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Fibrocystic Changes

by Mary Ann Kosir, MD

Fibrocystic changes (formerly called fibrocystic breast disease) include breast pain, cysts, and lumpiness that are not due to cancer.

Most women have some general lumpiness (including fibroadenomas) in the breasts, usually in the upper outer part, near the armpit. Many women have this kind of lumpiness, breast pain, breast cysts, or some combination of these symptoms—a condition called fibrocystic changes.

Normally, the levels of the female hormones estrogen and progesterone fluctuate during the menstrual cycle. Milk glands and ducts enlarge and breasts retain fluid when levels increase, and the breasts return to normal when levels decrease. (These fluctuations partly explain why breasts are swollen and more sensitive during a particular time of each menstrual cycle.) Fibrocystic changes may result from repeated stimulation by these hormones. The following increase the risk of these changes:

  • Starting to menstruate at an early age

  • Having a first baby at age 30 or later

  • Never having a baby

Other breast disorders, such as infections, can cause fibrocystic changes.

The lumpy areas may enlarge, causing a feeling of heaviness, discomfort, tenderness to the touch, or a burning pain. The symptoms tend to subside after menopause.

Most fibrocystic changes do not increase the risk of breast cancer, but a few of them do, although only slightly. Changes that increase the risk of breast cancer include the following:

  • Moderate or severe hyperplasia: The cells that line the milk glands or ducts multiply too much, and their arrangement may become distorted (called atypical hyperplasia).

  • Sclerosing adenosis: The number of milk glands increases, and scar tissue forms, distorting the arrangement of milk glands.

  • Papilloma: Noncancerous, finger-like tumors develop in the cells that line the breast ducts.

  • Complex fibroadenoma: The cells that line the breast ducts and connective tissue in the breasts form a benign tumor with many types of changes in tissue, such as sclerosing adenosis, hyperplasia, and papillomas.

Typically, a sample of tissue from an area that appears abnormal or different from other areas must be removed and examined under a microscope (biopsy) to rule out cancer. Sometimes the sample can be removed with a needle, but sometimes it must be removed surgically.

Fibrocystic changes may make the breasts appear dense on mammograms and thus may make breast cancer more difficult to detect.

Treatment

If there is only one lump or if one lump appears to be different from other lumps, the lump may be removed.

No specific treatment is available or required for fibrocystic changes, but certain measures may help relieve symptoms:

  • Wearing a soft, supportive bra, such as an athletic bra

  • Taking pain relievers such as acetaminophen

Sometimes cysts are drained, but they may recur (see Breast Cysts).

If symptoms are severe, doctors may prescribe drugs, such as danazol (a synthetic male hormone) or tamoxifen (which blocks the effects of estrogen ). Because side effects can occur with long-term use, the drugs are usually given for only a short time. Tamoxifen has fewer side effects than danazol.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • CRINONE
  • NOLVADEX
  • No US brand name
  • TYLENOL