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Fibrocystic Breast Disease
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Fibrocystic breast disease is a breast condition made of scar-like tissue that makes the tissue feels lumpy or ropy in nature. This tissue is referred to as nodular or glandular tissue of the breast. Breast fibrocystic disease is very common. Up to half of all women have some degree of fibrocystic disease. Because it is so common, some doctors refer to it as just "fibrocystic breasts" because it isn't a disease at all.
The major symptoms seen in fibrocystic breast disease are pain in the breasts, tender breasts and a lumpy feeling to the breasts. The symptoms are usually worse during menstruation. The size of the breast lumps tend to vary with the time of the menstrual cycle. There can be a green or brown discharge that isn't blood from the nipples. There are changes occurring in both breasts at the same time. The breast changes are worse from the time of ovulation until the time of the menses. The disease is most common when women are in their 20s to 50s. It tends to disappear after menopause unless a woman takes estrogen replacement therapy.
Most fibrocystic breast changes are completely normal and require no medical intervention. You should seek medical care if you have a new lump that lasts past the time of your period or if a previous breast lump that seems to suddenly change.
No one knows exactly why some women get fibrocystic breast disease. The growth of the nodules and scar tissue is related to the use of estrogen or the presence of estrogen in the body. Under the microscope the breast tissue involved in fibrocystic breast disease shows fluid filled round cysts or sacs, a lot of scar tissue (known as fibrosis), overgrowth of the cells that line the milk ducts and overgrowth of enlarged breast lobules.
Fibrocystic breast disease doesn't increase your chances of getting breast cancer unless the cells under the microscope have atypia or changes suspicious for precancerous lesions. Women with atypia have a higher chance of getting breast cancer. Atypia is found when a breast biopsy is done to evaluate a suspicious lump in the breasts. It is not routine to do biopsies on all women with fibrocystic breast disease.
Certain tests are available to check for breast changes in fibrocystic breast disease. Doctors will do a clinical breast exam to check for scar tissue or lumps in the axilla or armpit. The exam should be done both before and after a period. A mammogram will show thickened and dense breasts and may show cysts in the breast. An ultrasound can detect cysts on the breasts that are able to be aspirated with a fine needle, especially if they hurt or are persistent. Fluid filled cysts can be differentiated from solid cysts, which may be scar tissue or fibrocystic disease.
A breast biopsy is a surgical test that takes a small sample of the tissue of the breast so that it can be examined under the microscope. It can be the definitive diagnosis of fibrocystic breast disease and can tell if there is atypia or not.
No treatment is needed if the disease is mild and relatively asymptomatic. As it does not turn into cancer, mammograms can be done at routine intervals. If a woman has severe pain or very large cysts, there can be fine needle aspiration of the breast cysts under ultrasound guidance if necessary. The entire cyst can be removed surgically as well.
Some women just need pain relief. Over the counter medications like Aleve, ibuprofen and Tylenol can control the pain. Birth control pills lower the level of cycling estrogen so that the fibrocystic breast disease is controlled. A new medication called Danazol is similar to male sex hormones so that severe pain in the breast can be controlled. It carries the side effects of acne and excessive body hair.