Fibrocystic Breast Disease
Definition
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.
Description
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,
