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Fibrocystic breast disease

Definition

Fibrocystic breast disease is a commonly used phrase to describe painful, lumpy breasts. The word "disease" makes women worry that their breasts are abnormal, but this is not really a disease.

Some health care providers use the phrase "fibrocystic change" because it sounds less worrisome to the patient.

Alternative Names

Mammary dysplasia; Diffuse cystic mastopathy; Benign breast disease

Causes, incidence, and risk factors

During a woman's menstrual cycle, the breasts are affected by hormones made in the ovaries. These hormones can cause the breasts to feel swollen, lumpy, and painful. After menopause, these changes in the breasts usually stop happening.

There is no definite cause of painful, lumpy breasts. Some women feel that eating chocolate, drinking caffeine, or eating a high-fat diet can cause their symptoms, but there is no clear proof of this.

Fibrocystic changes in the breast with the menstrual cycle affect over half of women, and most commonly start during their 30s. Women who take hormone replacement therapy may have more symptoms. Women who take birth control pills have fewer symptoms.

Symptoms

Symptoms are usually worse right before the menstrual period, and then improve after the period starts.

You may feel pain or discomfort, usually in both breasts.

• Breast pain commonly comes and goes, but it can last through the whole cycle.
• Your breasts may feel full, swollen, and heavy. You may feel the symptoms near your armpit.

Your breasts may feel thick or lumpy.

• You may notice a lump in the same area that becomes larger before your menstrual cycle, and then shrinks afterward.
• The lumps will move if you push on them and not feel stuck or fixed to anything.

Some women will have discharge from the nipple. If the discharge is clear, red, or bloody, talk to your health care provider right away.

Signs and tests

If you have any concerns about your breasts, your health care provider will examine you.

Ask your health care provider how often you should have a screening mammogram. Usually women should have a yearly mammogram beginning at age 40. If there are any worrisome lumps, you might have a diagnostic mammogram, ultrasound, or both.

Treatment

If you have painful breasts, the following may help:

• Take medication such as acetaminophen or ibuprofen
• Use heat or ice on the breast
• Wear a well-fitting bra

Although some women believe that eating less fat, caffeine, or chocolate helps with their symptoms, there is no good evidence that this helps.

Vitamin E, thiamine, magnesium, and evening primrose oil are not harmful in most cases, but they have not shown any benefit in most studies. Before taking any medication or supplement, be sure to talk with your health care provider.

Most women are not as worried about their symptoms if their breast exam and imaging tests are normal. Remember that most of these symptoms will go away over time.

Support Groups

Expectations (prognosis)

Fibrocystic breast changes do not increase your risk of breast cancer. Symptoms usually improve after menopause.

Complications

Women who have very lumpy breasts may be more difficult to examine. Mammograms may be harder to interpret. Therefore, early cancer might be more difficult to detect.

Calling your health care provider

Call your health care provider if:

• You find any new or different lumps on your breast self exam
• You have a new discharge from the nipple or any discharge becomes bloody or clear
• You have any redness or puckering of the skin, or flattening or indentation of the nipple

Prevention

There is no proof that anything you do or don't do will prevent symptoms.

References

Miltenburg DM, Speights VO Jr. Benign breast disease. Obstet Gynecol Clin North Am. 2008;35:285-300.

Valea FA, Katz VL. Breast diseases: diagnosis and treatment of benign and malignant disease. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa. Mosby Elsevier; 2007:chap 15.