Related theory

Benign breast disease is a term used to describe a variety of breast changes that are prevalent in the population. This is unsurprising when the stimulatory nature of the menstrual cycle on breast tissue is considered. Benign changes are hugely varied and can be developmental, inflammatory, fibrocystic or neoplastic in nature. They are often proliferative but not atypical in nature. Most can be safely left without intervention once biopsy proven (Guray and Sahin [59]). The most common benign presentations are listed in Table 20.8, related to age. Breast cancer is, however, the most commonly diagnosed cancer amongst women in the UK with 54,800 cases diagnosed per year (Cancer Research UK [22]) and has a high media and social profile (Xu et al. [175]).
Table 20.8  Benign breast changes across ages
 berration of normal development and involution (ANDI)
AgeNormal processClinical presentationUnderlying conditionDisease
15–24Duct and lobule formationDiscrete lumpFibroadenomaGiant or multiple fibroadenoma
Stroma formationUneven or excessive breast development
Juvenile hypertrophy
Asymmetrical development
Uni‐ or bilateral macromastia
Poland's syndrome
25–34Cyclical hormonal effects causing mild breast pain and alterations in size which fluctuate
Exaggerated hormonal effects causing moderate breast pain, nodularity and tenderness
Generally cyclical
None
Severe breast pain and tenderness interfering with normal activities
Cyclical or non‐cyclical in nature
Continued nodularity
 Discrete lumpFibroadenoma or macrocystsMalignancy (uncommon in absence of family history)
35 onwardsCyclical hormonal effects causing mild breast pain 
Multiple microcysts
Sclerosing adenosis
Lobular hyperplasia
 
Lobular involution – microcysts, apocrine change, fibrosis, adenosis
Ductal involution
Discrete lumps
Nipple discharge
Nipple retraction
Isolated macrocysts
Duct ectasia
Ductal hyperplasia
Nipple discharge
Malignancy
Multiple macrocysts
Periductal mastitis
Atypical ductal hyperplasia
Multiple papillomata
Normal 
Periductal fibrosis
Nipple retraction
Discrete lumps requiring biopsy
Source: Adapted from Hughes ([72]). Reproduced with permission of OUP; permission conveyed through Copyright Clearance Center, Inc.