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February 10, 2012

Fibrocystic Breast Condition (cont.)

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How is the risk of breast cancer in fibrocystic breast condition patients calculated?

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.

Breast cancer risk assessment can also be performed using a system known as the Gail Breast Risk Assessment tool. This system takes into account the following factors when calculating an individual women's risk: age (the model is valid only for women aged >35 yrs), age at menarche (the begnining of menstruation), age at first live birth, number of first-degree relatives with breast cancer, number of previous breast biopsies, the presence of atypical hyperplasia on any previous breast biopsy, and race.

What are the treatments for fibrocystic breast condition?

The treatments for fibrocystic breast condition are directed at the individual components of the condition, including the relief of symptoms (such as breast pain and tenderness) and the correction of hormonal irregularities:

  1. Relief of symptoms: Some simple measures, such as adequate support of the breasts and perhaps wearing a bra at night, may provide relief from many of the symptoms of fibrocystic breast condition. Antiinflammatory medications, including acetaminophen and nonsteroidal antiinflammatory medications (NSAIDs), often reduce the breast pain significantly.

There are reports suggesting that a variety of vitamins may be of benefit in relieving the symptoms of fibrocystic breast condition. These have included vitamin C, vitamin E, vitamin B6 and vitamin A, among others. In general, the rationale for using these vitamins is unclear and is not based on duplicated, controlled clinical studies. The exception may be vitamin E where, at least in some studies, there appears to be a measurable benefit for some patients.

Another food supplement that has been claimed to be of some benefit in clinical studies is Oil of Primrose. This substance contains certain essential fatty acids that allegedly benefit some fibrocystic breast condition patients by reducing their breast pain. There is no evidence showing any correction (resolution) of the microscopic cellular abnormalities with use of this substance, but some women experience symptom relief with this supplement.

  1. Hormonal irregularities: Some women with very irregular menstrual cycles seem to progressively suffer more severe fibrocystic breast condition. This tendency is most likely due to the prolonged and irregular hormonal stimulation of the breasts. In these patients, it is sometimes helpful to establish menstrual cycle regularity with oral contraceptives. Regular cycles seem to allow the breast tissue to recover more completely at the end of each menstrual cycle.

In patients who have had a hysterectomy and who are on hormone therapy, it may be helpful to be "off estrogen" for five days during each monthly cycle rather than remain on continuous estrogen. Again, this schedule is designed to avoid the continuous stimulation of the breast tissues by estrogen. It is important that any such hormone regulation be under the direct supervision of a physician.

Certain common hormonal (endocrine) abnormalities, such as diabetes or thyroid dysfunction, may contribute to fibrocystic breast condition. Since these conditions may aggravate the symptoms of fibrocystic breast condition, they should be diagnosed and treated.

  1. Studies have shown some benefit from the short term use of the antiestrogenic drug Tamoxifen in relieving breast pain. However, tamoxifen (Nolvadex) use may be associated with a number of adverse effects, especially in postmenopausal women, and its use should be limited to the short term. Likewise, the androgenic steroid drug danazol (Danocrine) has also been shown to reduce breast pain and nodule size in women with fibrocystic breast condition. Danazol is also associated with a number of serious side effects. Both of these medications may be considered for use in women with severe cyclical breast pain due to fibrocystic condition.

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