
• The tumors can appear as a firm mass; larger tumors may be felt by touch
• Small tumors may be missed during a physical exam
• In general, the tumors are around 1 cm in size
• Complex sclerosing lesions (CSLs) are similar to radial scars and indicate larger-sized tumors; radial scars (RSs) denote tumors of relatively smaller size

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 Sclerosing Lesion of Breast Diagnosed?

Sclerosing Lesion 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
• 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 Sclerosing Lesion 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 Sclerosing Lesion of Breast?

• There may not be any significant complications of Sclerosing Lesion of Breast
• Abnormal findings on the mammogram may cause emotional distress for breast cancer, until a definitive diagnosis is made
• Studies indicate that these benign lesions have an increasing risk for cancer (into the future)

How is Sclerosing Lesion of Breast Treated?

The following treatment methods for Sclerosing Lesion of Breast may be considered:

• A simple surgical excision and removal of the entire Sclerosing Lesion of Breast is normally sufficient treatment. It is the recommended treatment due to association of the tumor with malignancy and recurrence potential
  • 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 Sclerosing Lesion of Breast be Prevented?

Sclerosing Lesion 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 Sclerosing Lesion of Breast? (Outcomes/Resolutions)

• The prognosis of Sclerosing Lesion of Breast is generally excellent on a surgical excision and removal of the tumor
• In general, Sclerosing Lesion of Breast is 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
• Generally, in women above 50 years and tumor size greater than 6 mm (Complex Sclerosing Lesion), the potential risk for cancer can be higher
• Periodic follow-up check-ups with screening is required

Additional and Relevant Useful Information for Sclerosing Lesion of Breast:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/