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 in the breasts, usually in the upper outer part, near the armpit. In the United States, 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 progesteroneSome Trade Names
CRINONE ENDOMETRIN
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 these 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. These changes typically require a biopsy to rule out cancer and may make the breasts appear dense on mammograms. They include the following:

• 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.
• 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.

Fibrocystic changes may make breast cancer more difficult to detect.

Treatment

Lumps, usually only one lump at a time, may be removed, and a biopsy may be done to rule out cancer. Sometimes the biopsy sample can be withdrawn with a needle, but sometimes it must be removed surgically.

Sometimes cysts are drained, but they tend to recur. No specific treatment is available or required, but certain measures may help relieve symptoms:

• Wearing a soft, supportive brassiere
• Taking pain relievers

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.

Last full review/revision November 2008 by Victor G. Vogel, MD, MHS