Fibrocystic Breast Condition
(Cysts, Fibrosis, Lumps)

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Living with the pain of fibrocystic breasts

Generally, the following measures are recommended for women with fibrocystic breast condition:

  1. Have regular breast examinations by a physician. Examinations may be as often as every four to six months for the highest risk patients, such as those with atypical hyperplasia and a strong family history of breast, ovarian, and/or prostate cancer.
  2. Follow an appropriate breast-imaging program. This usually includes yearly mammograms, sometimes with combined with an ultrasound examination. The mammograms should ideally be done under similar conditions (such as at the same point in the woman's menstrual cycle) so that the images on previous mammograms can be meaningfully compared with the newest mammogram. In certain cases, an MRI (magnetic resonance imaging test) may be useful.
  3. For all women, screening recommendations for breast cancer from the American Cancer Society include having a baseline mammogram between the ages of 35 TO 40 years and subsequently every year from age 40 onwards. However, the US Preventive Services Task Force (USPSTF) recommends that routine screening of women at average risk begin at age 50 rather than 40, and that screening mammograms should occur every two years up to age 74. Women should speak with their doctor about their own risk factors to determine an appropriate screening program.
  4. Understand the statistical risk of breast cancer based on all available information. Professional counseling may be necessary to help the woman with this goal. Most patients overestimate their personal and immediate risk. There should be some reassurance that, although it is necessary to be attentive, most women with fibrocystic breast condition will never develop breast cancer. There must be a balance between careful surveillance and quality of life.
  5. According to American Cancer Society recommendations, breast self-examination is an option for women starting during their 20s, but it has certain limitations. If you choose to do breast self-examination, it is important to learn the proper technique. The self-examination of the breast is best done when there is the least amount of hormonal stimulation of the breast. This occurs 7 to 10 days after the start of the last menstrual cycle (or three days after a period ends). At that time, the fluid retention in the breast and the cellular growth activity are minimal.

  6. An ideal setting in which to conduct the exam is the bath or shower. First, with the hand and breast wet with soap, the woman should begin with the fingers flat together and work sweeping from the outer part to the center of the breast. It helps to mentally divide the area into four sections (quadrants) and work around them in sequence. The upper outer quadrant should be mentally extended into the armpit (to examine the part of the breast that often reaches into the armpit). Second, the process is repeated in the same sequence with the fingers moving in a fluttering motion. These different motions, flat-fingered stroking and fluttering fingertips, allow detection of somewhat different types of tissue abnormalities. This examination by feeling the breast (palpation) should be accompanied by a brief visual exam. With the arms at the sides looking in a mirror, the woman should note the evenness (symmetry) of the breasts. Then the woman should raise her arms slowly overhead, checking for any areas 'tugging' the skin or any visible lumps or distortion. The entire examination process can be done in a few minutes.

What my chances or risks of getting breast cancer?

Assessing the statistical risk for any individual woman requires a careful assessment of all her relevant health issues. The best estimates of cancer risk relate specifically to the microscopic tissue types of fibrocystic condition. Other factors such as family history and the presence of an inherited gene that increases the risk of breast cancer (BRCA 1 and 2 genes) are also taken into account. However, unless a woman with fibrocystic breast condition has a breast biopsy; it is not possible to calculate her specific risk of developing breast cancer.

Only 5% of women with fibrocystic breast condition have the type of cellular changes, namely cellular hyperplasia, which represents a risk factor for breast cancer. When compared to a "normal population" of women, these patients have a two to six fold increased risk of breast cancer. The exact risk depends on the degree of the hyperplasia and whether atypical-appearing cells are also present.

It is critical for the patient with fibrocystic breast condition to understand that this figure represents her total risk accumulated over a lifetime. This means that her actual increased risk of breast cancer in any given year is rather low.

Your doctor also can use a breast cancer risk assessment system called the "Gail Breast Risk Assessment Tool," to calculate your risk. This system takes into account the following factors when calculating an individual woman's risk: age (the model is valid only for women aged >35 years), race, age at menarche (the beginning of menstruation), age at first live birth, number of first-degree relatives with breast cancer, number of previous breast biopsies, and the presence of atypical hyperplasia on any previous breast biopsy.

REFERENCES:

American Cancer Society. "American Cancer Society Releases New Breast Cancer Guideline." Oct 20, 2015.
<https://www.cancer.org/latest-news/american-cancer-society-releases-new-breast-cancer-guidelines.html>

Miller, AC, MD. "Breast Abscesses and Masses." Medscape. Updated Apr 13, 2017.
<http://emedicine.medscape.com/article/781116-overview>

Medically Reviewed by a Doctor on 7/13/2017

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