Fibrocystic Disease of the Breast

What is Fibrocystic Disease?

This is a process that occurs in the breasts of women. In can cause the breast to be lumpy or tender. It can cause nipple discharge. It can cause changes on mammogram. It is an entirely different problem than cysts elsewhere in the body or fibroid tumors of the uterus. The age of onset and severity varies from person to person, but is found to some degree in all adult women as they age. It seems to be related to levels of female hormones. Most women notice that the tenderness and lumpiness in the breast from fibrocystic disease is the worst just before their menstrual period. The severity of the symptoms may be the worst just before menopause, and may resolve completely sometime after menopause.

When the breast tissue is viewed through a microscope, the pathologist may see cysts, calcium deposits, scarring, or any of several other types of changes. These are all classified as "fibrocystic disease" or "fibrocystic change".

If you had a lump in your breast from fibrocystic disease, it is possible that you may develop other lumps in the future. If that happens, it is important that the new lump be evaluated, and that you don't assume that it is fibrocystic disease. It is not unusual for a woman with fibrocystic disease to develop several lumps from this during her lifetime. But it is also possible for her to develop breast cancer, and we do not want to miss an early diagnosis.

Most of the time fibrocystic disease has no relationship to the development of breast cancer, other than the fact that we have to biopsy the lump to make sure that it is not cancer. However, there are situations where the pathologist sees specific changes within the fibrocystic disease. He then uses the descriptive terms "atypical hyperplasia" or "atypical proliferative" fibrocystic disease. If that was the case, you would have a slightly increased chance of developing breast cancer than the normal female population. However, even in those situations the increased chance of developing breast cancer is low enough that no specific treatment is recommended other then careful surveillance.

Treatment of fibrocystic disease
There are some simple, successful treatments that can be tried to relieve the symptoms of fibrocystic disease. For women with tender breasts, avoidance of caffeine, coffee and cola has been recommended. This is occasionally effective. Benefits have been claimed for evening primrose oil and high doses of Vitamin E, but neither has not been established as clearly effective. Sometimes birth control pills can decrease the pain and lumpiness. For some unknown reason, thyroid hormone seems to relieve symptoms in some patients.

There is a hormonal medication called Danazol that has been shown to be effective for severe cases of pain or lumpiness. This is a male hormone which has undesirable masculinizing side effects, so most patients are reluctant to use this. There have been situations where the breast tissue is completely removed, and implants inserted. However, this is a fairly aggressive solution to the problem, and is reserved for very severe situations.

Follow up recommendations
All women should perform monthly Breast Self Exam. A benign biopsy at one point in time does not change this. If you notice any changes or any new lumps, please bring them to my attention, or to the attention of your family physician. Additional information is available from the Eau Claire Chapter of the American Cancer Society 715-832-0181. In addition, be sure to follow your family physician's recommendations regarding periodic physical examination and screening mammography. The current recommendations are that women between 40-50 should have a mammogram every one or two years, and then every year after age 50.