Fibrocystic breast changes

ALSO KNOWN AS: Fibrocystic conditions of the breast

RELATED CONDITIONS: Cysts, mastalgia, trigger-zone breast pain, fibroadenoma, fibrosis, hyperplasia

DEFINITION: Fibrocystic changes in the breast are benign (noncancerous) and related to normal hormonal fluctuations during a woman’s menstrual cycle. The word refers to the thickening of tissue (fibro) and fluid-filled sacs (cysts) in the breast. The term loosely groups several benign conditions, some of which can cause physical symptoms of discomfort or pain called mastalgia. Other conditions may be visible on mammograms but not noticeable physically.

In the past, the term fibrocystic breast disease was used, a misleading label, given that the majority of women experience some breast changes or have mammograms that reveal them.

Risk factors: Women in their childbearing years or postmenopausal women taking hormone replacement therapy may be prone to several types of fibrocystic changes. Because these changes are related to menstrual cycle hormones, they usually cease after natural menopause.

Etiology and the disease process: Fibrocystic breast changes are not a disease. They include several different categories of benign changes in breast tissue caused by the fluctuations of hormones during a woman’s menstrual cycle. Each month, a woman’s body prepares for pregnancy, and hormones stimulate milk-producing cells, creating as much as three to six teaspoons of fluid within each breast. The fluid is reabsorbed if pregnancy does not occur. The fluid can collect in sacs and form cysts.

Breast pain may be cyclical, appearing at the time of a woman’s ovulation or just before or during her menstrual period. Cyclical breast pain may be related to the presence of cysts and the pressure they cause. However, the number of cysts or the amount of lumpiness a woman has does not necessarily relate to the amount of pain she experiences. Cyclical pain is usually most intense at the beginning and the end of the childbearing years, in a woman’s teens and again in her forties.

Pain also may be noncyclical, with no apparent pattern related to the menstrual schedule. Often, it is in a specific area of the breast and is known as trigger-zone pain. It can be constant or intermittent. The causes of noncyclical breast pain are unclear. For some women, previous trauma, like a blow to the breast or a biopsy, is sometimes the cause. Some evidence suggests different levels of the hormone progesterone or a sensitivity to hormones produced by the thyroid may cause the pain.

Other fibrocystic changes include fibrosis and hyperplasia. Fibrosis occurs in some women when the normal fatty tissue of the breast is replaced over time with fibrous tissue, which may feel firm or rubbery. Some women develop extra cells within the breast's lobules—the tubes designed to move milk through the breast. These areas of extra cells are called hyperplasia and appear only on mammograms. They are not cause for concern unless the cells change their normal shape. This rare condition is called atypical hyperplasia and does not cause cancer.

Incidence: Varying estimates indicate that 30 to 60 percent of women have some form of fibrocystic changes, which supports the theory that the symptoms are mostly related to normal changes in the breasts.

Symptoms: Symptoms of fibrocystic changes vary according to the type of change a woman experiences. She may have feelings of heaviness, tenderness, or swelling of the breasts. Cysts are usually felt as smooth and are generally round and movable when prodded. If they are deep within the breast, they may feel hard because the breast tissue overlays them. Cysts may cause a feeling of lumpiness throughout the breast, or because of pressure on the breasts caused by collected fluid within the cysts, they may cause tenderness or actual pain. However, pain cannot always be attributed to cysts or other causes. The amount of pain may differ between a woman’s right and left breast. The pain intensity can vary from month to month for the same woman. Breast pain can sometimes be intense enough to interfere with a woman’s normal life.

Some women experience no physical symptoms, but breast examinations or mammograms may reveal cysts or areas of fibrosis.

Screening and diagnosis: To identify changes, a woman should be familiar with how her breasts feel at different times of the month. Annual breast examinations as part of a physical examination are also important to track any changes. Women over forty should have routine yearly mammograms. If breast examination reveals suspect lumps, mammograms may be needed earlier. Women with hyperplasia may require more frequent examinations or follow-up mammograms.

A woman should bring any defined lumps or masses or persistent breast pain to her doctor’s attention. A doctor may attempt to aspirate a suspect lump with a fine needle to determine whether it is a cyst or a solid lump. If it is a cyst, the doctor can puncture the cyst with a needle and draw the fluid out of the cyst. In this case, generally, no further action is needed. However, the doctor may have a pathologist check the fluid for cancer cells. A mammogram is usually done for further diagnosis if a lump yields no fluid and proves solid. Modern ultrasound technology can create diagnostic images of the breast. Although it is generally not a good screening tool, it is helpful in further diagnosing areas of concern identified on mammograms. Because it uses sound waves to create images, ultrasounds are beneficial for distinguishing between cysts and solid masses and between benign and cancerous lumps. For women with fibrocystic changes in the breast, which often cause the breast tissue to be particularly dense and may make mammograms difficult for radiologists to read, ultrasound is usually a more accurate diagnostic tool.

A biopsy may be required to analyze cells to rule out cancer. This can be done by a needle core biopsy, where a doctor removes a sample of cells from the area of the breast. Alternatively, it can be done by surgical biopsy, in which case the whole lump or suspect area is cut out of the breast.

Treatment and therapy: Cysts generally need no treatment. If a cyst is very large and creates much pressure and pain, a doctor may use a needle to aspirate it and remove the fluid. Once the fluid is gone, the cyst deflates, resolving the pressure.

Most cyclical changes in the breast do not cause enough discomfort to require treatment. Breast pain can generally be relieved with anti-inflammatory drugs such as ibuprofen or naproxen. A sports bra with good support can ease pressure and related pain. Birth control pills can treat more intense breast pain because they level out the fluctuations in hormonal levels.

Some women relieve symptoms by consuming less caffeine (such as coffee, tea, and chocolate) or using herbal remedies like primrose oil. However, research has not provided convincing data that these make a difference for women overall. There is some evidence that a low-fat diet may reduce symptoms of cyclical breast pain.

Prognosis, prevention, and outcomes: About half of all benign breast conditions disappear over time. None cause cancer. Only atypical hyperplasia is associated with any added risk of cancer. Women with atypical hyperplasia who also have a family history of breast cancer may have a slightly increased risk of cancer over their lifetimes.

Bibliography

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