Fibrocystic breast changes

Definition
Fibrocystic breast changes are benign changes in breast tissue that may cause pain, lumpiness or cysts (pockets of fluid) in the breast.

Anatomy
The breasts are made of lobules, ducts and stroma. Lobules are the glands that produce milk, and the ducts connect the lobules to the nipple. Stroma is the fatty tissue and support structure that surrounds the lobules and ducts. Blood and lymphatic vessels are also found in the breasts. The lymphatic vessels carry lymph, a clear fluid that helps fight infection and removes tissue waste products.

Causes/associated factors
The exact cause of fibrocystic breast changes is unknown. The hormones produced by the ovaries, particularly estrogen, seem to encourage changes within the stromal and lobular components of the breast. These hormones may cause the breasts to swell with fluid or increase in lumpiness the week before menstruation. The lumps caused by fibrocystic changes typically disappear or decrease in size after your period. Due to repeated exposure to hormones, the breast tissue may become thicker and firmer, and cysts may form. Sometimes these changes become permanent.
Most women experience some degree of fibrocystic breast changes, usually between ages 30 and 50, and often have a family history of the condition. Women who take birth control pills seem to have fewer fibrocystic breast changes. For most women, unless hormone therapy is begun, the changes disappear after menopause.


Signs/symptoms
Symptoms often affect both breasts. They're typically worse the week before your period and decrease or disappear after menstruation. They may include:
multiple lumps, which may change rapidly in size
pain or tenderness
breast swelling
rarely, nipple discharge that may be clear, white, gray or green
By definition, benign lumps do not become cancerous. Cancerous lumps can develop near benign lumps, however. Consult your doctor right away if you notice new undiagnosed lumps, dimpling of the skin or nipple discharge. If you have a family history of breast cancer, remember to tell your doctor. Also, based on your age and family history, ask your doctor about the frequency of mammograms and clinical breast exams.


Diagnosis
First, your doctor will ask questions about your medical history and do a physical breast exam. By looking at your breasts, the doctor may identify areas of asymmetry or change in color and texture. By feeling your breasts and the area under your armpits, he or she may be able to determine changes in the texture of your breasts and surrounding tissues.
In addition to a mammogram (a specialized low-dose X-ray of the inner structures of the breast), you may need an ultrasound (using high-frequency sound waves to make an image of the breast). An ultrasound can be used to help determine whether a lump is a fluid-filled cyst or a solid mass. If questions remain, a fine needle aspiration (testing fluid or tissue from a cyst), an excisional biopsy (complete removal of the suspicious lump for further evaluation) or other additional tests may be done.


Treatment
Most symptoms of fibrocystic breast changes respond well to simple treatment measures, such as wearing a supportive bra day and night or applying cool compresses to your breasts. Your doctor may suggest taking an over-the-counter pain reliever. Prescription pain medication is seldom needed. Medications used to block hormones that affect the breasts are rarely used because they do not cure the problem and the side effects can be severe.
Many women report an improvement in symptoms after omitting caffeine-containing foods such as coffee, tea, cola and chocolate from their diets. However, most studies have failed to show a relationship between caffeine consumption and fibrocystic breast changes. The effectiveness of taking vitamin E or evening primrose oil remains controversial. Dietary fat intake and its relationship to breast changes is also being studied. Ask your doctor about any dietary changes that may be helpful for you.


Complications
Most women who have fibrocystic breast changes don't face an increased risk of breast cancer. The tissue changes can make it difficult to detect cancerous lumps at an early stage, however. A small percentage of women with fibrocystic breast changes have a condition called atypical hyperplasia (an excessive proliferation of normal cells). These women face a four to five times greater risk of breast cancer.

Pregnancy-specific information
During pregnancy, you will probably experience many breast changes, including enlargement, increased sensitivity and color changes. There's no indication that fibrocystic breast changes are affected by pregnancy, however. Discuss any breast changes with your doctor.

Senior-specific information
Although fibrocystic breast changes are less common after menopause, they may appear if you take hormone replacement therapy. Discuss any postmenopausal breast changes with your doctor.

Prevention
Although some authorities recommend monthly breast self-exams, other experts consider them optional because they're not as sensitive as clinical exams. If you do a monthly breast self-exam, do it about a week after your period and at a regular time each month after menopause. If you find a new lump or one that's never been diagnosed, recurring masses, changes in existing lumps or nipple discharge, consult your doctor right away for further evaluation.
Some health professionals recommend clinical breast exams every two to three years between ages 20 and 39 and every year beginning at age 40. The U.S. Preventive Services Task Force concluded that there's insufficient evidence to recommend for or against routine clinical breast examination alone to screen for breast cancer. Based on your age and other risk factors, decide with your doctor how often to have professional exams.

The debate on the timing of mammography continues. Some health care professionals recommend regular mammograms every one to two years beginning at age 40 and annually beginning at age 50. The U.S. Preventive Services Task Force recommends mammograms every one to two years, with or without clinical breast examination, for women age 40 and older. Consult your doctor to decide if you need earlier or more frequent screenings.