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Fibrocystic Breast Disease - Lumpy Breasts

What Are Fibrocystic Breasts?

Fibrocystic breast condition is a common, non-cancerous condition that affects more than 50% of women at some point in their lives. The most common signs of fibrocystic breasts include lumpiness, tenderness, cysts (packets of fluid), areas of thickening, fibrosis (scar-like connective tissue), and breast pain. Having fibrocystic breasts, in and of itself, is not a risk factor for breast cancer. However, fibrocystic breast condition can sometimes make it more difficult to detect a hidden breast cancer with standard examination and imaging techniques.

Fibrocystic breast condition is most common among women between the ages of 30 and 50, although women younger than 30 may also have fibrocystic breasts. Because the condition is related to the menstrual cycle, the symptoms will usually cease after menopause unless a woman is taking hormone replacement therapy. In some cases, fibrocystic breast symptoms may continue past menopause.

Fibrocystic breast condition is the most common cause of non-cancerous breast lumps in women between 30 and 50 years of age. More than 50% of women have fibrocystic breast symptoms at some point in their lives.

Symptoms of fibrocystic breasts include:

  • cysts (fluid-filled sacs)
  • fibrosis (formation of scar-like connective tissue)
  • lumpiness
  • areas of thickening
  • tenderness
  • pain

The degree to which women experience these symptoms varies significantly. Some women with fibrocystic breasts only experience mild breast pain and may not be able to feel any breast lumps when performing breast self-exams. Other women with fibrocystic breasts may experience more severe breast pain or tenderness and may feel multiple lumps in their breasts. Most fibrocystic breast lumps are found in the upper, outer quadrant of the breasts (near the axilla, armpit, region), although these lumps can occur anywhere in the breasts. Fibrocystic breast lumps tend to be smooth, rounded, and mobile (not attached to other breast tissue), though some fibrocystic tissue may have a thickened, irregular feel. The lumps or irregularities associated with fibrocystic breasts are often tender to touch and may increase or decrease in size during the menstrual cycle.

What is Fibrocystic Breast Disease?

In the past, many physicians have referred to fibrocystic breasts, or lumpy breasts, as "fibrocystic breast disease." This term is misleading because fibrocystic breast condition is not a disease at all. Rather, it is a common, non-cancerous breast condition that affects over half of all women at some point in their lives. Today, most physicians refer to this condition as "fibrocystic breast condition" or "fibrocystic breast change." Other terms that may be used to describe the condition include "cystic disease," "chronic cystic mastitis," or "mammary dysplasia."

In fact, since fibrocystic breasts are so common among women during their reproductive years, some physicians do not even like to label the symptoms as a "condition." They believe that these women simply have lumpier and more tender breasts than others.

What Causes Fibrocystic Breasts?

Fibrocystic breasts occur from changes in the glandular and stromal (connective) tissues of the breast. These changes are related to a woman’s menstrual cycle and the hormones, estrogen and progesterone. Women with fibrocystic breasts often have bilateral cyclic breast pain or tenderness that coincides with their menstrual cycles.

During each menstrual cycle, normal hormonal stimulation causes the breasts’ milk glands and ducts to enlarge, and in turn, the breasts may retain water. Before or during menstruation, the breasts may feel swollen, painful, tender, or lumpy. The severity of these symptoms varies significantly from woman to woman. Some women only experience mild breast swelling during menstruation, while others experience constant breast tenderness. Because the condition is hormone-related, it will usually affect both breasts (bilaterally). Symptoms of fibrocystic breasts usually stop after menopause but may be prolonged if a woman takes hormone replacement therapy.

How Are Fibrocystic Breasts Diagnosed?

Fibrocystic breasts are often first noticed by the woman, and further investigated by her physician. Breast tenderness, pain, and/or lumpiness are common indicators of fibrocystic breasts, especially when they coincide with menstruation. Often, fibrocystic breasts will be diagnosed with a physician-performed clinical breast exam alone.

While having fibrocystic breasts is usually not a risk factor for breast cancer, the condition can sometimes make breast cancer more difficult to detect. Therefore, in some cases, breast imaging exams, such as mammography or ultrasound, will need to be performed on women who show symptoms of fibrocystic breasts. However, screening mammography may be more difficult to perform on women with fibrocystic breasts because the breast density associated with fibrocystic breasts may eclipse breast cancer on the mammogram film. In some cases, additional mammography or ultrasound imaging, followed by fine needle aspiration or biopsy, will be performed on women with fibrocystic breasts to determine whether breast cancer is present. Fine needle aspiration (to drain large, painful cysts) may also be performed by a physician help relieve some of the more severe symptoms of fibrocystic breast condition.

How Are Fibrocystic Breasts Treated?

Often, physicians may recommend that the symptoms of fibrocystic breasts be treated with self-care. Depending on the individual situation, several measures may be recommended to relieve the symptoms of fibrocystic breasts. For instance, women may wish to wear extra support (athletic type) bras to help hold the breasts closer to the chest wall, which may provide some symptomatic relief. Extra support bras are especially important for large breasted women and may provide relief when breasts are full and tense with fluid. Physicians will often recommend that a support bra be worn both during the day and at night, especially during times of the woman’s menstrual cycle when the breasts are most tender.

In addition, certain vitamins (particularly vitamin E, vitamin B6, or niacin) or herbal supplements such as evening primrose oil may help alleviate the symptoms of fibrocystic breasts by reducing inflammation and fluid retention. It is important that these supplements be used according to directions and that women avoid megadoses since serious side effects may occur from incorrect use.

Some women also find that reducing their caffeine intake by avoiding coffee, tea, chocolate, and soft drinks decreases water retention and breast discomfort. However, this is a controversial topic among healthcare professionals because studies linking breast pain and caffeine have been inconsistent.

In 1978, a study revealed that patients who took oral contraceptives were less likely to have fibrocystic breasts. The study has since been reconfirmed several times, though some health care professionals (and women) do not believe oral contraception has any significant effect on treating fibrocystic breasts.

If fibrocystic breast pain is severe and interferes with a woman’s daily activities, further treatment may be necessary. Diuretics, substances that encourage the excretion of excess fluid from the body in the form of urine (which may in turn reduce tissue swelling and pain) are usually reserved for women who experience non-cyclical breast pain, but may be used to alleviate the symptoms of fibrocystic breast condition in some cases. The release of fluid in the body can help decrease breast pain and swelling.

Additional drug treatments for severe breast pain include:

  • bromocriptine (brand name, Parlodel)
  • danazol (brand name, Danocrine)

Bromocriptine and danazol both relieve cyclical breast pain by blocking estrogen and progesterone. However, these drugs may cause serious side effects in some women. Bromocriptine is poorly tolerated by many patients; side effects include nausea, dizziness, and fertility problems. Side effects of danazol may include weight gain, amenorrhea (absence of menstruation), and masculinization (such as extra facial hair) when given high doses. Other drugs, such as tamoxifen (brand name, Nolvadex) or goserelin  (brand name, Zoladex) have been shown to have some effect on cyclical breast pain; however, these drugs are currently only approved for use in the United Kingdom for treating severe fibrocystic breast pain.