An Overview of Intraductal Papillomas in the Breast

This benign condition affects the lining of the milk duct

Intraductal Papilloma of the Breast
Ed Uthman/Flickr/CC BY 2.0

Intraductal papilloma is a little benign (non-cancerous) 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. Intraductal papillomatosis is when you have many little warts instead of just one. Having one or more intraductal papillomas may slightly increase the risk of developing breast cancer.

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

Symptoms

There are two different types of intraductal papillomas, as well as one other condition which is closely related to intraductal papillomas. These include:

  • 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 quite near your nipple and see some discharge, talk to your doctor, but don't 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.

There are many different presentations of nipple discharge, as well as many potential causes. While precancers and cancers can be to blame, they rarely actually are. 

The two of you may decide that you want to have the fluid is tested. If the lump is large enough for you to easily feel it, a needle biopsy may be done to obtain a tissue sample. She may also recommend that you have the lump imagined via a ductogram or galactogram, imaging studies that are done specifically on the milk duct system.

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.

Treatment of Intraductal Papillomas

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.

Don't confuse intraductal papillomas with papillary carcinoma of the breast, also known as intraductal papillary carcinoma, a rare type of breast cancer accounting for less than one percent of all invasive breast cancers.

Intraductal Papillomas and Your Risk of Breast Cancer

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 she would recommend breast cancer screening above and beyond the general guidelines.

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