Fibrocystic Breast Disease

Definition

Also called fibrocystic condition, fibrocystic change or cystic mastitis, fibrocystic breast disease is more a characteristic of the breast than a disease. It is often more prominent during ovulation and just before menstruation.

Description

Fibrocystic changes occur during ovulation and just before menstruation. During these times, hormone level changes often cause the breast cells to retain fluid and develop into nodules or cysts (sacs filled with fluid), which feel like a lump when touched. The nodules or cysts can spread throughout the breast, may be located in one general area or simply appear as one or more large cysts. If the lump is not filled with fluid, it is called a fibroadenoma. A fibroadenoma is a solitary, firm distinct lump, composed of a mass or lump of fibrous tissue.

Having fibrocystic breasts does not place women at a higher or lower risk of developing breast cancer.

Causes and Risk Factors

The cause of fibrocystic breast change is not known, but the symptoms and signs are linked to a woman's hormone patterns. Each month, the breasts respond to the cyclic peaks and troughs of estrogen and progesterone. As hormone levels rise just before and during menstruation, mammary blood vessels swell, ducts and alveoli expand, and cell growth proliferates. Breast tissue retains fluid and grows larger. After menstruation, these processes reverse.

Years of such fluctuations eventually produce areas of dense or fibrotic tissue. Multiple small cysts and an increasing level of breast pain commonly develop when a woman hits her 30s. Larger cysts usually do not occur until after the age of 35.

The common symptoms of fibrocystic breast disease are:

• tenderness in one or both breasts with pressure or touch

• breast pain

• an intermittent or persistent sense of breast engorgement, associated with dull, heavy pain and tenderness

• intermittent appearance of cysts or lumps that form and then resolve within a few weeks

• a dense, pebbly consistency to breast tissue

• formation of persistent cysts or lumps

• nipple discharge or inflammation.

These symptoms can range from mild to severe. Many women notice monthly cyclic patterns, with symptoms most severe just before each menstrual period.

Diagnosis

Fibrocystic breast disease is usually diagnosed when a patient goes to her doctor for a checkup or seeks help for pain, tenderness or a lump that was probably discovered during breast self-examination. The doctor will examine the breasts and sometimes recommend a mammogram, an ultrasound exam and (rarely) a needle aspiration. Most of the time the diagnosis of fibrocystic breast characteristics does not require extensive testing.

Needle aspiration involves inserting a needle into the middle of the lump to see whether it's a mass of tissue or a fluid-filled cyst. If the lump does not yield fluid when aspired, it may still be a cyst or other benign growth, such as intraductal papilloma (warty growth), fat necrosis (a fatty lump), duct ectasia (a clogged mammary duct) or sclerosing adenosis (a calcium deposit).

Ultrasound will determine if it is a simple cyst. If the cyst is not normal in appearance, does not disappear with aspiration or recurs after repeated aspiration, the doctor may do a biopsy to check for possible cancer. A biopsy involves removing all or part of the lump and examining it for cancer. There are needle biopsies (removing cells), incisional biopsies (surgical removal of only part of the lump) and excisional biopsies (removing all of the lump).

During the examination of the lump sample, the pathologist might see excessive fibrous growth between the breast glands or cyst formation within the glands. This condition is called atypical hyperplasia. Atypical hyperplasia is associated with a fivefold increase in breast cancer risk and is found in an estimated 4 to 10 percent of women with lumpy breasts.

Treatment

There are no specific treatments for fibrocystic breast disease, other than those to minimize discomfort. Doctors may recommend the following:

• wear a firm bra that gives very good support for severe breast pain

• avoid caffeine and chocolate

• eliminate excessive dietary fat and limit salt intake

• take pain relievers for combating pain

• increase doses of vitamin E

Hormonal therapy.

For severe symptoms, doctors may prescribe hormonal therapies, such as birth control pills, danazol (danocrine) or bromocriptine. Birth control pills regulate estrogen and progesterone levels. Danocrine, a synthetic version of the male hormone testosterone, works by shutting down the menstrual cycle. Bromocriptine reduces prolactin release and suppresses breast milk production after pregnancy. Treatment is individualized and should be discussed with the doctor.

Be sure to:

• Perform monthly breast self-exams

• Have a yearly breast exam by a doctor

• Have regular mammograms when recommended by your health care provider

• See the doctor whenever new lumps appear, if an existing lump changes in any way, or if unexplained symptoms develop

Questions to Ask Your Doctor

What is causing the lumpiness in the breast?

Can cancer be ruled out?

Are further tests necessary?

Can medication help?

What will these medications do to menstruation?

Is a modification in diet likely to reduce the symptoms?

Will aspiration or biopsy be necessary?