Is conservative management of fibroadenomas feasible? 5-year results from the Durban Breast Unit

Abstract

Background: Fibroadenomas (FAs) usually present in young women and, despite being the commonest benign breast masses, are often excised. This study aimed to assess the results of a conservative management protocol in the setting of dedicated breast clinics to reassess the validity of this conservative approach.
Method: A retrospective chart review of a prospectively maintained database of the index presentation of patients diagnosed with FAs on triple assessment at the breast clinics of Inkosi Albert Luthuli Central Hospital (IALCH) and Addington Hospital (ADH) was undertaken. Women under 35 years with FA less than 5 cm and agreeable to the 5-year conservative management strategy from 2008 to 2015 were included. Variables assessed over the 5-year study period included adherence to clinic visits and any change in size of the lesion(s).
Results: Three hundred and six women were studied. The mean age of presentation was 21.5 years (IQR 12–34), and the mean FA size was 2.43 cm (IQR 0.5–4.8). 72.9% were of African ethnicity. 76.5% had a single FA, and in 16.3%, they were bilateral. 50.7% of patients were lost to follow-up, and 9.6% (n = 25) had spontaneous resolution of their FA. Conservative management of FAs was feasible in only 26.1% of patients.
Conclusion: Conservative management of FAs over 5 years is not practical in our local setting due to the high patient attrition rate. In those who completed the 5-year observation period, only 1 in 10 patients had complete resolution of their FA.