An Overview of Intraductal Papillomas in the Breast

An intraductal papilloma is a small, benign (noncancerous), wart-like growth on the lining of the milk duct that may cause nipple discharge. Intraductal papillomas are usually close to the nipple, but they can sometimes be found elsewhere in the breast. Whether you have one intraductal papilloma or several (known as intraductal papillomatosis), your risk of developing breast cancer may be slightly increased.

Intraductal papilloma makes up less than 10 percent of benign breast lesions and less than 1 percent of malignant (cancerous) breast tumors.

Symptoms

There are two different types of intraductal papillomas, as well as one other condition that is closely related. Symptoms depend on which of these you have:

• Solitary intraductal papillomas: If you have just one intraductal papilloma, you may feel a small lump near or just beside a nipple. When a papilloma breaks a duct, it can cause a little clear or bloody nipple discharge.
• Multiple papillomas: These consist of groups of lumps that usually occur deeper inside your breast and can't easily be felt. They usually don't cause discharge.
• Papillomatosis: Papillomatosis consists of small groups of cells inside the ducts that aren't as distinct as papillomas are. The condition usually won't cause nipple discharge.

Causes

Anyone can develop an intraductal papilloma, but the condition is most common in women between the ages of 35 and 55. It usually develops naturally as the breast ages and changes.

Diagnosis

If you find a small lump near your nipple and see some discharge, talk to your doctor and try not to panic—chances are it's benign. Your doctor will want to do a clinical breast exam and also check to see if you're up-to-date on breast cancer screening.

The two of you may decide that you want to have the fluid tested. If the lump is large enough for you to easily feel it, a needle biopsy may be done to obtain a tissue sample.

To begin this procedure, a patient must squeeze a small bit of discharge from the nipple, so that the radiologist can see exactly which duct is leaking. Once the duct is found, the radiologist gently inserts a very fine, hollow needle into the duct and injects some contrast fluid into the duct network. This contrast fluid will show up on a mammogram and trace the related ducts.

The resulting image may help to reveal the cause of your nipple discharge.

Sometimes, a ductogram or galactogram, imaging studies that are done specifically on the milk duct system, can be performed to help find papillomas.

Treatment

Intraductal papillomas can be surgically removed if they prove bothersome. A small incision is made along the edge of your areola, then the papilloma and its duct are removed. The resulting scar can be nearly undetectable.

Breast Cancer Risk

Solitary intraductal papillomas don't ordinarily increase your risk of developing breast cancer unless they contain regions of atypical hyperplasia. This is a precancerous condition where there are more cells lining the duct than would normally be there, and some of the cells are irregular in shape and size.

If you have multiple papillomas or papillomatosis, your risk for developing breast cancer is slightly increased.

Ask your doctor if they would recommend breast cancer screening above and beyond the general guidelines moving forward.