Most intraductal papillomas are not cancerous, however, 17-20% have been shown to be cancerous after complete removal of the tumor. In addition, about 20% of intraductal papillomas contain abnormal cells. Because there is even a small risk of cancer, papillomas must be surgically removed and biopsies should be performed. Intraductal papillomas are often removed by surgery.
The specialist may want you to have an operation called an excisional biopsy to remove the intraductal papilloma. An excisional biopsy may be performed under local or general anesthesia. You may be offered a vacuum-assisted excisional biopsy to remove the intraductal papilloma. Usually, the doctor recommends surgery to remove an intraductal papilloma.
When a papilloma needs treatment, it is by destruction or removal. A small sample (called a core needle biopsy) is usually taken to determine what the lesion is and its characteristics. Not all breast papillomas should be removed by surgery. If surgery is needed, the duct and papilloma are removed through a small cut made near the nipple and areola (the dark area around the nipple) or in another part of the breast, as needed.
You will be given a local anesthetic to freeze the area before the incision is made. After removing the duct and papilloma, they are sent to the laboratory to confirm that the tumor is a papilloma. The usual treatment is surgery to remove the papilloma and part of the duct in which it is found. Intraductal papilloma may be associated with another condition called atypical hyperplasia, which means abnormal cell growth.
There is a risk that atypical hyperplasia will develop into breast cancer over time if left untreated. If there are atypical cells in the papilloma when the biopsy is examined, they will usually be observed under a microscope. Multiple papillomas are more likely to be associated with atypical hyperplasia, but this is not always the case. You will need to talk to your doctor about the result of the biopsy to make sure.
People with multiple intraductal papillomas or whose intraductal papillomas contain atypical cells are more likely to have follow-up appointments. Although there is no specific way to prevent intraductal papilloma, you can increase the chance of early detection by seeing your doctor regularly for breast exams, getting breast self-exams every month, and having annual mammograms. Because biopsies are not completely accurate, doctors recommend that people consider surgery to remove intraductal papillomas. A ductogram (galactogram), in which a dye is injected into the nipple canal where the discharge is likely to come from and then an x-ray is taken, can sometimes be helpful in finding papillomas.
However, in three studies (1,15.1, 9.4— 33.3%) of papillary lesions confirmed as benign papillomas without atypia with NBC were elevated to DCIS or invasive cancer when re-evaluated after excision. Anyone with multiple intraductal papillomas should discuss breast cancer risk factors with their doctor, even if tests show that the cells are benign. If the papilloma is large enough to be felt or seen on ultrasound, a biopsy may be done to examine the tumor tissue under a microscope. Of 119 growths that biopsies had indicated to be papillomas, 21% were found to contain atypical cells.
When papillomas form in the smaller ducts farthest from the nipple, they usually form as groups of small tumors. Intraductal papillomas are more common in women over 40 years of age and usually present as the breast ages and changes. It is difficult to prevent a papilloma from becoming cancer because HPV cancer usually has no symptoms until it is in an advanced stage. This causes a rare condition known as recurrent respiratory papillomatosis, which occurs mainly in children.
Whether a papilloma lump or lesion needs treatment depends on its location and whether it is causing problems there. .
