PASH (Pseudoangiomatous Stromal Hyperplasia)

What Is PASH?

Pseudoangiomatous stromal hyperplasia (PASH) is a rare condition where you have an abnormal growth in one or both breasts. The growth forms a benign (noncancerous) lump that’s filled with collagen. That means the lump isn’t a breast cancer symptom. Having pseudoangiomatous stromal hyperplasia (SOOD-oh-an-jee-OH-muh-tuhs STROH-muhl hahy-per-PLEY-zhuh) doesn’t increase your breast cancer risk. The condition typically affects females who haven’t gone through menopause. Males who have gynecomastia may develop it.

What are the symptoms of PASH?

PASH may make your breasts get bigger. For example, you may notice one breast is so much larger than the other that you need a larger bra size, or your shirts don’t fit as well as they did. This condition may cause a lump that you can feel while doing a breast self-exam. But PASH may not cause noticeable changes in your breast. Most people learn they have PASH because they had a breast biopsy for another reason or after a routine mammogram.

What causes pseudoangiomatous stromal hyperplasia?

The exact cause isn’t clear. Researchers believe there’s a link between changes in your hormone levels. Some research suggests there’s a link between high estrogen and progesterone levels in those who have PASH. There may be a link between high estrogen levels in males who have gynecomastia.

How do healthcare providers diagnose PASH?

A healthcare provider will do a core needle biopsy. This is a type of breast biopsy, and the only way a provider can diagnose pseudoangiomatous stromal hyperplasia.

In this procedure, your provider injects a local anesthetic around the biopsy site to numb your breast. They’ll use a hollow needle to remove a sample of breast tissue. A medical pathologist will examine the breast tissue under a microscope to make sure the growth isn’t breast cancer or another type of breast disorder.

How is pseudoangiomatous stromal hyperplasia treated?

There’s no single treatment for PASH. It depends on your situation and your preferences. For example, if the growth is small and you don’t have symptoms, your healthcare provider may decide an annual mammogram is the best way to check on your situation. They may recommend surgery to remove a growth that’s larger than an inch (2 to 3 centimeters).

But it can be worrisome to have a lump in your breast even though you know it’s not cancerous. In that case, ask your provider about surgery to remove the lump.

Will I have to have a mastectomy?

Probably not. People at high risk for breast cancer can develop PASH. But being at risk for breast cancer doesn’t increase your PASH risk, and having PASH doesn’t mean you’re more likely to have breast cancer. Still, providers may recommend a mastectomy if the condition causes a very large lump.

What can I expect if I have pseudoangiomatous stromal hyperplasia?

Everyone’s experience with PASH is a bit different. If you have surgery to remove the growth, you’ll have more frequent mammograms or other imaging tests to check for signs the condition has come back. On the other hand, having it may not change your regular routine of an annual mammogram.

How do I take care of myself?

Research shows women may experience anxiety and depression when tests show they have PASH. If you’re feeling anxious or depressed about your PASH diagnosis, consider counseling. Talking to a mental health specialist may help. So can taking steps to protect yourself against breast cancer, like:

• Maintain a weight that’s right for you: Having a body mass index (BMI) greater than 30 (obesity) may increase your breast cancer risk.
• Stay active: Research shows those who are physically active are less likely to develop breast cancer than those who aren’t active. Being physically active doesn’t mean running marathons. Daily activities like walking or gardening count.
• Abstain from alcohol: Moderate alcohol consumption may increase breast cancer risk by 30% to 50%.
• Do regular breast self-exams: Monthly self-breast exams increase the chance you’ll notice changes in your breasts.

When should I see my healthcare provider?

Talk to your provider if you notice changes in your breast, like a lump that you can feel, or one or both of your breasts appear to be getting bigger.

What questions should I ask my doctor?

Pseudoangiomatous stromal hyperplasia is rare. You may not know much about this condition. Here are some questions you may want to ask your healthcare provider:

• What treatment do you recommend?
• If I don’t have surgery, how often should I have a mammogram?
• If I have surgery, what are the chances the growth will come back?