Intraductal Papillomas: A (Usually) Benign Breast Condition

What are intraductal papillomas? Can they raise the chance of getting breast cancer? How are they diagnosed, how are they treated, and what else do you need to know?

An intraductal papilloma is a tiny wart-like growth in breast tissue, that is composed of fibrous tissue and blood vessels. They grow inside the breast's milk ducts near the nipple. They are a benign breast condition, meaning that they are not cancerous and do not turn into cancer (though they may increase the risk which is described later on.)

Intraductal papillomas can cause benign (non-cancerous) nipple discharge by growing into and puncturing a milk duct.

What Do They Feel Like?

If you have just one intraductal papilloma, you may feel a small lump near or just beside a nipple. Solitary intraductal papillomas usually occur in the large milk ducts near your nipple. When one of these papillomas breaks a duct, it can cause a little clear or bloody nipple discharge. If you have multiple papillomas, they usually occur deeper inside your breast, and can't easily be felt. A group of papillomas like this won't usually cause nipple discharge.

If you find a small lump quite near your nipple and see some discharge, talk to your doctor, but don't panic yet.  Chances are that it is benign. Your doctor will want to do a clinical breast exam and also check to see if you are up to date on breast cancer screening.

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 in a procedure called a ductogram..

A ductogram, or galactogram, is an imaging study 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.

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: These usually consist of one lump, near the nipple, which causes nipple discharge.
• Multiple papillomas: These consist of groups of lumps, farther away from a nipple and usually cannot be felt and don't cause discharge.
• Papillomatosis: Papillomatosis consists of very small groups of cells inside the ducts, a type of hyperplasia.  This condition is much more scattered than that of multiple 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.

Solitary intraductal papillomas do not ordinarily increase your risk for developing breast cancer, unless they contain regions of atypical hyperplasia.  If you have multiple papillomas or papillomatosis, your risk for developing breast cancer is slightly increased.  Talk to your doctor about screening she would recommend above and beyond general screening if this is the case.