Overview of Fibrocystic Breast Disease

Benign Changes in Your Breast Tissue

Evening primrose oil capsules and flowers
Evening primrose in capsule form.  Creativ Studio Heinemann/Getty Images

Fibrocystic breast disease isn't a disease at all, but rather a description of breast tissue that has a lumpy or rope-like texture (nodular, glandular) but is otherwise perfectly healthy. In fact, the medical community is phasing out the word "disease" when referring to such breast tissue. While it may be unsettling to notice areas of thick or bumpy breast tissue, true fibrocystic breasts changes are largely due to hormones and rarely due to breast cancer.

Fibrocystic changes affect more than half of all women at some point in their lives, according to the Mayo Clinic.

Symptoms

Many women with fibrocystic breasts have no symptoms beyond noticing that their breasts feel different to the touch in some areas. That said, those who experience other symptoms often find the unpleasant.

The most common symptoms of fibrocystic breasts are:

  • Lumpy, rope-like texture: If you were to look at fibrocystic tissue under a microscope you would likely see several components that contribute to this, including round or oval-shape cysts filled with fluid; fibrous tissue that resembles scar tissue (fibrosis); hyperplasia (overgrowth) of cells lining the milk ducts and milk-producing lobules of the breast; and enlarged breast lobules (adenosis). 
  • Swelling
  • Tenderness
  • Generalized pain

Frequently, these symptoms worsen just before a woman's menstrual cycle and lessen near the end. The actual size of individual lumps may fluctuate with the menstrual cycle as well. Typically, the lumps aren't attached to surrounding tissue but will move slightly when manipulated. 

Some women with fibrocystic breasts experience a greenish or dark brown nipple discharge that's free of blood and tend to leak without pressure or squeezing. There also can be pain in the armpit.

While it should be reassuring to know that not all changes to your breast are worrisome, if you notice thickened areas or changes in texture, it's still a good idea to see your doctor to make sure that they are indeed due to fibrocystic breast disease, as you suspect. Bloody nipple discharge can be a sign of breast cancer; see a doctor immediately if you encounter this symptom.

Causes

What spurs breast tissue to develop the lumpy, tender, swollen areas that are characteristic of fibrocystic changes isn't fully understood. However, experts agree that reproductive hormones are closely involved. Estrogen is particularly likely to play a part. 

Note that fibrocystic breasts are most common in women between ages 20 and 50 or so—in other words, those who are still getting their periods. However, postmenopausal women who are on hormone therapy may experience fibrocystic breast changes due to estrogen replacement.

Diagnosis

According to the American Cancer Society (ACS), most women notice changes in their breasts (including symptoms that could indicate cancer) during activities such as bathing or dressing. For this reason, the ACS says, "Women should be familiar with how their breasts normally look and feel and report any changes to a healthcare provider right away." This type of vigilance is called breast self-awareness and is preferred over breast self-exams by the ACS, the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force, among others, based on lack of evidence that regular BSEs are beneficial.

Whether you choose to practice breast self-awareness or do BSEs (or both), you may find it difficult to distinguish lumps or bumps due to fibrocystic changes from potential tumors. It's important to remember, though, that the majority of breast lumps aren't cancerous. However, all breasts lumps must be investigated to rule out breast cancer and/or to begin immediate treatment if breast cancer is diagnosed.

This typically is done with a mammogram or ultrasound. It's sometimes difficult to tell the difference between a fibrocystic breast symptom and a potentially cancerous lump or growth on a regular mammogram and so an ultrasound may be the preferred method for diagnosing changes that are felt or that show up on a routine mammogram, according to the ACS. Women with dense breasts often are ordered to have both tests regularly.

When screening and/or testing reveal that a lump may be a fluid-filled cyst, sometimes a doctor will choose to do a fine-needle aspiration, in which a thin, hollow needle is used to extract the fluid.

If any of these tests are inconclusive—that is, a doctor still isn't certain that cancer can't be ruled out as the cause of lumps or other changes in breast texture—then a biopsy may be necessary. Most women with fibrocystic breasts will not have abnormal breast cells when a biopsy is performed.

Treatments

If your breasts are not bothering you, there is no need to treat fibrocystic breast disease. However, if you experience related discomfort, there are several options to consider.

Try a Different Bra

You may get relief from extremely painful breasts by wearing a bra that provides more support. Being fitted for a bra by a specialist is an ideal way to find one that's the right size and shape for you. If the band is too tight or the cup is too small, the fabric or underwire (if the bra has one) may be putting pressure on your breasts. If you play a sport or spend a lot of time working out, you may want to invest in a good sports bra as well. Consider buying an extra one to wear to bed at night during periods when your breasts are extra sensitive.

Apply Heat

This sometimes can help reduce pressure and swelling. Use a regular heating pad or make your own using a tube sock and rice.

Decrease Your Estrogen Intake

If you're postmenopausal and taking estrogen, talk to your doctor about reducing your dose or stopping hormone therapy altogether. It also may help to decrease sources of estrogen from your diet, such as commercially raised meats which sometimes contain excessive amounts of hormones.

Consider Medication

Over-the-counter mon-steroidal anti-inflammatory drugs (NSAIDS) such as Tylenol (acetaminophen) and Advil or Motrin (ibuprofen) may help ease soreness caused by fibrocystic breast changes. Take as directed or ask your doctor what type and dose of NSAID might work best for you. 

Prescription oral contraceptives may help to regulate levels of hormones that are linked to fibrocystic breast changes, helping to reduce or prevent them. The American Cancer Society also states that birth control pills are sometimes prescribed for pain related to fibrocystic breast changes and that tamoxifen and androgens also may be used, but only if symptoms are severe as these drugs can have serious side effects.

Consider Supplements

There's preliminary research showing that vitamin E might help relieve breast pain that comes and goes in accordance with menstruation. One study found that 200 international units (IU) of vitamin E taken twice daily for two months improved cyclic breast pain (although there were no additional benefits to taking vitamin E after four months of use).

Evening primrose oil contains an omega-6 fatty acid called gamma-linolenic acid that may make breast tissues less sensitive to hormonal changes. You can find it in drugstores and health food stores, usually in capsule form.

Other research suggests fish oil, another source of essential fatty acids, also may help reduce pain associated with fibrocystic breasts changes.

Change Your Diet

Although there's little-to-no research to support a link between diet and fibrocystic breasts, anecdotal reports hint that the following changes may help relieve symptoms. Together, they represent an overall nutritionally-smart approach to eating. At the very least, trying any or all of them will add up to general health and well-being.

  • Cut out (or cut down on) caffeine. This means coffee, tea, soda, energy drinks, and chocolate.
  • Lower your intake of added sugar
  • Lessen your sodium intake.
  • Limit the amount of fat in your diet.
  • Increase fiber intake to 30 grams a day.
  • Eat more fruits, vegetables, and whole grains.

Surgery

In extreme cases, cysts or lumps that cause pain can be removed. Options include:

  • Fine-needle aspiration, in which a hair-thin needle is inserted through the breast and into the cyst in order to drain the fluid from it. This will cause the cyst to collapse and relieve pain; it can also confirm that the lump is a cyst and not a tumor.
  • Surgical excision: A cyst that's persistent—in other words, it won't collapse even after being aspirated several times—may need to be completely removed.
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