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Fibrocystic Breasts

“Fibrocystic” can mean three different things. It can refer to symptoms of breast pain and tenderness. It can indicate dense, glandular, “lumpy”, often tender breast tissue felt on breast examination. Certain benign tissue patterns seen microscopically in breast tissue from a breast biopsy are classified as fibrocystic changes. These three findings often go hand-in-hand.

More than half of women experience fibrocystic breast changes at some point. The term “fibrocystic disease” is not used anymore because such a common finding should not be considered a disease.

Fibrocystic breast tissue is often painful and/or tender. Fibrocystic tissue is most common in the upper outer breast, but can be present elsewhere. It is usually symmetric, that is, mirror-image locations of the breasts feel similar. However, it might involve only one
breast at a time. This complex of lumpiness, pain, and tenderness is often cyclical, but not always. Fibrocystic tissue is typically most prominent just before a woman gets her period, and it usually regresses after menstruation starts. It is likely that there is an interaction between normal female hormones such as estrogen, and glandular breast tissue, which causes fibrocystic areas to develop. With the repeated hormonal effects associated with menstrual cycles over the years, cysts may become chronically inflamed, with thick fibrous tissue forming around them.

Fibrocystic breast changes occur most often in women who are menstruating, especially between the ages of thirty to fifty. It is most pronounced in women during the five to ten years before menopause. They can also be found in postmenopausal women who are taking hormone replacement therapy.

One should see a doctor if, there is a lumpy area which persists after your period starts, especially if the lump is new, or if a stable lump enlarges. Breast pain is very common and rarely suspicious but you should see a doctor if there is persistent pain in one location, especially if it worsens.

When examined under a microscope, fibrocystic breast tissue includes specific types of benign tissue including cysts (fluid-filled sacs), fibrosis (dense scar-like connective tissue) and proliferative changes (ductal or lobular hyperplasia, apocrine metaplasia or adenosis). These findings are not associated with an increased risk for breast cancer. Less commonly, fibrocystic tissue will be associated with atypical ductal hyperplasia or atypical lobular hyperplasia. These are benign findings which are associated with an increased risk for breast cancer.

The evaluation of a woman with fibrocystic breasts will include a detailed medical, dietary, and breast health history, a clinical breast examination, a mammogram for patients thirty or older, and possibly a breast ultrasound of any focal lumps or pain. Sometimes a biopsy is necessary to determine if a breast lump is caused by fibrocystic change or breast cancer; this can usually be accomplished with a minimally-invasive ultrasound-guided needle biopsy.

A variety of measures may help reduce breast pain associated with fibrocystic breast tissue.