Significance of Radial Scars: A Breast Abnormality

What are Radial Scars and Do They Raise Breast Cancer Risk?

drawing of a breast with a radial scar
What are radial scars and what is their role in the development of breast cancer?. Sciepro / Getty Images

If you've been told you have a radial scar you're probably feeling anxious. What exactly is a radial scar? Does a radial scar increase your risk of developing breast cancer? What is your next step?

About Radial Scars of the Breast

A radial scar is a star-shaped breast mass that may be completely benign, or it may be precancerous or contain a mixture of tissue, including hyperplasia, atypia, or cancer.

If a radial scar is rather large, it may appear on a regular screening mammogram. It can look like an irregularly shaped star, having spiked arms radiating away from the center. A radial scar in breast tissue usually won't cause a lump that you can feel, nor will it make breast skin dimple or discolor. In some cases, a radial scar may cause some breast pain.

Radial scars are also known as a complex sclerosing lesion of the breast, a "black star." sclerosing papillary proliferation, infiltrating epitheliosis, and indurative mastopathy

Radial Scars of the Breast Are Rare

An estimated 0.04 percent or six out of every 15,000 patients are diagnosed annually with a radial scar of the breast. Women between the ages of 41 and 60 are at the highest risk for a radial scar. These breast lesions are even less common in women under 40 or over 60 years old.

The fact that these are uncommon probably is of little comfort if you are diagnosed.

Significance of a Radial Scar Diagnosis

Having a radial scar causes concern because a large one looks like breast cancer when seen on a mammogram. It is difficult to properly diagnose a radial scar, even with a biopsy, because under a microscope, the cell geometry closely resembles tubular carcinoma.

This typically benign breast mass sometimes has malignant tissue hiding behind it.

Increased Risk For Breast Cancer

If you have been diagnosed with a radial scar, then your lifetime risk for developing breast cancer is double that of someone who does not have a radial scar. Many patients have extra screening mammograms to document any breast changes. Some women may choose a lumpectomy to remove the suspicious tissue.

Causes of a Radial Scar in Your Breast

A radial scar is not always made of scar tissue, but it takes its name from its scar-like appearance on an x-ray. A radial scar may be caused by breast surgery, breast inflammation or hormonal changes. It may also be the byproduct of fibrocystic changes in the breast that normally occur as you age.

Tests Used to Diagnose a Radial Scar

Some of the tests used to evaluate a radial scar include:

  • Mammogram images can sometimes detect a radial scar which can appear as a border of microcalcifications.
  • Ultrasound - An ultrasound used sound waves to define the area in question.
  • MRI With Contrast - MRI's are very sensitive in detecting abnormalities in the breast and are more accurate than either mammogram or ultrasound.
  • Core Needle Biopsy - In a core biopsy a sample of the abnormal area is taken and evaluated by a pathologist.

A Breast Biopsy is a Must

You may not need all of these tests, but it is important to have a breast biopsy so a pathologist can examine the tissue, to get a clear diagnosis. Studies have found that mammography and ultrasound alone can't exclude the presence of cancerous tissue in a radial scar, and therefore a biopsy of some form will be needed for anyone with a radial scar until better diagnostic techniques are developed.

Radial Scar Treatment Options

You may have options for radial scar treatment. Many doctors advise patients to have this breast mass surgically removed, in order to prevent a possible malignancy from forming. This may be done with an open surgical biopsy or a lumpectomy, depending on the size of the radial scar. The tissue from your surgery will be examined and tested in a lab. If your radial scar did not contain any invasive breast cancer cells, you won't need radiation, chemotherapy, or hormonal therapy as follow-up treatments.

Reducing Your Risk of Breast Cancer

If you do have an increased risk of having a malignancy, then your doctor may suggest being extra vigilant about your breast health. Keep your risk of breast cancer low by sticking to an anticancer diet and other strategies which reduce breast cancer risk such as regular exercise, keeping slim and lowering your stress levels. Avoid using alcohol and tobacco to protect your overall health.

Coping with a Radial Scar

It is frightening to know you have a condition that can raise the risk of developing breast cancer. What has helped some people at risk of breast cancer better cope with these odds is knowing that at least you have an awareness. All women are at risk of breast cancer, with the disease happening in one out of eight of us. Those at an increased risk due to a radial scar or a family history are often more likely to follow through with screening tests. In this sense, having a risk factor for breast cancer may at least increase the chance that, if you develop breast cancer, you may find it at an earlier stage than someone who is not as vigilant about screening measures.

Bottom Line on Radial Scars

It deserves repeating that a biopsy will be needed for anyone who is diagnosed with a radial scar until better methods of diagnosis are available. Mammograms and ultrasounds are not yet accurate enough to predict whether cancer is present.

Sources:

Bianchi, S., Giannotti, E., Vanzi, E. et al. Radial Scar Without Associated Atypical Epithelial Proliferation on Image-Guided 14-Gauge Needle Core Biopsy: Analysis of 49 Cases from a Single-Centre and Review of the Literature. Breast. 2012. 21(2):159-64.

Linda, A., Zuiani, C., Furlan, A. et al. Radial Scars Without Atypia Diagosed at Imaging-Guided Needle Biopsy: How Often is Associated Malignany Found at Subsequent Surgical Excision, and do Mammography and Sonography Predict Which Lesions are Malignant?. AJR American Journal of Roentgenology. 2010. 194(4):1146-51.

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