Fibroadenoma

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Fibroadenoma is a benign (non-cancerous) breast tumour made up of glandular tissue and stromal (connective) tissue. It is the most common type of benign breast lump, particularly in younger women aged 15 to 35.

Aetiology

The exact cause of fibroadenomas is unknown, but they are believed to be related to hormonal factors, particularly oestrogen. This is supported by the fact that fibroadenomas are more common during reproductive years and may increase in size during pregnancy or with hormone therapy.

Pathophysiology

Fibroadenomas develop from the lobules of the breast. The glandular tissue and ducts grow over the lobules and are surrounded by stromal tissue. The exact mechanism by which these growths occur is not fully understood, but it is thought to involve a localised hormonal imbalance or hypersensitivity of the breast tissue to normal circulating hormones.

Risk Factors

• Age: Most common in women aged 15-35.
• Hormonal factors: Use of oral contraceptives before age 20 may be associated with an increased risk.
• Pregnancy: Fibroadenomas may increase in size during pregnancy.
• Family history: A family history of fibroadenomas or breast cancer may increase risk.

Signs and Symptoms

• A painless, firm, and mobile lump in the breast.
• Typically smooth, round, and well-defined.
• The size of the lump may fluctuate with the menstrual cycle or during pregnancy.
• Most fibroadenomas are discovered incidentally during self-examination or routine clinical exams.

Investigations

• Clinical Examination: Palpation of the breast to assess the size, mobility, and consistency of the lump.
• Ultrasound: Often the first imaging modality used to assess the characteristics of the lump, especially in younger women with dense breast tissue.
• Mammography: May be used in older women or when ultrasound findings are inconclusive.
• Fine-Needle Aspiration (FNA) or Core Biopsy: Performed to obtain a tissue sample for histopathological examination, particularly if the lump has atypical features or if there is concern about malignancy.

Management

• Primary Care:
  • Observation: Many fibroadenomas do not require treatment and can be monitored with regular follow-up and self-examination, especially if they are small and not causing symptoms.
  • Reassurance: Provide reassurance about the benign nature of the lump and educate on self-monitoring.
• Specialist Care:
  • Surgical Excision: Indicated if the fibroadenoma is large, symptomatic, or shows suspicious changes on imaging or biopsy.
  • Cryoablation: A minimally invasive technique that may be used as an alternative to surgery for treating fibroadenomas.
  • Follow-Up: Regular follow-up may be advised, particularly if the fibroadenoma is left in situ, to monitor for any changes in size or characteristics.

References

1. NHS (2024) Fibroadenoma. Available at: https://www.nhs.uk/conditions/fibroadenoma/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Breast Lump: Assessment and Management. Available at: https://cks.nice.org.uk/topics/breast-lump-female/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Benign Breast Disease: Fibroadenomas. Available at: https://www.bmj.com/content/350/bmj.h4600 (Accessed: 24 June 2024).
4. American Academy of Family Physicians (2024) Management of Fibroadenomas. Available at: https://www.aafp.org/afp/2024/0624/p4500.html (Accessed: 24 June 2024).

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