nipple pain

[tiredpoet]

Hi!  I had an FNA done on a small lump in my right breast on the outer top near my underarm about 5 years ago (I had just turned 30) The result was benign but also called atypical (to this day no one has ever explained to me what was atypical about it).  A year later I had switched doctors and I had a follow up ultrasound and mammogram and was told I didn't even have to worry about it again (which of course I ignored, because I found that advice dismissive and quite frankly wrong).  I have very dense breasts but I feel no other lumps anywhere, not even before my period.  My gyn does a manual exam every year and although we both feel that the mass feels very large, every time they do the ultrasound the radiologist and surgeon make a big scene about saying that they had trouble even finding it on the ultrasound.  

I'm finding the differing opinions quite odd, actually.  The first ultrasound 5 years ago said it was 8x4x10mm no cystic component noted, well demarcated hypoechogenicity, some internal flow possibly defining a hilum.  The radiologist at that time said it was probably a small lymph node.

A month later, they did the FNA and at the time also saw a similar lump about the same size on the same breast just above the nipple, which they did not biopsy or even report on the results:  The original FNA says it was 4.9mm solid mass: atypical, multiple clusters of fairly bland ductal cells.  foam cells and apocrine metaplasia present.

As I said, no one has explained to me what is meant by the use of the word atypical here.  I'm fine with the assertion that the lump is benign, but it would be nice if they could explain what's atypical about it and if it's in fact atypical why I'm being told not to follow up on it and am treated like a hypochondriac when I do follow up.  Also, when I mention that they saw the second lump during the FNA no one even looks for it or feels the need to follow up on that.

How should I be following up on this?

[tiredpoet]

Thanks for the response!  I've read that apocrine metaplasia may be associated with increased risk of breast cancer - is this so?  And if so, would you suggest I have at least a yearly ultrasound?  My primary care physician says I just need manual breast exams going forward.

[Cleveland Clinic]

Dear tiredpoet:  There are many “atypical” findings that describe tissue but do not have significance in terms of increasing cancer risk.  In these cases, the follow up would be as recommended based on your age and any other risk factors you may have (family history, etc.).  Atypical ductal hyperplasia is one type of atypia that is associated with an increased cancer risk.  The treatment for this is to remove the entire area of concern and follow up with regular exam and mammogram.  

Breast pain is very common and is not usually associated with breast cancer.  You should bring it up to your doctor who can do an examination and determine if any additional evaluation is warranted.  Another options is to seek the advice of a medical breast specialist.  These are often affiliated with large academic medical centers.  

[tiredpoet]

oops, forgot to mention that oddly enough I have now begun experiencing sharp pains in the nipple of my other breast, the left one.  I'm nervous to bring it up with my doctor because I'm treated like such a worrywart about the other breast lump, and am wondering if I'm right to be vigilant or if I can just let everything be.