Breast Tumors: What You Need to Know About Diagnosis and Treatment

What are the issues related to breast tumors?

I am 42 years old.
When I was 17, I had a fibroma in my left breast, approximately 2-3 cm in size, resembling a bird egg.
During a routine check-up at age 26, a biopsy was performed, and it was determined to be benign.
After that, I did not have any further examinations.
After turning 35, I noticed that it seemed to be getting smaller.
At age 39 (3 years and 4 months ago), I gave birth to my second child.
While breastfeeding, I felt a noticeable movable round hard lump in my right breast, similar in size to a soybean, with a hardness comparable to the lump in my left breast.
After I stopped breastfeeding, it was not as prominent, and I felt it was about the same size (or even flatter and smaller than during breastfeeding, not as protruding), so I neglected it.
In March of this year, I went to the hospital for a comprehensive health check-up, which included an ABVS 3D ultrasound of the breasts.
The results showed a tumor in each breast: 1.1 cm in the left breast and 1.45 cm in the right breast.
The examining physician assessed that the left one appeared benign, while the right one could not rule out malignancy, categorizing it as BI-RADS 4A.
They scheduled me for a follow-up appointment for further evaluation.
The outpatient doctor reviewed the images and felt that both lumps appeared benign, scheduling another ultrasound for a week later.
Feeling anxious, I went to another hospital for a repeat ABVS.
The left lump increased to 1.4 cm, and the right lump increased to 1.8 cm (larger than during the health check-up, which was only a week prior).
The doctor indicated that the right lump appeared more benign, while the left one showed calcifications, making it harder to rule out malignancy (the assessments were opposite to those of the health check-up physician).
A mammogram was performed, revealing no calcifications in the right breast, but "popcorn" calcifications in the left breast.
The doctor believed both lumps were benign, suggesting that the calcifications in the left breast might be due to the aging of the fibroma from when I was 17.
However, it could not be determined whether this was the same fibroma or a new one (meaning the original fibroma could have disappeared, and a new one could have developed in the same location).
Due to the larger size, they recommended minimally invasive surgery to remove it for more accurate testing.
I have already scheduled the surgery date, but an elder with breast cancer experience advised that I should first have a biopsy to determine if it is malignant.
If it is, chemotherapy should be administered to see if the tumor shrinks, which would help assess the effectiveness of the chemotherapy drugs.
If the tumor is completely removed first, there would be no tumor left to evaluate the chemotherapy's effectiveness.
This has made me hesitate about whether to cancel the surgery.
I would like to ask the doctor how to proceed.
Additionally, is it common for a 2-3 cm fibroepithelial tumor to completely disappear? Regarding the hard lump discovered during breastfeeding three years ago, what is the likelihood of it being malignant, considering it has remained about the same size for three years? I have undergone 2D ultrasound, ABVS ultrasound, and mammography, and both outpatient doctors indicated that both lumps appear benign, but I am still worried and would appreciate the doctor's clarification.
Thank you.

Kang Ping, 40~49 year old female. Ask Date: 2021/03/21

Dr. Yuan Tianmin reply Breast and Thyroid

I agree with using minimally invasive surgery; however, a biopsy should be performed beforehand to confirm that it is benign, as minimally invasive surgery is applied to the removal of benign tumors.

Reply Date: 2021/03/21

More Info

Understanding breast tumors, particularly in the context of diagnosis and treatment, can be quite complex and often causes anxiety for patients. Your situation involves a history of fibrocystic changes and recent findings of breast masses, which understandably raises concerns about the possibility of malignancy.

Firstly, it’s important to clarify the nature of the tumors you’ve encountered. Fibroadenomas, which you had at 17, are benign tumors that can sometimes change in size or even disappear over time. It is not uncommon for fibroadenomas to regress, especially after hormonal changes such as pregnancy or breastfeeding. The fact that you felt the left breast mass becoming smaller over the years aligns with this phenomenon.

Regarding your recent findings, the distinction between benign and malignant tumors often relies on imaging studies, physical examinations, and sometimes biopsy results. The BI-RADS (Breast Imaging-Reporting and Data System) classification you mentioned is a standardized system used by radiologists to categorize breast imaging findings. A BI-RADS score of 4a indicates a suspicious abnormality that requires further evaluation, typically through a biopsy.

In your case, the left breast mass has shown some calcifications, which can sometimes indicate a higher risk of malignancy, but they can also be associated with benign processes. The right breast mass, on the other hand, has been assessed as more likely benign. The variability in assessments between different healthcare providers can be attributed to the subjective nature of interpreting imaging studies, as well as the inherent limitations of imaging techniques.

The recommendation for surgical excision of the left breast mass is a common approach when there is uncertainty about the nature of a lesion, especially when calcifications are present. Surgical excision allows for a complete pathological examination of the tissue, which can provide definitive information about whether the tumor is benign or malignant.
Your concern about whether to proceed with surgery or to opt for a biopsy first is valid. In many cases, if there is a strong suspicion of malignancy, a biopsy is performed first to determine the nature of the tumor before any surgical intervention. However, if the imaging studies suggest that the tumors are likely benign, and if the clinical judgment leans towards surgical removal for peace of mind and definitive diagnosis, then proceeding with the excision may be appropriate.

As for the risk of malignancy in the masses you have described, it is difficult to provide a precise probability without the results of a biopsy. However, given that both physicians you consulted believe the masses appear benign, the likelihood of them being malignant is likely low, especially considering your age and the benign nature of your previous fibroadenoma.

In summary, here are some key points to consider:
1. Surgical Excision vs. Biopsy: If there is significant concern about the nature of the left breast mass, surgical excision may be warranted. However, if you are uncertain, discussing the option of a biopsy first with your healthcare provider could be beneficial.

2. Follow-Up and Monitoring: Regardless of the decision, regular follow-up with your healthcare provider is essential. Self-examinations and routine screenings should continue as recommended.

3. Understanding Your History: Your history of a benign fibroadenoma does not inherently increase your risk for developing breast cancer, but it is important to remain vigilant with breast health, especially with any new changes.

4. Consultation with Specialists: If you have ongoing concerns, seeking a second opinion from a breast specialist or oncologist may provide additional reassurance and clarity regarding your treatment options.

Ultimately, the decision should be made in collaboration with your healthcare provider, taking into account your personal health history, the findings from your imaging studies, and your comfort level with the proposed management plan.

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