Fibrocystic breast condition definition and facts
- Fibrocystic breast condition is lumpiness in one or both breasts.
- For some women, symptoms of fibrocystic breast condition include breast tenderness and breast pain.
- Fibrocystic breast condition is a very common and benign condition.
- Normal hormonal variation during the menstrual cycle is the primary contributing factor to fibrocystic breast condition.
- Fibrocystic breast condition is a cumulative process that mainly affects women over 30 years of age.
- The foremost concern is not fibrocystic breast condition itself but the threat of breast cancer.
- The lumps in fibrocystic breast condition can mimic and mask breast cancer.
- Recommended measures for women with fibrocystic breast condition include learning about the problem and its symptoms; having regular breast exams by a health care professional; and having regular mammograms.
- Treatment of fibrocystic breast condition aims at the relief of breast pain and tenderness and correction of menstrual irregularities.
What are fibrocystic breasts?
Fibrocystic breasts are characterized by lumpiness and usually discomfort in one or both breasts. The lumpiness is due to small breast masses or breast cysts. The condition is very common and benign, meaning that fibrocystic breasts are not malignant (cancerous). Fibrocystic breast disease (FBD) is now referred to as fibrocystic changes or fibrocystic breast condition, is the most common cause of "lumpy breasts" and affects more than 60% of women. The condition primarily affects women between the ages of 30 and 50, and tends to resolve after menopause.
The diagnosis of fibrocystic breasts is complicated by the fact that the condition can vary widely in its severity.
Picture of the anatomy of the breast
What are the symptoms of lumps, cysts, or fibrosis of the breasts?
In some women, the symptoms of fibrocystic breast condition can be very mild with minimal breast tenderness or pain. The symptoms can also be limited in time, usually occurring only premenstrually. It may not even be possible to feel any lumps when the breasts are examined by the woman herself or by her doctor. In other women with fibrocystic breasts, the painful breasts and tenderness are constant, and many lumpy or nodular areas can be felt throughout both breasts.
Which women are more likely to develop the condition?
Fibrocystic breast condition primarily affects women 30 years of age and older. The reason for this is that the condition likely results from a cumulative process of repeated monthly hormonal cycles and the accumulation of fluid, cells, and cellular debris within the breast. The process starts with puberty and continues through menopause. After menopause, fibrocystic breast condition becomes less of a problem.
Is there a difference between fibrocystic breast condition and fibrocystic breast disease?
No. In the past, fibrocystic breast condition was often called fibrocystic breast disease. However, it is not a disease, but a condition. Most women tend to have some lumpiness in their breasts. Therefore, it is now being more appropriately termed fibrocystic breast condition. The abbreviation is FCC (an acronym derived from FibroCystic breast Condition).
Other names that have been applied to fibrocystic breast condition include mammary dysplasia, chronic cystic mastitis, diffuse cystic mastopathy, and benign breast disease (a term that includes other benign breast disorders, including infections).
Can the condition affect just one breast?
Not usually. As a rule, fibrocystic breast condition tends to be symmetrical (bilateral) and affects both breasts. A woman can have more fibrocystic involvement in one breast than in the other. The less affected breast, however, often "catches up" over the years, and eventually both breasts become almost equally fibrocystic.
Breast Pain Symptoms
Many women experience mild monthly breast pain in conjunction with their
menstrual periods. For some women, however, the pain can be more severe. This
premenstrual breast pain is referred to as cyclic breast discomfort.
Much less common causes of breast pain include benign growths in the breasts (including cysts
such as in fibrocystic breast condition), breast cancer, and certain medications. Breast pain is called mastodynia, mastalgia, or mammalgia by physicians.
What causes cysts, fibrocystic, or "lumpy" breasts?
Fibrocystic breast condition involves the glandular breast tissue. The sole known biologic function of these glands is the production, or secretion, of milk. Occupying a major portion of the breast, the glandular tissue is surrounded by fatty tissue and support elements. The glandular tissue is composed of different types of cells: (1) clusters of secretory cells (cells that produce milk) that are connected to the milk ducts (tiny tubes); and (2) the cells that line the surfaces of the secretory cells, called the epithelial cells.
The most significant contributing factor to fibrocystic breast condition is a woman's normal hormonal variation during her monthly cycle. Many hormonal changes occur as a woman's body prepares each month for a possible pregnancy. The most important of these hormones are estrogen and progesterone. They directly affect the breast tissues by causing cells to grow and multiply.
Many hormones aside from estrogen and progesterone also play an important role in causing fibrocystic breasts. Prolactin, growth factor, insulin, and thyroid hormone are some of the other major hormones that are produced outside of the breast tissue, yet act in important ways on the breast. In addition, the breast itself produces hormonal products from its glandular and fat cells. Signals that are released from these hormonal products are sent to neighboring breast cells. The signals from these hormone-like factors may, in fact, be the key contributors to the symptoms of fibrocystic breast condition. These substances may also enhance the effects of estrogen and progesterone and vice versa.
The same cyclical hormones that prepare the glandular tissue in the breast for the possibility of milk production (lactation) are also responsible for a woman's menstrual period. However, there is a major difference between what happens in the breast and uterus.
In the uterus (the womb), these hormones promote the growth and multiplication of the cells lining the uterus. If pregnancy does not occur, this uterine lining is sloughed off and discharged from a woman's body during menstruation.
In the breast, these same hormones stimulate the growth of glandular breast tissue. They also increase the activity of blood vessels, cell metabolism, and supporting tissue. All this activity may contribute to the feeling of breast fullness and fluid retention that women commonly experience before their menstrual period.
When the monthly cycle is over, however, these stimulated breast cells cannot simply slough away and pass out of the body like the lining of the uterus. Instead, many of these breast cells undergo a process of programmed cell death, called apoptosis. During apoptosis, enzymes are activated that start digesting cells from within. These cells break down and the resulting cellular fragments are then further broken down by scavenger cells (inflammatory cells) and nearby glandular cells.
During this process, the fragments of broken cells and the inflammation may lead to scarring (fibrosis) that damages the ducts and the clusters (lobules) of glandular tissue within the breast. The inflammatory cells and some of the breakdown fragments may release hormone-like substances that in turn act on the nearby glandular, ductal, and structural support cells.
The amount of cellular breakdown products, the degree of inflammation, and the efficiency of the cellular cleanup process in the breast vary from woman to woman. These factors may also fluctuate from month to month in an individual woman. They may even vary in different areas of the same breast.
Types of fibrocystic breasts
When biopsies (samples) of breast tissue are studied under the microscope, it is possible to identify different types of fibrocystic breast condition. Some cases of fibrocystic breast condition show little disturbance of the breast tissue. Other cases involve a large number of cysts, along with fibrous (scar) tissue, in the breast tissue. Additionally, in some cases of fibrocystic breast condition, the breast cells do not have a normal appearance.
Cysts and fibrosis: Usually, even when the breast is not stimulated to produce milk, some secretions are produced by the secretory glandular cells. These secretions are normally reabsorbed "downstream" in the ducts. However, when there has been tissue damage and scarring (fibrosis) in the breast, these secretions may be trapped in the glandular portions of the breasts, thereby leading to the formation of fluid-filled sacs called cysts. In some areas of the breasts, there may be excessive fluid secretions due to stimulation by hormone-like substances. The resulting cysts may remain microscopic or enlarge until they contain several teaspoons or even tablespoons of fluid. These larger cysts may be felt as palpable (capable of being detected by touching) breast lumps. Even microscopic cysts may sometimes be felt as palpable lumps if many cysts are clustered together and there is a buildup of fibrous (scar) tissue around the cysts.
Hyperplasia and atypical hyperplasia of breast cells: With repeated stimulation from normal hormones, and possibly the effects of many of the hormone-like substances produced in the breast, a few of the epithelial cells (cells that line the ducts in the breast) may eventually lose some of their genetic controls, which normally limit their multiplication (cell division). When this happens, cells may proliferate, leading to an abnormal architectural pattern of the epithelial cells. This over-proliferation of cells is termed hyperplasia. Sometimes these proliferating cells begin to appear abnormal and to look different from one another. They are now described as "atypical." As other more normal cells continue to cycle, die and break down, these atypical cells can move in, spread out, and accumulate. This extensive overgrowth and accumulation of atypical cells is called atypical hyperplasia.
Can caffeine cause fibrocystic breasts?
Caffeine has been implicated as contributing to both the symptoms and scarring (fibrocystic) changes in fibrocystic breast condition. However, when the scientific evidence is reviewed, the results are conflicting, and no firm benefit of caffeine restriction has been scientifically established. Additionally, there appears to be no evidence that caffeine increases the risk of breast cancer. However, in women with fibrocystic breast condition, a trial of caffeine restriction may be helpful. (Note that coffee is not the only source of caffeine. Tea, chocolate, and certain soft drinks also contain caffeine.)
At this time, there is a great deal of circumstantial evidence that dietary and hormonal factors can affect fibrocystic breast condition. Still, a firm association between dietary factors and fibrocystic breast condition has not been established.
Why is it important to diagnosis fibrocystic breasts?
The basic problem with fibrocystic breast condition is the threat of breast cancer. Fibrocystic breast condition is itself benign (non-cancerous) and exceedingly common. Additionally, breast cancer is a common malignancy in women. Both conditions, one benign and the other a leading cause of cancer deaths in women involve the same organ - the breast, and both can involve the presence of breast masses.
Fibrocystic lumps in the breast can closely mimic those found in breast cancer. They can also sometimes make breast cancer difficult to detect. Therefore, fibrocystic breast condition often makes both the patient and her physician quite concerned about the possibility of breast cancer. If a woman's breasts are fibrocystic, other diagnostic tests in addition to screening mammography may be necessary in order to rule out an underlying breast cancer.
How is fibrocystic breast condition diagnosed?
A common indicator of fibrocystic breast condition is breast pain or discomfort, but women with fibrocystic breasts may also not have any symptoms. If discomfort is present, the discomfort may include a dull, heavy pain in the breasts, breast tenderness, nipple itching, and/or a feeling of fullness in the breasts. These symptoms may be persistent or intermittent (coming and going), frequently appearing at the onset of each menstrual period and going away immediately afterwards.
The primary method of diagnosing fibrocystic breast condition is physically touching and feeling (palpation) the lumpy areas in the breast(s). These lumps may be detected by a woman on self-examination or by her physician. This lumpiness is most commonly found in the upper outer quadrant of the breast. (The breast is conventionally divided into quadrants or quarters. The upper outer quadrant is the one closest to the armpit.) The lumps in fibrocystic breast condition are typically mobile (they are not anchored to overlying or underlying tissue). They usually feel rounded, have smooth borders, and may feel rubbery or somewhat changeable in shape. Sometimes, the fibrocystic areas may feel irregular, ridge-like, or like tiny beads. These characteristics all vary from one woman to another.
Extremely fibrocystic breasts in women can be very difficult to examine by palpation (touching and feeling). Even mammograms of such extremely fibrocystic breasts may be difficult to interpret. In these cases, specialized breast ultrasound exams and other tests can be very helpful for cancer screening. It may sometimes be necessary to obtain a sample (biopsy) of breast tissue with a needle or by surgery in order to make an accurate diagnosis and differentiate between fibrocystic breast condition and breast cancer.
Do all women with fibrocystic breasts need breast biopsies?
One reason to undergo a breast biopsy is to diagnose breast cancer. Another reason is to identify those women with fibrocystic breast condition who may have atypical hyperplasia and are at an increased risk of developing breast cancer in the future. However, it is important to note that the severity of a woman's symptoms and clinical signs of fibrocystic breast condition (pain and lumpiness) do not necessarily correlate with the severity or the cellular changes seen under the microscope. Therefore, it is difficult to single out every woman with fibrocystic breast condition for whom a breast biopsy would be useful.
Additional reasons why breast biopsies are not done on every woman with fibrocystic breast condition include: (1) the invasive nature of the biopsy procedure; (2) the necessity of anesthesia; and (3) cost-benefit considerations. Instead, most women with fibrocystic breast condition are followed over time as if they all are at an increased risk for developing breast cancer. The woman herself must ensure that her clinician is appropriately monitoring her on a regular basis.
What are the treatments for breast lumps, cysts, and fibrosis?
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:
- 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. Anti-inflammatory medications, including acetaminophen (Tylenol and others) and nonsteroidal anti-inflammatory 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.
- Hormonal irregularities: Some women with very irregular menstrual cycles 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 diseases may aggravate the symptoms of fibrocystic breast condition, they should be diagnosed and treated.
- 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. Your doctor may consider tamoxifen or danazol if you have severe cyclical breast pain due to the condition.
Are fibrocystic breasts associated with an increased risk of breast cancer?
Fibrocystic breast condition that involves hyperplasia is associated with a slightly elevated risk of breast cancer, and atypical hyperplasia is associated with a moderately increased risk of breast cancer when compared to women without fibrocystic changes. This is because genetic errors (mutations) have begun to accumulate in cells that no longer respond normally to the signals that usually control cell growth and division. These cells may also have an impaired ability to repair any genetic damage. As the atypical cells increase in number, they accumulate additional genetic errors.
Environmental, dietary, and metabolic toxins may also interact with a woman's complex hormonal system to increase the risk of mutations and thus increase the risk of breast cancer. It has been demonstrated that individuals differ significantly in their ability to break down and remove toxins from the body. Some of this varied response to toxins may be due to inherited differences. The potential for DNA damage (leading to genetic errors or mutations), which can be caused by a variety of damaging agents combined with the stimulation of cell division, is what ultimately leads to the risk of breast cancer that is associated with some cases of fibrocystic breast condition. The ability to recognize and repair DNA damage, a process that cells must continuously perform, varies from person to person.
Living with the pain of fibrocystic breasts
Generally, the following measures are recommended for women with fibrocystic breast condition:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
American Cancer Society. "American Cancer Society Releases New Breast Cancer Guideline."
Oct 20, 2015.
Miller, AC, MD. "Breast Abscesses and Masses." Medscape. Updated Apr 13, 2017.
Reviewed on 7/13/2017
American Cancer Society. "American Cancer Society Releases New Breast Cancer Guideline."
Oct 20, 2015.
Miller, AC, MD. "Breast Abscesses and Masses." Medscape. Updated Apr 13, 2017.