(Benign Breast Masses, Breast Cysts, Cystic Disease, Chronic Cystic Mastitis, Mammary Dysplasia)
Definition
Fibrocystic disease occurs when there are fluid-filled lumps surrounded by a scar-like capsule of tissue in the breasts.
Although harmless, these lumps can sometimes cause pain (mastalgia) that recurs with the menstrual cycle. The greatest problem with fibrocystic disease is telling the difference between it and breast cancer. Some forms of fibrocystic disease are more common in women who go on to develop breast cancer.
Breast Cysts
Causes
The glandular tissue of the breasts cycles monthly with menstrual periods, enlarging to prepare for a pregnancy, and then diminishing if one does not occur. This cycling causes cysts and excess fibrous tissue to build up. Virtually all women will have some form of this condition during their reproductive years, though many will not seek treatment for it.
Risk Factors
All women between puberty and menopause are at risk for this condition.
Symptoms
• Multiple lumps (cysts) in both breasts that cycle with menstrual periods
• Cysts may produce no symptoms or cause pain (mastalgia) and tenderness
• Although at any given time a fibrocystic lump may be difficult to tell apart from a cancerous mass, its rapid disappearance and reappearance helps distinguish this condition from breast cancer
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. There are generally only two concerns that arise from these symptoms:
• Are you uncomfortable?
• Do you have breast cancer?
Tests may include the following:
• Mammogram (x-ray of the breasts)
• Needle aspiration of a lump
• Excisional biopsy of a suspicious area
It is important to note that mammograms alone cannot reliably distinguish between a benign cyst and a cancer. A lump that does not show significant monthly changes must be evaluated by other means. One of these means is aspiration (see below).
Treatment
Once it has been determined that the lump is not a cancer, it can be left alone. If its identity is still in doubt, it should be biopsied.
Aspiration
After numbing the area with a local anesthetic (eg, Novocain), a small needle on a syringe is inserted into the lump to draw fluid out. If the lump disappears, cancer is highly unlikely. If the lump remains, or if the fluid withdrawn is bloody, it will need to be biopsied to see if a cancer is present.
Biopsy
There are two types of biopsies:
• A fine needle biopsy is nearly identical to an aspiration. The only difference is that a tiny piece of tissue is also drawn out of the lump and sent to the laboratory to be identified under a microscope.
• An excisional biopsy removes the entire lump through a surgical incision. This can be done with local anesthesia (eg, Novocain) if the lump is small and superficial. Otherwise you may have to undergo a somewhat more extensive operation, but it is still considered minor surgery.
Once cancer has been satisfactorily ruled out, fibrocystic disease may be safely treated with observation and conservative measures, including:
• Pain relievers
• Local heat application
• Highly supportive bra
For particularly painful fibrocystic disease there are a few hormonal drugs (eg, danazol or tamoxifen) that may reduce the symptoms, but they have significant side effects and should be used in only severe cases and for as short a time as possible.
Some women with fibrocystic diseases who regularly consume caffeine (coffee, tea, cola, or chocolate) may find relief by eliminating it from their diet. Also, vitamin E (400 IU daily) may help some women.
Prevention
There is no well established way to prevent fibrocystic disease.
The most important issue relating to this condition is the ever-present danger of breast cancer. Women over 40 years old and relatives of breast cancer patients should have a mammogram and breast exam yearly and do their own breast examination monthly. Fibrocystic disease can make the evaluation of mammograms difficult and can also complicate palpation of the breast. For this reason, regular exams and mammograms are particularly important in women with fibrocystic disease.
Breast Self-examination
This examination is best performed within a week after a menstrual period when the breasts are less swollen and tender, and it is easier to do a thorough examination without discomfort. For the technique, please see the fact sheet on breast cancer. Routine breast examinations, even for women under 40 years old, will make you familiar with your breasts and therefore more likely to detect changes that should prompt a visit to a physician.
