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 be the site of 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.
Causes
The glandular tissue of the breasts cycles monthly with menstrual periods. It enlarges to prepare for a pregnancy, and then shrinks 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. However, most women will not seek treatment.
Symptoms
- Multiple lumps (cysts) will occur 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. He or she will do 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 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 is inserted into the lump. This is 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 If the lump remains, or if the fluid withdrawn is bloody, it will need to be examined to see if cancer is present.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 (for example, 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. The following recommendations are for women with no symptoms who are not at high risk for breast cancer:
-
Mammograms:
- Age 40-49—recommendations vary from waiting until age 50 to having the screening every 1-2 years
- Age 50-74—ranges from every year to every two years
-
Clinical breast exam:
- Age 20-39—ranges from every year to every three years
- Age 40 and older—every year
-
Breast self-exam
:
- Age 20 and older—Optional; talk to your doctor about the risks and benefits.