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Fibrocystic Breast Disease

Fibrocystic breast disease (FBD) is a very common benign condition characterized by the presence of noncancerous lumps in the breast which frequently cause discomfort.


Presentation

The changes of FBD are characterized by the emergence of fibrous tissues and the appearance of a lumpy and cobblestone texture throughout the breast. The characteristic lumps are generally very smooth and with well defined edges, which often appear movable in relation to the adjacent structures and frequently located near the armpit in the upper and outer breast sections. The grade of mobility and visibility of these lumps markedly decreases because of the irregularities in the breast texture and the numerous fibrous structures surrounding them, while their size continuously changes following a monthly cycle. The moments in which the lumps are largest are usually associated with the swelling of the breast, when subjects might experience an persistent and intermittent aching. On the other hand, when the swelling reduces, the breast appears more tender and softer.

As previously said, the main symptoms of FBD follow a periodic trend closely related to the menstrual cycle and the hormonal changes associated with it. These signs peak immediately before a period, to decrease and get to the previous levels afterward. To date, no complication due to FBD has ever been found in breastfeeding.

Nipple Discharge
  • Moreover, most of the study variables, viz. mastodynia, palpable structure, amount of glandular tissue, non-cystic nodularity, small cysts, duct ectasia, nipple discharge, and fibrosis, also tended to increase significantly in intensity and/or frequency[ncbi.nlm.nih.gov]
  • Nipple discharge also decreased. The extent of fibrosis appeared to be unaffected by therapy.[ncbi.nlm.nih.gov]
  • Although fibrocystic breast changes do not increase a woman's risk of having breast cancer, women are encouraged to see their health practitioner if they notice they are experiencing flattening or indentation of the nipple, bloody nipple discharge, or[jamaicaobserver.com]
  • Common breast symptoms are swelling and tenderness, nodularity, palpable lumps, nipple discharge, and inflammation. These changes are typically accompanied by breast pain.[goodbreasthealth.com]
Breast Mass
  • Clinical manifestations and diagnosis of a palpable breast mass. . Accessed Feb. 6, 2019. Understanding breast changes: A health guide for women. National Cancer Institute. . Accessed Jan. 26, 2016. Jacobs LJ. Management of benign breast disease.[mayoclinic.org]
  • Differences between cancer and a cyst To help determine if a lump is a cause for concern, Aliabadi explains: “Benign breast masses often have a smooth edge, are very mobile and do not quickly grow.[sheknows.com]
  • A biopsy allows the physician to remove the entire breast mass so that the cells can be examined microscopically for any cancerous changes. Fortunately, most masses are benign.[healthy.net]
  • Also Read Symptoms Of Fibrocystic Breast Condition Symptoms Of A Fibrocystic Breast How To Treat Fibrocystic Breast Disease Through Diet Causes Of Fibrocystic Breast Disease Fibrocystic Breast Masses & Menopause What to Do After Diagnosis If the diagnosis[ladycarehealth.com]
Mastodynia
  • Abstract Thirty premenopausal women with recurrent, pronounced cyclical mastodynia associated with mammographically confirmed fibrocystic disease were studied.[ncbi.nlm.nih.gov]
  • Abstract The purpose of the investigation was to study various aspects of danazol treatment in patients with fibrocystic breast disease and pronounced mastodynia.[ncbi.nlm.nih.gov]
  • Abstract This study aimed at providing a detailed anamnestic, clinical, and mammographical characterization of 109 patients with fibrocystic breast disease, who were selected on the basis of pronounced mastodynia, prominent palpable structure and mammographical[ncbi.nlm.nih.gov]
Breast Engorgement
  • These lumps have a tendency to resolve spontaneously, often after menses; Pain usually worse before menstrual periods; May be indistinguishable from cancerous tumor of the breast; Breast engorgement; Breast thickening; Nipple discharge (sometimes).[rxmed.com]
  • The common symptoms of fibrocystic breast disease are: tenderness in one or both breasts with pressure or touch breast pain an intermittent or persistent sense of breast engorgement, associated with dull, heavy pain and tenderness intermittent appearance[healthcentral.com]
Painful Breast Lump
  • This can result in swelling and tender or painful breast lumps. Symptoms are most common just before or during your period. You may develop lumps in your breasts caused by cysts and swelling of your breast lobules, the milk-producing glands.[healthline.com]
  • I use whole organic lemons to stop painful breast lumps. After washing the lemon WITH SOAP! I cut it up and put everything, skin, pulp, fiber and juice in the blender with a little water.[earthclinic.com]

Workup

After excluding malignancy as possible cause of the appearance of breast lumps, it is possible to perform the diagnosis of FBD, which is usually based on a clinical breast examination. The clinician initially checks for unusual breast areas, both manually and visually, and then for the lymph nodes in the area around the armpits and the lower neck. Generally, this procedure is sufficient to diagnose FBD, but sometime there might be signs with unclear clinical appearance which require further examinations like imaging techniques and breast biopsy.

The imaging techniques are very useful to establish whether the lumps are cysts or other types of structures. The major and most commonly used imaging technique is undoubtedly diagnostic mammography, which consists of analyzing the breast through X-rays in a methodology that provides very clear imagines of specific breast areas. Mammography is especially recommended for young women under 30 years of age, and is generally used in conjunction with ultrasounds and MRIs, which allow to distinguish between fluid-filled breast cysts and solid masses.

On the other hand, biopsy is generally used in the cases of unclear diagnosis, when even the imaging techniques are not enough to properly evaluate the breast changes. There are four types of breast biopsy: fine-needle aspiration biopsy, core-needle biopsy, stereotactic biopsy, and surgical biopsy. The fine-needle aspiration biopsy is used when a lump is almost certainly a cyst, and is usually performed in conjunction with ultrasound to guide the needle during penetration. The procedure is painless and consists in inserting the needle in the breast tissue while the physical breast examination is being performed. The core-needle biopsy, instead, requires a larger needle used to remove a small cylinder of breast tissue, and is performed under local anesthesia. In the stereotactic biopsy, the needle is guided by using a three-dimensional X-ray from 2 different angles into the breast area concerned, while in the surgical biopsy entire lumps or parts of them are removed, in a procedure which is painful and also requires local anesthesia.

Treatment

Most of the women with FBD show no clinical sign and therefore need no treatment, even though a close follow-up is always recommended. As for the clinical approach, there is not a largely accepted treatment for FBD and usually many physicians use that for clinical breast pain to treat their patients. Anyways, for mild cases of FBD it is generally recommended to use over-the-counter pain relievers like ibuprofen or acetaminophen, which are effective at relieving pain and discomfort, and to wear well-fitting and supportive bras which can reduce breast pain and tenderness. The more severe cases, instead, can be addressed with a medical intervention, such as the use of contraceptives and hormones, which might reduce breast changes, and the use of the fine-needle aspiration, generally employed to remove the fluid in the larger and more painful cysts. If the aspiration brings no positive results, it can be replaced by the surgical removal of the cysts.

There are some other strategies now under investigation that might prove themselves to be effective in the future for the treatment of FBD. The first one is undoubtedly dietary changes, like reduced intake of caffeine and salt , that according to a few small-scale studies might have positive effects on the breast. The integration of vitamins might also have a positive outcome, but to date there is no organic approach in this regard. The dietary changes could be integrated to a therapy based on oral contraceptives and hormone replacement [8], even though it is still not clear whether this methodology improves or worsens benign breast conditions.

Another strategy now under investigation is iodine supplementation. It has been observed that iodine has a series of positive effects in women with fibrocystic breast changes, like a decrease in the number of breast cysts, fibrous tissue plaques and pain [6] [9], especially if administered as molecular form (I2) [9][10]. According to some studies performed in vitro, iodine appears to inhibit cancer progression in its early stages, through a iodine-based modulation of estrogen, and to decrease breast pain, tenderness and nodularity, but the efficacy of this approach and the effects with large doses in vivo [11] is still not clear.

Prognosis

There is no adverse side effect usually associated with FBD, and the only possible serious complication to remember is the difficulty to detect cancerous formations in women with numerous and pronounced fibrocystic breast changes. In any case, as previously mentioned, the formation of these fibrocystic changes subsides after menopause, as the hormone levels and their fluctuations decrease and stabilize.

Etiology

The breast tissues continuously undergo changes due to the influence of hormones produced by ovaries. Sometime these changes appear much more pronounced and this result in the swelling of breast and the appearance of tender or painful lumps. The symptoms begin to emerge just before or during the period of a woman, and are characterized by the appearance of the already mentioned lumps caused by cysts (fluid-filled sacs) and the swelling of lobules (the milk-producing glands of the breast). Furthermore, it is also possible to notice the appearance of a lumpy thickening in the breast as consequence of a pronounced growth of fibrous tissues.

Epidemiology

The estimated figures for the prevalence of FBD vary largely according to the source, ranging from a minimum rate of 30% to a maximum one of 60% [1]. However, the condition appears extremely common among women between 30 to 50 years of age [4].

The typical lumps of FBD frequently appear in conjunction with proliferative and non-proliferative lesions of breast tissues, suggesting some type of connection between the emergence of FBD signs and the risk of developing breast cancer. Unfortunately, it is not clear whether the lesions have to be seen as early precursors of a forthcoming cancerous condition or rather a mere indication of an increased cancer risk, but many experts tend to back the former theory [5].

Sex distribution
Age distribution

Pathophysiology

The exact pathophysiological mechanism of FBD is not yet fully understood. However, since the condition is strictly related to the menstrual cycle and subsides after menopause, experts believe that it must be somehow connected with hormone levels. It is known that fibrocystic breast change is a cumulative process partly caused by the normal hormonal variations taking place in the body of a woman during the monthly cycle, which in turn is characterized by pronounced changes in the levels of important hormones such as estrogen, progesterone, and prolactin. In the breast tissues, these hormones have the important role of directly or indirectly influencing the activation and regulation of cell growth and proliferation. After many years, the fluctuations of hormone levels might cause the production and accumulation of many small cysts and areas of dense fibrotic tissues, which start becoming particularly numerous after 30 years of age, when cysts get larger and provoke increasingly higher levels of pain.

Over the time, lesions too begin to emerge, which might cause the appearance of epigenetic, genetic and karyotypic changes, presumably in response of aberrant growth signals. It is particularly interesting to notice that, according to the preliminary evidence now available, iodine deficiency plays an important role in the emergence of these fibrocystic changes, as it increases the breast tissue sensitivity to estrogen [6] [7], something which does not come as unexpected given the essentiality of this element in the structure of most of these hormones.

Prevention

The prevention of FBD is heavily based on dietary measures, in particular the elimination of caffeine, saturated fats and salt, to prevent the cyclical fluctuations in the size and tenderness of breast cysts. Particularly advised is also a high fiber diet, with the integration of plant-based foods free of pesticides and hormones to eliminate unwanted toxins and avoid the dangerous reabsorption of xenoestrogens. A great part of these plant-based foods should be represented by vegetables, especially the cruciferous family, whose main ingredient, indole carbinol, promote the production of the protective estrogen 2 hydroxyestrone and limits the proliferative effects of the cancerous estrogen 16 alphahydroxyestrone.

Lifestyle changes are also heavily recommended, especially the integration of exercise programs in the daily routine, which should promote weight loss, mood stabilization and especially hormone balance, avoiding further dangerous hormonal fluctuations that favor fibrocystic breast changes.

Summary

Fibrocystic breast disease (FBD) is often related to the influence of menstrual cycle hormones and appears to be very common, affecting from 30 to 60% of all women and at least 50% of those in childbearing age [1]. Despite its frightening name, this condition is not dangerous at all, even though it might make the detection of breast cancer more difficult. On the contrary, on the basis of its frequent occurrence some experts tend not to think of it as a disease [2], but as a particular form of breast inflammation (mastitis) [3].

FBD is known with many terms, like chronic cystic mastitis, fibrocystic mastopathy, and mammary dysplasia, or with the names of those who have given their important contribution in its description. According to ICD-10, the 10th version of the medical classification list by the World Health Organization, the condition is called diffuse cystic mastopathy or, in case of epithelial proliferation emergence, fibrosclerosis of breast.

Patient Information

Fibrocystic breast disease (FBD) is a very common benign condition characterized by the presence of noncancerous lumps in the breast which frequently cause discomfort. FBD is often related to the influence of menstrual cycle hormones and appears to be very frequent, affecting from 30 to 60% of all women and at least 50% of those in childbearing age.

A fibrocystic breast change is a cumulative process partly caused by the normal hormonal variations taking place in the body of a woman during the monthly cycle, which in turn is characterized by pronounced changes in the levels of important hormones such as estrogen, progesterone, and prolactin. After many years, the fluctuations of hormone levels might cause the production and accumulation of many small cysts and areas of dense fibrotic tissues, which start becoming particularly numerous after 30 years of age, when cysts get larger and provoke increasingly higher levels of pain

The prevention of FBD is heavily based on dietary measures, in particular the elimination of caffeine, saturated fats and salt to prevent the cyclical fluctuations in the size and tenderness of breast cysts. Particularly advised is also a high fiber diet, with the integration of plant-based foods free of pesticides and hormones to eliminate unwanted toxins and avoid the dangerous reabsorption of xenoestrogens. Lifestyle changes are also recommended, especially the integration of exercise programs in the daily routine, which should promote weight loss, mood stabilization and especially hormone balance, avoiding further dangerous hormonal fluctuations that favor fibrocystic breast changes.

References

Article

  1. Norwoord SL. Fibrocystic Breast Disease An Update and Review. JOGNN – Journal of Obstetric Gynecologic, & Neonatal Nursing 1990 19: 116–121.
  2. Santen RJ, Mansel R. Benign breast disorders. N. Engl. J. Med. 2005 353 (3): 275–85.
  3. Gokhale S. Ultrasound characterization of breast masses. Indian J Radiol Imaging 2009;19:242-7 
  4. Smith RP. Netter's Obstetrics and Gynecology. Elsevier Health Sciences. p. 371. 2008
  5. Page DL, Schuyler PA, Dupont WD, Jensen RA, Plummer Jr WD, Simpson JF. Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study. Lancet 2003 361 (9352): 125–9.
  6. Cann SA, van Netten JP, van Netten C. Hypothesis: iodine, selenium and the development of breast cancer. Cancer Causes and Control 2000 (review) 11 (2): 121–127.
  7. Pizzorno JE, Murray MT. Textbook of Natural Medicine. Elsevier Health Sciences. p. 1371. 2012
  8. Gadducci A, Guerrieri ME, Genazzani AR. Benign breast diseases, contraception and hormone replacement therapy. Minerva Ginecologica 2012 64 (1): 67–74.
  9. Ghent WR, Eskin BA, Low DA, Hill LP. Iodine replacement in fibrocystic disease of the breast. Canadian Journal of Surgery. Journal Canadien De Chirurgie 1993 (Comparative study) 36 (5): 453–60.
  10. Stoddard II, Frederick R. Iodine Alters Gene Expression in the MCF7 Breast Cancer Cell Line: Evidence for an Anti-Estrogen Effect of Iodine. International Journal of Medical Sciences 2008 5: 189–96.
  11. Kessler JH. The effect of supraphysiologic levels of iodine on patients with cyclic mastalgia. The Breast Journal 2004 (Randomized Controlled Trial) 10 (4): 328–36.

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Last updated: 2019-06-28 10:02