Your Health - Fibrocystic Disease

Fibrocystic Disease

(Benign Breast Masses; Breast Cysts; Cystic Disease; Chronic Cystic Mastitis; Mammary Dysplasia)

Definition

Fibrocystic disease occurs when there are fluid-filled cystic lumps of duct tissue. These lumps are surrounded by a scar-like capsule of tissue in the breasts.

Although harmless, these lumps can sometimes cause pain (mastalgia) that recurs late in each menstrual cycle. The greatest problem with fibrocystic disease is telling the difference between this condition and breast cancer. Some forms of fibrocystic disease are more common in women who go on to develop breast cancer.

Breast Cysts

Causes

The glandular tissue of the breasts cycles monthly with menstrual periods, enlarging to prepare for a pregnancy, and then diminishing if one does not occur. This cycling causes cysts and excess fibrous tissue to build up. Virtually all women will have some form of this condition during their reproductive years. Although, most women will not seek treatment.

Risk Factors

All women between puberty and menopause are at risk for this condition.

Symptoms

Multiple lumps (cysts) in both breasts that cycle with menstrual periods
Cysts may produce no symptoms or cause pain and tenderness
A fibrocystic lump may be difficult to tell apart from a cancerous mass. But, its rapid disappearance with menses and reappearance in the next menstrual cycle help to distinguish this condition from breast cancer

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. There are generally only two concerns that arise from these symptoms:

Are you uncomfortable?
Do you have breast cancer?

Tests may include the following:

Mammogram (x-ray of the breasts)—Mammograms alone cannot reliably distinguish between a benign cyst and cancer. A lump that does not show significant monthly changes must be evaluated by other tests, such as aspiration.
Needle aspiration of a lump (if the fluid is removed, the cyst usually resolves)
Excisional biopsy of a suspicious area

Treatment

Once it has been determined that the lump is not a cancer, it can be left alone. If the lump's identity is still in doubt, it should be biopsied.

Aspiration

After numbing the area with a local anesthetic, a small needle on a syringe is inserted into the lump to draw fluid out. If the lump disappears, cancer is highly unlikely. If the lump remains, or if the fluid withdrawn is bloody, it will need to be biopsied to see if cancer is present.

Biopsy

There are two types of biopsies:

A fine needle biopsy is nearly identical to an aspiration. The only difference is that a tiny piece of tissue is also drawn out of the lump.
An excisional biopsy removes the entire lump through a surgical incision. This can be done with local anesthesia if the lump is small and superficial.

Once cancer has been ruled out, fibrocystic disease may be safely treated with observation and conservative measures, including:

Taking pain relievers
Taking hormonal medicine (for severe symptoms)
Applying a heating pad
Wearing a supportive bra
Changing your diet (eg, avoiding caffeine, taking vitamin E)

Prevention

There is no clear way to prevent fibrocystic disease.

The most important issue for you and your doctor is being able to distinguish this condition from breast cancer. Follow your doctor's guidelines for breast cancer screening. For example, if you are age 40 or older, you should have a mammogram every year. If you have a family history of breast cancer, you may need to have a mammogram at an earlier age.

You can also do a monthly breast self-exam. Try to do this within a week after your menstrual period. This is when the breasts are less swollen and tender. Doing this every month will make you more familiar with your breasts. You may be more likely to detect changes that should prompt a visit to your doctor.

RESOURCES:

American Cancer Society
http://www.cancer.org/

Womens Health.gov
http://www.womenshealth.gov/

CANADIAN RESOURCES:

Canadian Breast Cancer Foundation
http://www.cbcf.org/

Canadian Women's Health Network
http://www.cwhn.ca/

References:

Berkow R, Beers M, Fletcher AJ. The Merck Manual of Diagnosis and Therapy. New York, NY: Pocket Books; 1999.

Fibrocystic breast disease. US National Library of Medicine, MedlinePlus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000912.htm. Updated May 2008. Accessed July 27, 2009.

Fibrocystic breasts. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/fibrocystic-breast-changes/AN00715. Updated December 2007. Accessed July 27, 2009.

Last reviewed October 2009 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.