fibrocystic breast disease
Fibrocystic breast disease describes healthy breast tissue that feels lumpy, which may result in breast pain in some individuals. It is not harmful because it is not a true disease. Fibrocystic changes is another name that is sometimes used by the medical community to describe this disease.
Fibrocystic breast disease is quite common. Some specialists estimate that about estimate that about 50% of women ages 20–50 in the U.S. experience fibrocystic breast changes at some point in their life.
Causes of fibrocystic breast disease:
Medical experts have yet to completely understand the reason for fibrocystic breast illness, however there seems to be a robust affiliation between hormones and breast changes. Breast tissue responds to fluctuating ranges of hormones, particularly estrogen. Changes within the breasts might include:
- An overgrowth of cells that line the milk ducts
- A rise in fibrous tissue
- The formation of cysts
People who develop fibrocystic changes could also be extra delicate to hormonal fluctuations through the menstrual cycle. It is common for signs to become more bothersome right before or throughout a menstrual period.
Fibrocystic breast disease tends to have an effect on people who find themselves premenopausal and between the ages of 20 and 50. Some individuals who take estrogen replacement therapy after menopause also develop fibrocystic changes.
Image credit: Stephen Kelly, 2018
Symptoms of fibrocystic breast disease:
Symptoms of fibrocystic breast disease might come and go in the course of the menstrual cycle. Symptoms can also differ from month to month.
The changes usually happen in both breasts, however lumps and ache could also be worse in one breast than the other.
Although it could possibly fluctuate, the ache or discomfort is often located within the undersides of the breasts or within the upper areas, when nearly all of milk glands are.
Typical symptoms include:
- Breasts that really feel lumpy or have rope-like bumps
- Tenderness
- Ache beneath the armpit
- Swelling
- Breasts that feel heavy
While lumpy breasts and discomfort are common in individuals with fibrocystic breast disease, it is important to know when to see a physician.
If an individual develops new lumps or skin puckering, or if the ache continues to worsen, it is best to talk to a health care provider.
Is fibrocystic breast disease linked to cancer?
According to the American Cancer Society, having fibrocystic breast disease doesn’t enhance an individual’s possibilities of developing breast cancer. There is no identified association between the 2 conditions.
Fibrocystic breast disease could make it tough to distinguish between a new breast lump and fibrocystic changes.
Doing month-to-month breast self-exams and following a physician’s recommendations for for clinical exams and mammograms may help catch any harmful changes early.
Diagnosis of fibrocystic breast disease:
Symptoms of fibrocystic breast disease can include tenderness and swelling.
A health care provider might diagnose fibrocystic breast disease after a clinical breast exam and a evaluation of symptoms.
During the exam, the physician feels each breast to examine for lumps or irregular areas. Fibrocystic breast changes are likely to feel different from the lumps related to breast cancer.
Usually, fibrocystic changes contain lumps that aren’t connected to the surrounding tissue. The lumps are typically moveable when a physician palpates them.
Sometimes, a lump might feel firmer than typical, or a physician might have other concerns. Performing a mammogram or breast ultrasound may help them make a diagnosis.
These imaging studies may reveal extra detail in regards to the breast tissue and any cysts, such as whether or not a cyst is fluid-filled or solid. If a cyst is discovered to be both stable and fluid filled, a biopsy will help rule out cancer.
Treatment of fibrocystic breast disease:
After obtaining normal findings on clinical and imaging studies, reassurance is often all that is required. A simple assurance that the patient does not have breast cancer provides adequate relief for 78 to 85 percent of women. Such patients would also benefit from a follow-up visit in two to three months to exclude or treat recurrent/persistent pain.
People who experience mild breast pain from fibrocystic breast disease may choose not to use treatment. In other instances, the following treatments can help:
First-line therapy
First-line therapy for breast pain is conservative and typically includes physical support, over-the-counter analgesics, and manipulation of hormone-based medications for those who take them. It is typically safe but may not be effective. We prefer to treat with first-line therapy for six months before moving onto one of the second-line therapies, which may be more effective but also have more side effects. Some practitioners also endorse therapies such as caffeine abstinence or evening primrose oil (EPO). Although such therapies have not been proven effective by vigorous placebo controlled trials, they are generally harmless and may provide relief for some patients.
Physical support
- Support garments – A well-fitting brassiere to better support the breast is widely advocated. The use of a support bra with steel underwire tends to reduce mastalgia in women with pendulous breasts. In addition, use of a “sports bra” during exercise has been shown to reduce pain related to breast movement. Wearing a soft, supportive bra at night stops the breast pulling down on the chest wall, supports tender breast tissues, and helps many women sleep. Women with asymmetric breasts may benefit from specialized fitting to place extra padding on one side, which permits appropriate support of that side without over-compressing the contralateral side.
- Compresses – Some women obtain relief from application of warm compresses or ice packs or gentle massage. For those who breast feed, ice packs are recommended during the obstructive (prebacterial) phase of puerperal mastitis to decrease milk production regionally and thereby relieve ductal intraluminal pressure and subsequent pain. (See “Common problems of breastfeeding and weaning” and “Lactational mastitis”.)
Acetaminophen or NSAID
Acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID), or both, can be used to relieve breast pain. Topical NSAIDs may also be useful. While the weaker types of topical NSAID (eg, ibuprofen gel) may not be effective in relieving breast pain, data from randomized trials demonstrated significant improvement in those treated with diclofenac gel with minimal side effects. In the United States (US), two types of topical NSAIDs are available:
- Salicylate, the active ingredient in aspirin, is found in Aspercreme and Nuprin.
- Diclofenac, which has the same active ingredient as the oral NSAID Voltaren, is found in the Flector Patch or a gel form
Second-line therapy
Treatment with one of the second-line therapies may be required in patients who still have debilitating breast pain despite first-line therapy for six months. Tamoxifen is preferred first because it has fewer side effect than danazol. It is preferred to treat with tamoxifen or danazol for one to three months, until either pain subsides or side effects increase.
- Tamoxifen — For patients with more severe mastalgia refractory to other treatments, tamoxifen can provide breast pain relief. A meta-analysis of three randomized trials found tamoxifen to be more effective in relieving breast pain than placebo (relative risk 1.92, 95% CI 1.42-2.58).
- Tamoxifen is associated with menopause-like symptoms such as hot flashes, vaginal dryness, joint pain, and leg cramps.
- It can also increase the risk of blood clots, strokes, uterine cancer, and cataracts. Thus, tamoxifen is infrequently used to treat mastalgia.
- Restricting tamoxifen to the luteal phase of the menstrual cycle has also been suggested to reduce side effects.
- Danazol — Danazol is an androgen and is the only medication approved by the US Food and Drug Administration (FDA) for the treatment of mastalgia (fibrocystic breast disease). Danazol is effective in relieving breast pain and tenderness.
- The use of danazol is limited by its androgenic effects. At the recommended dose of 200 mg daily, significant proportions of patients reported side effects such as weight gain (30 percent), menstrual irregularity (50%), deepening of the voice (10%), and hot flashes (10 %).
- Restricting the use of danazol to the luteal phase of the menstrual cycle reduces the side effects without compromising its effectiveness.
Therapies not proven by randomized trial data
The role of diet and lifestyle in relieving cyclical breast pain is unclear, with a strong likelihood of a placebo response for many interventions. However, some practitioners feel that some of these treatments (eg, caffeine abstinence and evening primrose oil) are worth trying because they are generally harmless and may offer some women pain relief.
- A low-fat (15% of calories), high complex carbohydrate diet has been effective in some observational studies and small randomized trials. However, the trials could not be blinded, which may invite a placebo effect. Additionally, such low-fat diets are difficult to maintain beyond a few weeks.
- Elimination of caffeine has not been effective in controlled trials, although it seems to be helpful in some women.
- Evening primrose oil (EPO) or its active ingredient gamma linoleic acid (GLA) has been studied in multiple randomized trials of breast pain. Despite early enthusiasm, neither has been shown to be effective beyond the placebo effect.
- Vitamin E has been shown in multiple randomized trials to be no better than placebo in the treatment of benign breast disease. Thus, vitamin E should not be prescribed to treat mastalgia.
- Bromocriptine is a dopamine agonist that inhibits prolactin release. Although bromocriptine is effective in relieving pain compared with placebo, it is less effective than danazol, and up to 80% of women develop side effects such as headaches and dizziness. Therefore, it is no longer used to treat breast pain. Several other drugs that affect estrogen or prolactin secretion (including bromocriptine and other gonadotropin-releasing hormone [GnRH] agonists) have been studied but are not advocated for use in patients with severe mastalgia because of unfavorable side effect profiles.
- Pyridoxine (vitamin B6): One study, which included 94 participants with fibrocystic breast disease who took Vitamin B6 for six months reported a decrease in breast pain severity at 1, 2, and 3 months of treatment.
Outlook:
The outlook for individuals with fibrocystic breast disease is good. Some individuals don’t experience bothersome symptoms, and invasive treatment is often unnecessary.
While doctors do not know the precise cause, hormones are a significant factor in breast changes.
Trying a combination of home remedies, such as heating pads, pain medicines, and wearing a supportive bra, may help individuals get relief.
The signs of fibrocystic breast disease often ease after menopause.