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Fibrocystic Disease

(Benign Breast Masses; Breast Cysts; Cystic Disease; Chronic Cystic Mastitis; Mammary Dysplasia)

by Ricker Polsdorfer, MD

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.

Breast Cysts

Breast cyst2
Copyright © Nucleus Medical Media, Inc.

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.

Risk Factors    TOP

All women between puberty and menopause are at risk for this condition.

Symptoms    TOP

  • 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    TOP

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    TOP

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    TOP

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.

RESOURCES:

American Cancer Society
http://www.cancer.org/
Womens Health.gov
http://www.womenshealth.gov/

CANADIAN RESOURCES:

Canadian Breast Cancer Foundation
http://www.cbcf.org
Canadian Women's Health Network
http://www.cwhn.ca

References:

American Congress of Obstetricians and Gynecologists. Diabetes and pregnancy. The American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient_education/bp051.cfm. Accessed July 2010.
Berkow R, Beers M, et al. The Merck Manual of Diagnosis and Therapy. New York, NY: Pocket Books; 1999.
Breast cancer screening: research and guidelines. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated November 2009. Accessed January 19, 2010.
DynaMed Editorial Team. Fibrocystic breast disease. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us. Updated July 20, 2010. Accessed November 4, 2010.
Fibrocystic breasts. Mayo Clinic website. Available at: http://www.mayocli.... Updated December 2007. Accessed July 27, 2009.
Last reviewed September 2012 by Andrea Chisholm
Last Updated: 09/28/2012