Intraductal Papilloma

What are intraductal papillomas of the breast?

Intraductal papillomas are benign (noncancerous) breast tumors in your milk ducts. “Papillomas” are wartlike growths covered in epithelial cells. Epithelial cells cover internal and external surfaces in your body. “Intraductal” just means that the tumors are inside (intra) your milk ducts (ductal).

Although an intraductal papilloma is benign, your healthcare provider will test it to ensure it doesn’t contain atypical cells that could become cancerous.

Types of intraductal papilloma

Types include:

• Solitary papillomas: Usually, an intraductal papilloma is a single tumor that forms in the large milk ducts near your nipple. Depending on how big it gets, you may be able to feel a lump behind or near your nipple. This type doesn’t increase your lifetime breast cancer risk.
• Multiple papillomas (papillomatosis): Multiple papillomas form in the smaller milk ducts farther away from your nipple. Having this type slightly increases your breast cancer risk over your lifetime. Only about 10% of diagnosed papillomas are papillomatosis.

How common is intraductal papilloma?

Approximately 10% of benign breast lesions (areas of abnormal or damaged tissue) are intraductal papilloma. Most are solitary papillomas (a single tumor).

What are the symptoms?

Not all papillomas cause symptoms. You may not learn you have a papilloma unless a healthcare provider spots an abnormal area (lesion) during an imaging procedure, like a mammogram.

But some papillomas cause breast changes. Symptoms include:

• Clear or bloody discharge from your nipple (usually affecting only one breast).
• A tiny lump behind your nipple (may or may not be painful).
• Pain or a feeling of discomfort located in one area of your breast.

Contact your healthcare provider if you’re experiencing these symptoms.

What causes intraductal papilloma?

Intraductal papillomas form when epithelial cells in your milk ducts overgrow. But experts don’t know what fuels the growth. Research is ongoing to determine what causes intraductal papilloma.

Some people who hear the word “papilloma” assume intraductal papillomas are associated with human papillomavirus (HPV) infections. But there’s no connection. It’s true that some high-risk strains of HPV increase your risk of certain cancers.

But an HPV infection doesn’t cause intraductal papillomas or increase your risk.

What are the risk factors?

Research is ongoing to determine risk factors for intraductal papilloma. Factors that researchers do know may increase your risk include:

• Age: You’re more likely to have intraductal papillomas if you’re between ages 35 to 55. Most people diagnosed are perimenopausal. People with multiple papillomas tend to be younger than people with solitary papillomas.
• Exposure to estrogen: You may be more at risk if you’ve had more lifetime exposure to estrogen. Getting your period early, starting menopause late and never getting pregnant all increase your exposure to estrogen. Using birth control containing estrogen is also a factor.
• Family history: A family history of breast cancer increases your breast cancer risk. It also increases your chances of developing some benign breast conditions, like intraductal papilloma.

Does intraductal papilloma increase my cancer risk?

Intraductal papillomas aren’t cancerous. Still, your healthcare provider will need to check these growths. Intraductal papillomas are a “high-risk precursor lesion.” This means providers sometimes find cells inside or near papillomas that could become malignant (cancer).

Although it’s rare, providers sometimes find signs of:

• Atypical cells, or atypical ductal hyperplasia (ADH): These cells in your milk ducts multiply rapidly and grow abnormally. They can transform into cancer cells. Only about 3% of intraductal papillomas get upgraded to ADH.
• Ductal carcinoma in situ (DCIS): DCIS is a noninvasive or preinvasive cancer. It doesn’t typically spread beyond your milk ducts, like aggressive cancers do. Only about 2.5% of intraductal papillomas get upgraded to DCIS.

Multiple papillomas are more likely to contain atypical cells than solitary papillomas. Multiple papillomas also slightly increase your lifetime breast cancer risk. Researchers are still studying the reasons why.

Still, it’s important to remember that treatments are available that can cure ADH and DCIS.

How is intraductal papilloma diagnosed?

The only way to diagnose an intraductal papilloma is with a breast biopsy. During a biopsy, a provider removes all or part of the papilloma. Afterward, a pathologist tests it for abnormal cells.

Traditional imaging studies, like a mammogram, ultrasound or magnetic resonance imaging (MRI) may show unusual growths. But without a biopsy, there’s no way to know that the tumors are papillomas.

For example, on a mammogram, an intraductal papilloma may look like a mass, nodule or calcifications. These are signs of many kinds of benign and malignant (cancerous) breast tumors.

Your healthcare provider will need to test the tissue directly to diagnose intraductal papilloma.

How do you treat papillary lesions in the breast?

Treatment for intraductal papilloma depends on how many tumors you have, among other factors.

• Solitary papillomas need to be removed if they contain atypical cells or are causing symptoms. The size of your tumor and your breast cancer risk also inform whether you need surgery. Sometimes, providers choose to monitor solitary papillomas with imaging instead.
• Multiple papillomas need to be removed. Although they’re benign growths, they’re more likely to give rise to precancerous breast changes.

Do all intraductal papillomas need to be removed?

Your healthcare provider may recommend monitoring small solitary papillomas that don’t cause symptoms. But most intraductal papillomas need to be removed.

Treatments to remove papillomas include:

• Vacuum-assisted excision (VAE): This procedure uses a tiny needle connected to a suction device that can remove the lesion.
• Excisional breast biopsy (lumpectomy): This procedure removes the lesion and a margin of healthy tissue to ensure no abnormal cells remain.
• Mastectomy: You may need an entire breast removed if you have multiple papillomas and are at high risk for breast cancer.

Your healthcare provider will explain the best treatment options based on your biopsy results.

Can papillomas be prevented?

There’s no way to prevent intraductal papillomas. But regular breast cancer screenings allow your provider to keep tabs on your breast health. Scheduling an appointment with your provider at the first sign of breast changes can help, too.

Catching changes early and getting treated can prevent benign breast conditions from ever progressing to cancer.

How serious is intraductal papilloma?

Intraductal papillomas aren’t cancerous. Rarely, these tumors can harbor atypical cells that may require treatment. Multiple papillomas may slightly increase your lifetime cancer risk. This means you may need more frequent monitoring for cancer.

The good news is that treatment to remove the cells can prevent atypical or precancerous cells from forming. And if you do have atypical cells, surgery can prevent them from becoming cancerous.

What questions should I ask my healthcare provider?

Questions to ask include:

• How many tumors do I have?
• What imaging procedures will I need to locate all papillomas?
• What do my biopsy results mean?
• Am I at an increased risk for breast cancer?
• Will I need surgery or additional treatments to remove the papillomas?
• How often will I need breast cancer screenings following treatment?

A note from Cleveland Clinic

Intraductal papillomas are benign. But you’ll still likely need treatment or monitoring if you have one or more papillomas. Most intraductal papillomas never progress to cancer, but occasionally they give rise to atypical cells that do. Your biopsy results, the number of papillomas you have and your lifetime breast cancer risk all factor in when it comes to your treatment options. Your healthcare provider will advise you based on your diagnosis.