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Fibrocystic Breast Changes

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Overview

Fibrocystic breast changes (also referred to as fibrocystic breasts or fibrocystic breast disease) is a benign condition of the breast which causes the breast to feel lumpy. They aren’t harmful or dangerous but can cause discomfort in some cases. This is a relatively common breast condition that is said to affect 1 in 2 women around the globe. Having fibrocystic breasts can make detection of breast cancer more challenging.  

Types

The term fibrocystic breast disease is used for a wide range of benign breast conditions such as: 

  1. Cysts (containing fluid)
    Breast cysts are formed due to the accumulation of fluid in the breast. Based on their size, they can present as a palpable breast lump. They are extremely common, occurring in as many as one third of all women aged between 35-50 years.  In most cases, they are so small that they show up only in imaging scans such as ultrasounds.  
  2. Sclerosing Adenosis
    Sclerosing adenosis is a benign breast condition in which enlarged milk producing glands are distorted by scar like tissue. It can sometimes be confused with tubular carcinoma however, no direct link between sclerosing adenosis and breast cancer has been made so far. It commonly occurs in women between the ages of 30 and 45 years. It is generally asymptomatic but can cause sensitivity and discomfort in some cases.  
  3. Epithelial hyperplasia
    Also referred to as proliferative breast disease, epithelial hyperplasia is an overgrowth of cells that line the milk glands or ducts inside the breast. It is classified as lobular hyperplasia or ductal hyperplasia depending on which part of the breast (milk glands or ducts) it affects. It can be described as usual or atypical based on the cell structure studied under a microscope. The risk of breast cancer is higher for women with atypical epithelial hyperplasia.   
  4. Radial Scar
    This condition is a form of sclerosing duct hyperplasia. It has a characteristic star like appearance due to translucent, circular regions in the centre of the radiating structure. It may indicate an underlying condition of the breast tissue and or issues in the functional elements (such as lobules, ducts etc). In severe cases, it can also be a symptom of cancer. Research shows that women with radial scars are at a higher risk of developing breast cancer.  
  5. Apocrine metaplasia
    Apocrine metaplasia is considered to be a common metaplastic change of the breast. It is characterised by enlarged epithelial cells that show abundant eosinophilic cytoplasm and apical snouts when examined under a microscope. This condition is common in women older than 25 years of age. This condition does not necessarily increase the risk of developing breast cancer
  6. Papilloma
    Papillomata are a solid lump of new cells. They resemble warts and are benign growth occurring in the breast ducts. It can result in complete blockage of the duct. They are made up of mammary epithelium (the cells that line the duct wall of the breast). By itself, it is a benign condition, however, if they appear in multiples it can increase the risk of developing breast cancer. It is commonly seen in women between the ages of 35-55 years.  

About The Condition

“Fibrocystic changes” is an extremely common condition in women. It tends to occur in premenopausal women, usually between the ages of 25-55 years, Post-menopausal women can develop fibrocystic breast changes if they are on hormone therapy. This condition is generally asymptomatic but, in some cases, it can cause breast pain, tenderness and lumpiness in the upper outer area of the breasts. These symptoms are known to exacerbate right before menstruation. 

The exact cause behind fibrocystic changes is still unknown, although research shows a strong link between hormone levels in the body and breast changes.  

Risk of Developing Fibrocystic Breast Changes

Age plays a significant role in increasing the risk of developing fibrocystic breast changes. It occurs mainly in menstruating women. It widely believed that this condition develops from a cumulative process of repeated hormonal cycles (during the menstrual cycle) and the accumulation of cells, cellular debris and fluid in the breast.  

Symptoms

Common symptoms of fibrocystic breasts include: 

  1. Breast with rope-like bumps or free moving masses often near the armpit  
  2. Breast tenderness and pain 
  3. Pain under the armpit 
  4. The feeling of swelling or heaviness in the breast
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If you notice any new lumps in your breast, prominent thickening, worsening breast pain, changes that persist after your period or existing bumps increasing in size regardless of your menstrual cycle, seek immediate medical attention to rule out any other underlying causes.   

Diagnosis of Fibrocystic Breast Changes

Your doctor might perform the following tests to diagnose and assess the severity of your condition.  

  1. Clinical Breast Exam
    Your doctor would detect any unusual areas by visual and physical examination of your breasts and lymph nodes. If your medical history and clinical breast changes show conclusive signs of normal breast changes, additional tests are not required. If any new lumps are detected, your doctor might ask you to come back for a follow up after your period for another breast exam. Based on the results, you might need to undergo additional diagnostic tests 
  2. Imaging scans
    Imaging scans like mammograms and ultrasounds are performed to distinguish between fluid filled cysts and solid masses.  
  3. Fine-needle aspiration
    In this test, your doctor will attempt to drain fluid from the cyst. It is helpful in making a distinction between lumps that are hard masses (not containing fluid) from cysts (containing fluid). It also helps in collapsing the cyst to reduce discomfort.  
  4. Breast Biopsy
    In case the imaging scans are inconclusive and your doctor is still concerned about a lump, a breast biopsy will be carried out. In this procedure a small sample of breast tissue is removed for analysis under the microscope to study the cells. 

Treatment of Fibrocystic Breast Changes

In case you are not experiencing any of the symptoms, or if you are exhibiting extremely mild symptoms that are not interfering with your daily life, you would not require any treatment. Treatment options for extremely large and/or painful cysts include: 

  1. Fine-needle aspiration
    This procedure involves the use of a hair-thin needle to drain the fluid from the cyst, collapsing it and relieving pain.  
  2. Surgical excision
    Severe cases of fibrocystic breasts requiring surgery is quite rare. Surgical treatment is recommended for cysts that don’t resolve after repeated needle aspiration or if it has features that concern your doctor. 

Over the counter pain medication and oral contraceptives are also prescribed to manage the pain and symptoms of this condition.  

Prevention

As the exact causes of fibrocystic breast changes are yet to be defined, there are no preventive measures you can take to reduce the risk of developing this condition. The following home remedies are known to mitigate the symptoms of fibrocystic breasts: 

  1. Wear proper fitting bras 
  2. Limit or avoid caffeine 
  3. Adopt a low-fat diet 
  4. Seek medical advice for any hormone therapy 
  5. Use warm compress to relieve discomfort

FAQs

1. Can fibrocystic breast disease become cancer?

“Fibrocystic breasts” is not a cancerous condition. It also does not increase your risk of developing breast cancer. It can however make diagnosing breast cancer more challenging. 

2. Do fibrocystic breasts go away on their own?

“Fibrocystic breast changes” is a benign breast condition that can cause discomfort in certain cases. This condition is common among menstruating women and the symptoms resolve themselves after menopause. It can also develop in menopausal women undergoing hormone therapy.

3. How can you tell the difference between a lump and a cyst?

Cysts are generally non-cancerous. They can feel tender to touch and more flexible as compared to lumps which are firmer. Breast cysts are fluid filled and you can easily move it under the skin. Lumps on the other hand are hardened masses. Diagnostic tests such as needle aspiration can be performed to confirm diagnosis.  

 

 
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