Nonproliferative Changes

Key Facts

Terminology

Clinical Issues

Frequent findings: Evident in up to 50-60% of women of reproductive age
Nonproliferative changes do not increase risk of breast cancer
Often presents as palpable masses (cysts) or mammographic lesions (densities or calcifications)

Top Differential Diagnoses

BBD with proliferative changes &/or atypia
- These changes increase subsequent risk of developing breast carcinoma

Reporting Considerations

“Fibrocystic changes” or “fibrocystic disease” can include a number of different pathologic processes
- Can be useful descriptive terms but not as diagnostic terms for pathologic diagnosis
Clinically more relevant to list specific types of benign lesions present including
- Lesion conferring highest risk of subsequent carcinoma (if present)
- Lesion that correlates with symptom or radiologic finding that prompted biopsy

Simple cysts are often aspirated to completion and do not need further evaluation. Cysts containing debris or blood

may appear solid and require biopsy to exclude the possibility of carcinoma.

Calcifications

are often found within clusters of apocrine cysts

. When detected on mammographic screening, biopsy is warranted as DCIS is also frequently associated with multiple calcifications.

TERMINOLOGY

Abbreviations

Synonyms

Definitions

Commonly encountered constellation of benign breast changes including cysts, apocrine metaplasia, stromal fibrosis, and adenosis

ETIOLOGY/PATHOGENESIS

Hormonal Effects

Responsiveness of breast tissues to monthly changes of estrogen and progesterone levels plays an important role in pathogenesis of BBD
- May be related to excess hormonal stimulation &/or hypersensitivity of breast tissue
Clinical factors associated with increased risk of BBD
- Late age at menopause, estrogen replacement therapy, nulliparity, low body mass index, and family history of breast cancer
Clinical factors associated with decreased risk of BBD
- High parity, oral contraceptives, physical activity
- Tamoxifen, when used for breast cancer prevention, is associated with 28% reduction in prevalence of BBD (relative risk 0.72)

CLINICAL ISSUES

Epidemiology

Incidence
- Very common
  - Some elements of BBD are evident in up to 50-60% of women of reproductive age
- Increased incidence of BBD seen in postmenopausal women receiving estrogens ± progestins for > 8 years (relative risk increased by 1.70)

Presentation

Mammographic screening
- May present with densities or calcifications
Palpable lumps
- Diffuse symmetrical lumpiness is commonly found on physical examination
- Size and symptoms may fluctuate over course of menstrual cycle
Cyclic breast pain may occur during late luteal phase of menstrual cycle