Intraductal papilloma

Intraductal papillomas are small, benign growths in the milk ducts of the breast. Milk ducts are the thin tubes that carry milk from the breast lobules to the nipple. In some cases, patients may be able to feel a “wart-like” lump behind or near the nipple.

Different types of cells may be found in these small growths—gland tissue, fibrous tissue and blood vessels. People between the ages of 35 to 55 tend to develop them most often.

There aren’t distinct types of intraductal papillomas. Instead, they’re categorized by how many are present, and symptoms may look different depending on the number of papillomas:

Intraductal papilloma categories

Solitary intraductal papillomas

• Occur when only one papilloma is present
• Grow in the large milk ducts close to the nipple
• May be felt behind or near the nipple
• May cause pain
• May cause a clear or bloody discharge from the nipple

Multiple intraductal papillomas

• Occur when more than one papilloma are present
• Often grow in the small milk ducts, farther away from the nipple
• May cause a clear or bloody discharge from the nipple, but it’s less likely than with solitary papillomas

Another condition, called papillomatosis, is similar to intraductal papillomas. With papillomatosis, small areas of cell growth develop in the milk ducts, but they aren’t as defined as papillomas.

Intraductal papilloma symptoms

In one or both breasts, patients may notice:

• Nipple discharge (clear or bloodstained)
• A lump in the breast
• Pain

A solitary papilloma is a common cause of nipple discharge, especially when it occurs in only one breast. With multiple papillomas, patients typically wouldn’t see that same discharge or a noticeable lump.

How are intraductal papillomas diagnosed?

Options for diagnosing intraductal papillomas include:

• Ductogram (medical imaging to view breast ducts)
• Mammogram
• Ultrasound
• Breast biopsy

Do intraductal papillomas affect breast cancer risk?

Having a single papilloma doesn’t increase the risk of breast cancer, unless other changes, such as atypical hyperplasia, occur in the cells in the breast or nearby.

Multiple papillomas may increase the risk for cancer if the patient also has one of the following:

• Atypical hyperplasia—an overgrowth of the cells that line the breast ducts or the milk glands and occur in a distorted pattern
• Ductal carcinoma in situ (DCIS)—when abnormal cells develop in the lining of a breast duct but haven’t spread to other tissues

The risk of cancer may be higher for people:

• Who develop them at an early age
• With a family history of cancer
• Who have five or more intraductal papillomas

Though the number of papillomas may affect the risk of cancer, the exact causes and risk factors for intraductal papillomas are still unknown.

Intraductal papilloma treatment

If a biopsy shows that the cells appear normal, and the patient doesn’t have a history of breast cancer, doctors may opt for “active surveillance,” to keep a close eye on the area.

In other cases, especially if a patient previously had breast cancer, doctors may recommend surgery to remove the papilloma even though the cells appear normal.

When atypical or cancerous cells are found in a biopsy, they’re removed during a surgical procedure, along with the part of the duct where the growth was found. Depending on which type of cells is found, the care team might recommend chemoprevention, which is medication to prevent cancer in the future.

Learn about other possible breast cancer causes and risk factors