Fibrocystic Breast Condition (cont.)

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What is the recommended follow-up for women with fibrocystic breast condition?

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.
  1. 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.
  1. For all women, screening recommendations for breast cancer include having a baseline mammogram between the ages of 35-40 years and subsequently every year from age 40 onwards.
  1. 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.
  1. According to American Cancer Society recommendations, breast self examination is an option for women starting in their 20s, but it has certain limitations. If you choose to do breast self-examination, it's 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.
  2. 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.

  1. 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.

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