Benign breast disorders: the clinician's view

Benign breast disorders can be considered from four points of view: clinical presentations, clinical significance, management, and pathogenesis. Understanding the pathogenesis is important for rational management and for assessing clinical significance. Clearly understood nomenclature is also important. Clinicians have tended to concentrate on the condition usually known as fibrocystic disease, a clinical condition (painful nodularity), but a terminology which relates to a histological picture of fibrosis, cyst formation, and epithelial hyperplasia, now known to occur in both asymptomatic and symptomatic breasts. To address these problems the aberrations of normal development and involution (ANDI) concept has been proposed as a framework for benign breast disorders which is comprehensive, accurate in terminology, and based on pathogenesis. For each disorder, there is a spectrum from normal through mild abnormality (aberration) and in some cases (only) to disease. This concept encompasses pathogenesis, clinical and histological significance, and general principles of management. It has proved particularly useful in giving an understanding of benign breast disorders to doctors in training.