Fibrocystic Breast Disease

At least 60% of women in reproductive years have breast lumps as a result of fibrocystic changes.

Changes in fibrocystic tissue are the most common cause of breast lumps in women ages 30 to 50. These changes are referred to as a chronic cystic mastitis, or mammary dysphasia, and are not cancerous. Most often fibrocystic changes are diagnosed by a physical examination or mammogram.

The Cause

Fibrocystic breast changes are related to the manner in which breast tissue responds to monthly changes in the levels of estrogen and progesterone. Estrogen and progesterone are female hormones produced by the ovaries during a woman's reproductive years. Each month during a woman's menstrual cycle, the breast tissue alternately swells and returns to normal. Hormonal stimulation of these tissues causes the milk glands and ducts to enlarge and the breasts to retain water; breasts become swollen, painful, tender, and lumpy. After menstruation is complete, the swelling in the breasts usually decreases and the breasts feel less tender and lumpy.

Fibrocystic Changes

As a result of repeated hormonal stimulation, there is an increase in firmness of the tissue and packets of fluid called cysts may form in obstructed or enlarged milk ducts. The breast tissue may feel like an irregular shaped area of thicker tissue with a lumpy or ridge-like surface. Fibrocystic tissue may also feel like tiny beads scattered throughout the breasts.

Generally fibrocystic changes are found in both breasts and most frequently are found in the upper outer quadrant and the underside of the breast where a ridge may sometimes be felt. Premenopausal women with a fibrocystic condition may experience an increase in size of the lumpy areas in the breast, as well as discomfort ranging from a feeling of fullness or heaviness to a dull ache, extreme sensitivity to touch, or a burning sensation. For some women, the pain is too severe to exercise or even lie on the abdomen. The condition tends to subside after menopause.

Breast Cysts

Some women with a fibrocystic condition develop cysts in their breasts. These fluid-filled sacs usually feel smooth, are firm, movable, and sometimes tender. The tenderness and lump size generally increase the week before the menstrual period and will subside somewhat the week following. Large cysts may feel round and similar to what you feel when you press lightly on the eyeball with a closed eyelid. Simple cysts can be aspirated with a needle and syringe in the physician's office. If the cyst disappears and doesn't come back, surgical removal is usually not necessary. After menopause, this cystic condition becomes less noticeable and often disappears.

Lumps versus Fibrocystic Changes

Confusion arises because not all women who discover a lump have fibrocystic changes. The breast is naturally a lumpy gland. The lumpy consistency arises from the milk glands and the ducts that separate and support them. Fibrous tissue also may be present in the breast and may feel ''lumpy'' but not represent a real lump. The regular practice of Breast Self-Examination (BSE) will help a woman become familiar with how her breast tissue normally feels so that she can identify a change. Any changes in how her breast normally feels should be reported to her health care professional.

Treatment of a Fibrocystic Condition

The treatment of a fibrocystic condition may require surgical removal (biopsy) or lumps that fail to disappear after brief observation and/or attempts at removal of fluid by a physician. For painful breasts, avoiding caffeine in coffee, tea, chocolate, and soft drinks may decrease water retention and discomfort. Local heat applications and a good support bra also provide additional relief. A physican may recommend aspirin or other pain relievers and on occasion, vitamin E.

Mammography Can Detect Breast Cancers Even Smaller Than The Hand Can Feel

For too many years, breast cancer that could have been cured could not be identified because the only diagnostic tool available was the human hand. When mammography proved it could detect lumps infinitely smaller than fingers could feel at minimal risk, a great breakthrough was achieved. Now there is hope that one of the leading causes of cancer deaths in women will lose its place in our lives.

For women with fibrocystic changes, additional imaging procedures may be used as a complement to mammography. Breast ultrasound is known to be effective when used in addition to mammography to detect small tumors that may be hidden by dense fibrous tissue in the breasts.

Best Time for BSE

The American Cancer Society urges women to perform breast self-examination (BSE) once a month about a week after the menstrual period. Post-menopausal women should choose a set day, such as the first of the month, to practice self-examination.