Fibrocystic changes are the most
common cause of breast lumps in women ages 30 to 50. Although fibrocystic
changes may also be referred to as fibrocystic disease, this is not a disease,
but a condition. It can be known as cystic disease, chronic cystic mastitis
or mammary dysphasia. This condition is not cancerous. At least 60% of the
women in their reproductive years have "lumpy" breasts as a result
of these non-cancerous conditions.
chronic cystic mastitis; mammary dysplasia; benign breast disease
Usually, fibrocystic changes can be diagnosed by physical examination or
mammography, an x-ray of the breast. Fibrocystic changes also may be found with
a biopsy. Fortunately, only about 5% of fibrocystic conditions have the type of
changes that would be considered a risk factor of developing breast cancer.
The cause of fibrocystic changes is related to the way breast tissue responds
to monthly changes in the levels of estrogen and progesterone, female hormones
produced by the ovaries during a woman's reproductive years. Each month during
one's menstrual cycle, the breast tissue alternately swells and returns to
normal. Hormonal stimulation of the breast tissue causes the milk glands and
ducts to enlarge, and the breasts to retain water. The breasts frequently feel
swollen, painful, tender, and lumpy at this time. After menstruation, swelling
in the breast usually decreases, and the breasts feel less tender and lumpy.
That's why the best time to examine the breast is 7-10 days after the start of
the menstrual period, when the breast tissue is at its most normal state.
As a result of repeated hormone stimulation, there is an increase in firmness
of the tissue, and packets of fluid called cysts may form in obstructed or
enlarged milk ducts. The breast tissue may feel like an irregularly shaped area
of thicker tissue with a lumpy or ridge-like surface. Fibrocystic tissue may
also feel like tiny beads scattered throughout the breasts. Generally,
fibrocystic changes are found in both breasts and most frequently are found in
the upper outer quadrant and the underside of the breast where a ridge may
sometimes be felt. Premenopausal women with a fibrocystic condition may
experience an increase in size of the lumpy areas in the breast, as well as
discomfort ranging from a feeling of fullness or heaviness to a dull ache,
extreme sensitivity to touch, or a burning sensation. For some women, the pain
is so severe that it precludes exercise or even lying on the abdomen. The
condition tends to subside after menopause (change of life).
Some women with a fibrocystic condition, but not all women, develop cysts in
their breasts which are fluid-filled sacs that usually feel smooth, firm,
movable and sometimes tender. The tenderness and lump size generally increases
the week before the menstrual period and will subside somewhat the week
following. Large cysts may feel round and similar to what you feel when you
press lightly on the eyeball with a closed eyelid. Simple cysts can be aspirated
with a needle and syringe in the physician's office. If the cyst disappears and
doesn't come back, surgical removal (biopsy) is usually not necessary. After
menopause, this cystic condition becomes less noticeable and often
disappears.
Confusion arises because not all women who discover a lump have fibrocystic
changes. The breast is naturally a lumpy gland. The lumpy consistency arises
from the milk glands, ducts and supervisory ligaments that separate and support
them. Fibrous tissue also may be present in the breast and may feel "lumpy" but
not represent a real lump. The regular practice of Breast Self-Examination (BSE)
will help a woman become familiar with how her breast tissue normally feels so
that she can identify a change. Any changes in how her breast normally feels
should be reported to her physician.
Reduce the intake of dietary fat and
caffeine if you have fibrocystic breast changes.
Signs and tests
Physical examination reveals the presence of mobile
(non-anchored) breast "masses". These masses are usually rounded, with smooth
borders, and either rubbery or slightly fluctuant (changeable in shape ). Dense
tissue may make the beast examination more difficult to interpret
Mammography may be difficult to interpret due to dense tissue.
A biopsy of the breast may be necessary to rule out other disorders.
Aspiration of the breast with a fine needle is often diagnostic and therapeutic for larger cysts.
If dietary changes decrease the symptoms, and are
maintained, the benefit most likely will persist. A combination of treatment and use
of medications may be necessary to obtain relief for severe cases.
Because fibrocystic changes may make breast
examination and mammography more difficult to interpret, early cancerous lesions maybe
occasionally be overlooked.