Sclerosing adenosis is a benign breast condition that involves excessive growth of lobules and stroma in the breast. Lobules are the glands that produce milk, and stroma is the supportive tissue around lobules and ducts. In sclerosing adenosis, there is an overgrowth of both lobular tissue and stroma.
What causes sclerosing adenosis?
Sclerosing adenosis is not cancerous and its exact cause is unknown. Some theories about what may contribute to sclerosing adenosis include:
- Hormonal influences – Estrogen exposure encourages growth of glandular tissue in the breasts.
- Inflammation – Chronic inflammation in the breast may trigger excess tissue growth.
- Injury – Past injury to the breast may promote scar tissue formation.
- Genetic factors – There may be inherited tendencies toward overgrowth of glandular tissue.
Often, sclerosing adenosis is an incidental finding on breast imaging or biopsy done for another reason. It is not directly linked to hormone therapy or birth control pills.
What are the symptoms of sclerosing adenosis?
In most cases, sclerosing adenosis does not cause any symptoms. Since it is a non-cancerous overgrowth of normal breast tissue, it is often harmless. Some women develop benign lumps or areas of thickened tissue that lead to detection of sclerosing adenosis. Symptoms may include:
- Lump or area of harder breast tissue
- Change in breast shape
- Nipple discharge
- Breast pain or tenderness
However, these symptoms are nonspecific and may also be caused by benign breast cysts or other conditions like fibrocystic changes. The diagnosis of sclerosing adenosis is usually made by biopsy after an abnormality is seen on imaging.
Who gets sclerosing adenosis?
Sclerosing adenosis can occur in women of any age, but it is most common in women between the ages of 30 and 50. Risk factors include:
- Age – More common in middle age.
- Childbirth – Pregnancy and breastfeeding may increase risk.
- Breast injury – Past trauma to the breast.
- Family history – Sclerosing adenosis may run in some families.
Up to 13% of benign breast biopsies show evidence of sclerosing adenosis. However, it is often an incidental finding and not the reason for the original imaging study or biopsy.
How is sclerosing adenosis diagnosed?
Sclerosing adenosis is diagnosed based on breast imaging and biopsy results. Typical steps in diagnosis may include:
- Screening or diagnostic mammogram showing an area of suspicion.
- Targeted ultrasound to further evaluate an abnormality seen on mammogram.
- MRI or biopsy recommended for suspicious findings.
- Core needle biopsy or surgical biopsy to remove samples of the abnormal tissue.
- Pathology examination of biopsy samples under a microscope.
Under a microscope, sclerosing adenosis shows overgrown lobules scattered throughout dense fibrotic stroma in the breast. This distinct pattern helps differentiate it from breast cancer.
How is sclerosing adenosis treated?
Since sclerosing adenosis is benign, treatment focuses on managing symptoms rather than curing the condition. Common treatments may include:
- Watchful waiting – If there are no symptoms, regular monitoring may be recommended.
- Pain medication – Over-the-counter pain relievers can help breast tenderness.
- Hormone therapy – Medications to suppress hormones or treat hormonal imbalance.
- Surgical removal – If large or painful areas of adenosis, surgical excision may be an option.
The outlook for sclerosing adenosis is generally very good. It does not become cancerous, although some types may slightly increase breast cancer risk.
What is the relationship between sclerosing adenosis and breast cancer?
Sclerosing adenosis is not cancer and does not directly become breast cancer. However, there are a few important points about sclerosing adenosis and breast cancer risk:
- Slightly increased risk – Some (but not all) studies show a mild increased breast cancer risk.
- Difficulty reading mammograms – Overlapping tissue patterns can obscure cancer detection.
- Radial scar adenosis – This rare subtype may be linked to higher risk.
- Biopsy is needed – Breast biopsy is required to rule out cancer.
Women with sclerosing adenosis should talk with their doctor about whether more frequent screening is recommended. But in most cases, sclerosing adenosis is not a pre-cancerous condition.
Table summarizing key points on sclerosing adenosis and breast cancer risk:
| Type of Adenosis | Breast Cancer Risk |
|---|---|
| Classic sclerosing adenosis | No increased risk |
| Radial scar adenosis | May be mildly increased risk |
| Atypical adenosis | Moderate 3-5x increased risk |
Conclusion
Sclerosing adenosis is an overgrowth of normal lobules and stroma in the breast lobe. It is benign but may appear suspicious on imaging, requiring biopsy. Treatment is usually conservative with pain management and monitoring. Breast cancer risk is generally not substantially increased in sclerosing adenosis. Women should discuss appropriate screening recommendations with their doctor.