Fibrocystic Breast Disease
Fibrocystic breast disease is a general term that refers to a variety of symptoms and diagnoses, including breast lumpiness, tenderness, and a wide range of vaguely-defined benign breast conditions. The term is also used diagnostically to describe the appearance of breast tissues viewed under the microscope, on x-ray film, or on ultrasound equipment.
There is no such thing as a typical or normal female breast. Breasts come in all shapes and sizes, with varying textures from smooth to extremely lumpy. The tissues of the female breast change in response to hormone levels, normal aging, nursing (lactation), weight shifts, and injury. To further complicate matters, the breast has several types of tissue, each of which may respond differently to changes in body chemistry.
Fibrocystic breast disease is clearly not a single, specific disease process. Variations or changes in the way the breast feels or looks on an x ray may cause the condition to be called "fibrocystic change." Other names have been used to refer to this imprecise and ill-defined term: mammary dysplasia, mastopathy, chronic cystic mastitis, indurative mastopathy, mastalgia, lumpy breasts, or physiologic nodularity.
Estimates vary, but 40–90% of all women have some evidence of fibrocystic condition, change, or disease. It is most common among women ages 30–50, but may be seen at other ages.
Causes & symptoms
Fibrocystic condition refers to technical findings. This discussion will focus on symptoms a woman experiences,
which may fall under the general category of the fibrocystic condition.
The breast is not a soft, smooth, pulpy organ. It is actually a type of sweat gland. Milk, the breasts' version of sweat, is secreted when the breast receives appropriate hormonal and environmental stimulation.
The normal breast contains milk glands, with their accompanying ducts, or pipelines, for transporting the milk. These complex structures may not only alter in size, but can increase or decrease in number as needed. Fibrous connective tissue, fatty tissue, nerves, blood and lymph vessels, and lymph nodes, with their different shapes and textures, lie among the ever-changing milk glands. This explains why a woman's breasts may not feel uniform in texture, and why "lumpiness" may wax and wane.
Fibrocystic condition is the tenderness, enlargement, and/or changing lumpiness that many women encounter just before or during their menstrual periods. At this time, female hormones are preparing the breasts for pregnancy, by stimulating the milk-producing cells and storing fluid. Each breast may contain as much as three to six teaspoons of excess liquid. Swelling, with increased sensitivity or pain, may result. If pregnancy does not occur, the body reabsorbs the fluid, and the engorgement and discomfort are relieved.
These symptoms range from mildly annoying in some women to extremely painful in others. The severity of the sensations may vary from month to month in the same woman. Although sometimes distressing, this experience is the body's normal response to routine hormonal changes.
This cycle of breast sensitivity, pain, and/or enlargement can also result from medications. Some hormone replacement therapies used for post-menopausal women can produce these effects. Other medications, primarily, but not exclusively, those with hormones, may also provoke these symptoms.
Breast pain unrelated to hormone shifts is called "noncyclic" pain. This area-specific pain is also called "trigger-zone breast pain," and it may be continuous, or may be felt intermittently. Trauma, such as a blow to the area, or a breast biopsy performed several years before, or sensitivity to certain medications may also underlie this type of pain. Fibrocystic condition may be cited as the cause of otherwise unexplained breast pain.
Lumps, apart from those clearly associated with hormone cycles, may also be placed under the heading of fibrocystic condition. These lumps stand out from enlarged general breast tissue. The obvious concern with such lumps is cancer, although noncancerous lumps also occur. Two noncancerous types, fibroadenomas and cysts, are discussed here.
Fibroadenomas are tumors which form in the tissues outside the milk ducts. The cause of fibroadenomas is unknown. They generally feel smooth and firm, with a somewhat rubber-like texture. Typically a fibroadenoma is not attached to surrounding tissue, and will move slightly when touched. They are most commonly found in adolescents and women in their early 20s but can arise at any age.
Cysts are fluid-filled sacs in the breast. They probably develop as ducts become clogged with old cells in the process of normal emptying and filling. Cysts usually feel soft and round or oval. However, a cyst deep within the breast may feel hard, as it pushes up against firmer breast tissue. A woman with a cyst may experience pain, especially if it increases in size before her menstrual cycle, as many do. Women age 30–50 are most likely to develop cysts.
Sometimes one area of breast tissue persistently feels thicker or more prominent than the rest of the breast. This may be caused by hardened scar tissue and/or dead fat tissue from surgery or trauma. Often the cause of such tissue is unknown.
A number of other breast problems which are benign or noncancerous may be placed under the heading of fibrocystic condition. These include disorders which may lead to breast inflammation (mastitis), infection, nipple discharge, dilated milk ducts, milk-filled cyst,
Breast cancer is the concern in most cases of an abnormal breast symptom. A newly discovered breast lump should be brought to the attention of a family physician or an obstetrician-gynecologist. A physical examination of the area is usually performed. Depending on the findings, the patient may be referred for tests.
The most common tests are mammography and breast ultrasound. A cyst may be definitively diagnosed by ultrasound. To relieve the discomfort, the patient may choose to have the cyst suctioned, or drained. If there is any question as to the fluid diagnosis, the fluid is sent for analysis.
If a lump cannot be proven benign by mammography and ultrasound, a breast biopsy may be considered. Tissue is removed through a needle to obtain a sample of the lump. The sample is examined under the microscope by a pathologist, and a detailed diagnosis regarding the type of benign lesion or cancer is established.
A ductogram evaluates nipple discharge. A very fine tube is threaded into the duct, dye is injected, and the area is looked at for diagnosis. Other breast conditions such as inflammation or infection are usually recognized on the basis of suspicious history, such as breast-feeding and characteristic symptoms such as pain, redness, and swelling. A positive response to appropriate therapies will support the diagnosis.
Warm soaks, heating pads, or ice packs may provide comfort. A well-fitted support bra worn day and night can minimize physical movement and do much to relieve breast discomfort. Breast massage may promote removal of excess fluid from tissues and alleviate symptoms. Massaging the breast with castor oil, straight or infused with herbs or diluted essential oils, can help reduce and dissipate fibroadenomas as well as keep women in touch with changes in their breasts.
Many women have reported relief of symptoms when caffeine was reduced or eliminated from their diets. Decreasing salt intake before and during the period when breasts are most sensitive may also ease swelling and discomfort. Vitamins A, B complex, and E and selenium supplements have been reported to be helpful. Because fat promotes estrogen production, and estrogen is thought to be linked to breast tenderness, low-fat diets and elimination of dairy products also seem to decrease soreness for some women. Restricting salt intake may also help reduce fluid retention and lessen breast pain. It may take several months to realize the effects of these various treatments.
Evening primrose oil (Oenothera biennis), flax oil, and fish oils have been reported to be effective in relieving cyclic breast pain for some women. In addition, a focus on liver cleansing is important to assist the body in conjugation and elimination of excess estrogens. The herb chaste tree (Vitex angus-castus) can be used to help relieve symptoms of premenstrual syndrome (PMS), including breast tenderness.
A Chinese herbalist may recommend Herba cum Radice Asari with Radix Angelicae Sinensis and Flos Carthami Tinctorii for painful breast lumps, or Rhizoma Cyperi Rotundi with Radix Bupleuri and Fructus Trichosanthis for breast masses that swell around the time of menstruation.
A lump that has been proven benign can be left in the breast. Some women may choose to have a lump such as a fibroadenoma surgically removed, especially if it is large. Infections are treated with warm compresses and antibiotics. Lactating women are encouraged to continue breastfeeding, as it promotes drainage and healing. A serious infection may progress to form an abscess which may need surgical drainage.
Once a specific disorder within the broad category of fibrocystic condition is identified, treatment can be prescribed. Symptoms of cyclical breast sensitivity and engorgement may be treated with diet, medication, and/or physical modifications.
Over-the-counter analgesics (pain relievers) such as acetaminophen (Tylenol) or ibuprofen (Advil) may be recommended. In some cases, treatment with hormones or hormone blockers may prove successful. Birth control pills may be prescribed.
Most benign breast conditions carry no increased risk for the development of breast cancer. However, a small percentage of biopsies will uncover overgrowth of tissue in a particular pattern in some women that indicates a 15–20% risk of developing breast cancer over the next 20 years. Strict attention to early detection measures, such as annual mammograms, is especially important for these women.
No way has yet been proven to prevent the various manifestations of fibrocystic condition from occurring.
Kneece, Judy C. Finding a Lump In Your Breast. Columbia, SC: EduCare Publishing, 1996.
Love, Susan M., with Karen Lindsey. Dr. Susan Love's Breast Book. 2nd ed. Reading, MA: Addison-Wesley, 1995.
"Benign Conditions." Harvard Women's Health Watch 5 (May 1998): 4–5.