Risk Assessment in Benign Breast Lesions

Abstract

Benign breast lesions can present symptomatically or mammographically detected through screening programmes. Risk assessment is important for both the clinician and the patient to assist in making decisions regarding screening, prophylactic treatment and surveillance. Because of widespread use of mammography, clinically silent benign lesions are now easily detected, leading to pathological assessment to exclude the presence of malignancy. Fine needle aspiration cytology, needle core biopsies and excision biopsies are the methods used to confirm benignity and allay patient anxiety. When a woman has had a diagnosis of benign breast disease, more often than not she wishes to know what is the likelihood of the benign lesion predisposing to cancer at a later stage. With some conditions, such as fat necrosis, duct ectasia or hyalinised fibroadenoma, the clinician can reassure the patient confidently that there is no risk of developing cancer. However, some benign proliferative lesions confer an increased risk of subsequent malignancy, although in most cases the risk is very small. These conditions require careful explanation to the patient, not to alarm them but to encourage compliance with follow-up. The advantage of assessing the possible risk of progressing to malignancy in benign disease is that regular clinical and radiological follow-up can detect malignancy at an early, potentially curable stage.