Common benign breast concerns for the primary care physician

Article Figures & Data

TABLE 1

Benign causes of common breast symptoms

Symptom	Causes
Breast pain	Cystic lesions Fibrocystic disease Stretching of Cooper ligaments Mastitis Duct ectasia Postsurgical pain
Nipple discharge	Hypothyroidism Galactorrhea Intraductal papilloma Periductal mastitis Duct ectasia
Breast mass	Cyst Fibroadenoma Prominent fibroglandular ridge Fat lobule Intramammary lymph node

TABLE 2

BI-RADS breast density categories

Category	Description
A	Almost entirely fatty
B	Scattered areas of fibroglandular density
C	Heterogeneously dense, which may lower the sensitivity of mammography
D	Extremely dense, which lowers the sensitivity of mammography

TABLE 3

BI-RADS categories of screening mammography and their management

Categories	Assessment	Recommendation	Risk of malignancy
0	Incomplete	Diagnostic imaging or comparison films needed	Not applicable
1	Negative	Routine screening	Essentially 0%
2	Benign	Routine screening	Essentially 0%
3	Probably benign	Follow up at 6 months	> 0% but ≤ 2%
4	Suspicious	Biopsy
	a = low		4a > 2% to ≤ 10%
	b = moderate		4b > 10% to ≤ 50%
	c = high		4c > 50% to ≤ 95%
5	Highly suspicious	Biopsy	≤ 95%
6	Known cancer	Treatment, as appropriate	Not applicable

TABLE 4

Management of benign breast disease found on core-needle biopsy

Type of lesion	Pathology	Management
Nonproliferative (Relative risk [RR] of subsequent breast cancer 1.2–1.4)^28,29	Simple cyst Usual ductal hyperplasia (mild) Columnar cell change Apocrine metaplasia	Observation or aspiration Observation Observation Observation
Proliferative without atypia (RR 1.7–2.1)^28,29	Rbroadenoma Radial scar Intraductal papilloma Usual ductal hyperplasia (moderate to florid)	Observation, consider excision if > 2 cm < 1 cm: observation if solitary ≥ 1 cm: surgical consultation Surgical consultation if > 1 cm, atypical, or multiple Observation
Proliferative with atypia (RR 4.2)^28,29	Atypical ductal hyperplasia Atypical lobular hyperplasia Lobular carcinoma in situ	Surgical consultation Observation, offer chemoprevention Surgical consultation