Alternative Names fibrocystic disease of the breast, chronic cystic mastitis, mammary dysplasia
Definition Fibrocystic changes in the breast refer to a variety of irregularities in the breast tissue.
What is going on in the body? Changes in breast tissue are caused by hormones. The changes are most common in women between the ages of 20 and 50. The condition is uncommon after menopause unless the woman is taking hormone replacement therapy. This condition is very common, and is not cancer.
What are the signs and symptoms of the condition? The classic symptom is pain in both breasts. The pain occurs during a certain time of each menstrual cycle. Other changes include an increase in the size of the breasts, multiple lumps felt in the breast, and occasionally nipple discharge. The signs and symptoms are more obvious before menstruation, a woman's monthly bleeding. The pain is usually in both breasts, mostly in the upper areas. It can sometimes be felt in the shoulders and upper arms.
What are the causes and risks of the condition? Fibrocystic changes are thought to be caused by an imbalance of hormones produced by the ovaries. The hormones are called oestrogen and progesterone. An increase in another hormone, prolactin, may also be responsible for some of the changes. Prolactin is produced by the pituitary gland in the brain.
What can be done to prevent the condition? Prevention of this condition is usually not possible. Fibrocystic changes are so common they are considered normal in most cases.
How is the condition diagnosed? The condition is primarily diagnosed by the history of symptoms and a physical examination. On physical examination, the changes in the breast are similar to manipulating a plateful of peas. There are usually areas of lumpiness. Larger cysts often feel like small balloons filled with water. A breast biopsy is sometimes done, but is often not required for diagnosis in younger women.
What are the long-term effects of the condition? If a biopsy of the breast is done and shows certain unusual changes, there is an increased risk of developing breast cancer in the future. This risk of breast cancer can be about five times greater than the risk in women who do not have such changes. Notably, most women with fibrocystic disease do not have these unusual changes.
What are the risks to others? This condition is not contagious.
What are the treatments for the condition? Treatment depends on the age of the woman, severity of symptoms, and biopsy results, if one is done. Most symptoms can be controlled without surgery. If a mass persists or continues to grow, a biopsy is necessary.
Initial therapy consists of having the woman wear a support bra, both night and day. Diuretics, or medications that cause fluid loss through the urine, can help the discomfort. Decreasing the amount of smoking, coffee, tea, cola drinks, and chocolate has been thought to help in some cases. Oral contraceptive pills can also reduce symptoms.
For severe symptoms, a medication called danazol may be used for 4 to 6 months. This medication relieves breast symptoms and decreases lumps in the breast in about 90 percent of women. The effect of the medication lasts for several months after discontinuing it. If this medication does not work, others may be tried. On rare occasions, surgical treatment with removal of the breast is used. Surgery is usually only considered in severe cases not helped with medications or in cases with abnormal biopsy results.
What are the side effects of the treatments? All medications have side effects. These include allergic reactions and stomach upset. The side effects of the medications vary with the medication used.
What happens after treatment for the condition? Follow up depends on the results of the biopsy, as well as the woman's response to any medication used.
How is the condition monitored? Regular follow-up visits with the doctor and monitoring for symptoms are recommended.
Author: Carlos Herrera, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
