Fibrocystic breast disease

Definition

Fibrocystic breast disease is a commonly used phrase to describe findings on a breast exam. The word "disease" makes women worry that their breasts are abnormal, but this is not really a disease.

Most health care providers use this term when a woman has painful, lumpy breasts. Some health care providers use the phrase "fibrocystic change" because it sounds less worrisome to the patient.

Alternative Names

Mammary dysplasia; Diffuse cystic mastopathy; Benign breast disease

Causes, incidence, and risk factors

The breasts are mostly made up of tissue that is affected by hormones produced by the ovaries. Hormones change throughout a woman's menstrual cycle. They can cause the breasts to feel swollen, lumpy, and painful. After menopause, these changes in the breasts usually stop happening.

Changes in the breast with the menstrual cycle affect more than 60% of women, and are most common in women ages 30 - 50. Women who take hormone replacement therapy may have more symptoms. Women who take birth control pills have fewer symptoms.

There is no definite cause of painful, lumpy breasts. There is no proof that eating chocolate, drinking caffeine, or eating a high-fat diet can cause these symptoms.

Symptoms

Symptoms are usually worse right before your menstrual period, and then improve after the period starts. You may feel pain or discomfort, usually in both breasts. Breast pain commonly comes and goes, but it can be persistent. Your breasts may feel full, swollen, and heavy.

Signs and tests

If you have any concerns about your breasts, your health care provider will examine you. If there are any worrisome lumps, you might have a mammogram, ultrasound, or both.

Painful or growing breast cysts can be aspirated by a needle to remove fluid. For any suspicious growth, you may need a core needle biopsy.

Treatment

If you have painful breasts, the following may help:

• Take medication such as acetaminophen or ibuprofen
• Use heat or ice on the breast
• Wear a well-fitting bra

No treatment has been proven to help with symptoms.

• There is no evidence that changing your dietary intake of fat, caffeine, or chocolate makes a difference.
• Supplements such as vitamin E, thiamine, and evening primrose oil have not shown any benefit in most studies. However, taking these supplements is not harmful in most cases. Before taking any medications or supplements, talk with your health care provider.
• Several prescription medications, such as birth control pills or stronger hormone medicines, have been tried for breast symptoms. None have shown a consistent benefit. These medicines may have unwelcome side effects, and some are very expensive.

Most women are not as worried about their symptoms if their breast exam and imaging tests are normal. Remember that most of these symptoms will go away over time.

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Expectations (prognosis)

There is no increased risk of cancer. Symptoms usually improve after menopause.

Complications

Women who have very lumpy breasts may be more difficult to examine. Mammograms may be harder to interpret. Therefore, early cancer might be more difficult to detect.

Calling your health care provider

Call your health care provider if you find any new or different lumps on your breast self exam. Discuss when you should start having screening mammograms.

Prevention

There is no proof that anything you do or don't do will prevent symptoms.

Reducing the amount of fat and caffeine in your diet may help reduce symptoms, although studies have questioned their role in the disease.

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References

Miltenburg DM, Speights VO Jr. Benign breast disease. Obstet Gynecol Clin North Am. 2008;35:285-300.

Valea FA, Katz VL. Breast diseases: diagnosis and treatment of benign and malignant disease. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa. Mosby Elsevier; 2007:chap 15.