Fibrocystic Disease

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

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.

Breast Cysts

Breast cyst2
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Causes    TOP

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. A physical exam will be done.

Tests may include the following:

  • Mammogram —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.
  • Needle aspiration—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 If the lump remains, or if the fluid withdrawn is bloody, it will need to be examined to see if cancer is present.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:

  • Pain relievers
  • Hormone medications for severe cases
  • Applying a heating pad
  • Wearing a supportive bra
  • Changing your diet , such as caffeine avoidance

Prevention    TOP

There are not current guidelines 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 regular breast cancer screening.

RESOURCES:

American Cancer Society
http://www.cancer.org
US Office on Women's Health
http://www.womenshealth.gov

CANADIAN RESOURCES:

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

References:

A healthy pregnancy for women with diabetes. The American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.or... . Accessed July 26, 2013.
Miltenburg DM, Speights VO Jr. Benign breast disease. Obstet Gynecol Clin North Am . 2008;35(2):285-300.
Fibroadenoma of breast. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what . Updated August 1, 2012. Accessed July 26, 2013.
Last reviewed July 2013 by Andrea Chisholm; Brian Randall, MD
Last Updated: 5/11/2013
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