Can a Breast Tumor Change from Benign to Malignant in Three Months?

Can a breast lesion change from benign to malignant within three months?

Hello Dr.
Chen, I would like to ask you: I had a breast ultrasound on January 29 of this year, which revealed a tumor located at approximately the 12 o'clock position of the right breast measuring 1.9 cm, classified as BI-RADS category 4a.
The doctor promptly arranged for a biopsy on February 9, and the results were benign.
The doctor advised me to have a follow-up ultrasound in six months, but I requested to change it to three months.
The report from May 11 indicated that the tumor had grown to 2 cm.
The doctor also scheduled me for a core needle biopsy on May 19, and I will be able to see the report on May 25.
My question is, with such a short growth of 0.1 cm, does this also mean there is a possibility of it changing from benign to malignant? The waiting is truly agonizing, and I am very worried! I would appreciate your response, thank you!

Xiang Xiang, 60~69 year old female. Ask Date: 2021/05/12

Dr. Chen Jiaming reply Surgery

If the previous procedure was a standard core needle biopsy and the report was benign (regardless of the type of benign finding), the likelihood of it turning malignant within three months is very low.
However, since the initial ultrasound examination was categorized as BI-RADS category 4a, it indicates that the mass likely appeared suspicious from the beginning.
After three months (and considering that a biopsy was previously performed), it is expected that the imaging findings may still appear unusual (or even more atypical), which could lead the physician to be concerned and arrange for another biopsy.

Reply Date: 2021/05/12

More Info

The concern regarding the potential for a benign breast tumor to transform into a malignant one within a short period, such as three months, is a common and understandable worry for many patients. In your case, the initial ultrasound indicated a BI-RADS category 4a lesion, which suggests that there is a moderate suspicion of malignancy. However, the subsequent biopsy confirmed that the tumor was benign.
Generally speaking, the likelihood of a benign tumor transitioning to a malignant state in such a short timeframe is relatively low, especially if the initial biopsy results were clear and indicated no signs of cancer. The fact that your tumor increased in size from 1.9 cm to 2.0 cm over three months is concerning, but it is important to consider several factors before jumping to conclusions about malignancy.

1. Nature of Benign Tumors: Many benign tumors, such as fibroadenomas, can grow over time but remain non-cancerous. The growth rate of benign tumors can vary significantly among individuals and even among different tumors in the same person.
2. BI-RADS Classification: The BI-RADS system is a standardized way to categorize breast imaging findings. A category 4a indicates a low suspicion of malignancy, but it does not rule it out entirely. The recommendation for follow-up imaging or biopsy is often based on the characteristics of the tumor and any changes observed over time.

3. Monitoring and Follow-Up: Your decision to follow up in three months instead of six was proactive, and it is commendable that you are taking an active role in your health. The upcoming biopsy will provide more definitive information about the nature of the tumor. If the tumor is still benign, it may simply require continued monitoring.

4. Growth Rate: An increase of 0.1 cm in three months is relatively small, and while any growth can be concerning, it does not automatically indicate a transition to malignancy. The context of the tumor's characteristics, such as its shape, margins, and the presence of any associated symptoms, will be crucial in the evaluation.

5. Psychological Impact: The anxiety and stress associated with waiting for results can be overwhelming. It is important to communicate your concerns with your healthcare provider, who can provide reassurance and support. They may also discuss the possibility of additional imaging or tests if warranted.

In conclusion, while it is essential to remain vigilant and proactive about breast health, the evidence suggests that a benign tumor does not typically become malignant in a short period. The upcoming biopsy will be critical in determining the next steps. It is advisable to maintain open communication with your healthcare team and express any concerns you may have during this process. Remember, early detection and monitoring are key components in managing breast health effectively.

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