What is Fibrocystic Breast Disease?
Fibrocystic breast disease is a non-cancerous condition of the breast, affecting millions of women around the globe. Certain hormones play a key role in how this disease works, how it is evaluated, and how it is treated. This condition is a type of benign breast disease, a broad term for non-cancerous conditions of the breast, including tumors, trauma, breast pain, and nipple discharge.
It’s important to know that these benign or non-cancerous conditions don’t necessarily increase the risk of breast cancer. However, under specific clinical and histopathological scenarios—how a disease appears under a microscope—there could be up to a 50% risk of developing breast cancer. Both benign and malignant, or cancerous, conditions of the breast can lead to a noticeable lump. Symptoms can also include skin dimpling, also called “peau d’orange,” thickening, pain, and nipple discharge.
The most common methods used by doctors to look for these symptoms are mammograms and ultrasound. These tests help them detect any unusual changes in the breast tissue.
The primary parts of the breast affected by fibrocystic changes are the breast’s stroma, ducts, and lobules during hormonal fluctuations. In women of reproductive age, glandular breast tissue is directly related to the cyclical increases in two hormones: estradiol and progesterone.
What Causes Fibrocystic Breast Disease?
Research has shown a strong link between the development of non-cancerous breast diseases and women who are undergoing estrogen or anti-estrogen treatments. Postmenopausal women who have taken both estrogens and progestins, types of hormones, for more than eight years are 1.7 times more likely to develop these benign breast lesions. According to a large scale study known as the Women’s Health Initiative, using estrogen and progestin together was linked to a 74% risk of benign (non-cancerous) breast disease. On the other hand, using anti-estrogens was found to reduce the likelihood of less severe proliferative (abnormal cell growth) breast diseases by 28%.
In analyzing these findings, the study design involved both prospective cohorts (groups of people studied over time) and nested case-control studies (types of observational studies). The studies that were considered for the analysis had at least 300 cases and included meta-analyses, which are statistical procedures for combining data from multiple studies. Table 1 in the original document details some of these findings, including relative risks which were estimated from standardized incidence ratios.
Additionally, Polycystic Ovary Syndrome (PCOS), a condition that typically causes irregular or no ovulation (the release of eggs from the ovaries) and excess androgen (a type of hormone), is evident in 5-10% of women of reproductive age. This syndrome is also connected to non-cancerous breast conditions because it can cause high estrogen levels and lack of ovulation.
Past research has drawn a connection between high estrogen levels and a lack of ovulation to benign breast conditions. The reason for this is the growth of glandular breast tissue, the type that can produce milk, is affected by the levels of estrogen and progesterone (another type of hormone) during disease processes. In other words, if these hormone levels are not in balance, it could lead to non-cancerous growths in the breast.
Risk Factors and Frequency for Fibrocystic Breast Disease
There’s a wide range in literature, suggesting that between 30% and 60% of all women may experience certain conditions. These conditions are most common in women between 30 to 50 years old.
- Fibroadenomas, a type of benign breast disease, is one of the most prevalent kinds of this issue.
- This condition, which involves abnormal growth in the breast ducts and stroma, represents 70 to 95% of all benign breast tumors.
- Typically, this situation is mainly seen in young women aged 17 to 20, but can even occur two years before the first menstrual cycle, around the age of 35.
Signs and Symptoms of Fibrocystic Breast Disease
Benign cysts are lumps in the breast tissue, chest wall or skin that can be easily moved around. These cysts feel rubbery to the touch. Any discomfort or tenderness is usually mild or altogether absent, unless the cyst is inflamed. Multiple cysts are often found when patients undergo further tests.
Different types of cysts include hyperplastic fibrous cysts, adenosis, and papillomatosis. These cysts are commonly found in the upper outer parts of the breast and in the central margins. The feel of these cysts can vary widely, from firm to softer, smaller cysts.
Fibroadenomas are another type of lump that occur in various sizes. These have a uniquely oval shape and clear boundaries. Just like cysts, fibroadenomas can be moved around and are typically found in multiple instances at once or over time.
Abnormal discharge from the nipple can be the result of ductal ectasia, intraductal papilloma, or in rare cases, carcinoma (cancer). Intraductal papilloma is identified by a small lump behind the nipple that causes a sudden, bloody discharge, while duct ectasia often results in a green, yellow, or clear discharge from multiple ducts.
Testing for Fibrocystic Breast Disease
“Triple testing” is a key process for diagnosing possible health concerns in women. This testing combination involves a physical exam, imaging like x-rays or ultrasound, and a surgical removal of a small piece of tissue (known as a biopsy) for further examination under a microscope.
In younger women under 30 who experience lumpiness in their breasts, doctors typically monitor these symptoms and schedule follow-up exams within two to three months. If the lump has changed over time, or if new symptoms appear, further tests may be needed to ensure there’s no serious health risk.
For women over the age of 30, if they notice thickening or lumpiness in their breasts, additional tests are suggested. These often include a mammogram – an x-ray imaging of the breasts, and ultrasound – a test employing high-frequency sound waves to create images.
Keeping a regular track of any changes over time is crucial. The growth of a lump or other visible changes like alterations in the skin or nipple needs to be caught early for effective treatment.
When it comes to diagnosing breast health issues in women over 35 who encounter specific, noticeable lumps, it’s important to separate cysts, which are fluid-filled sacs, from solid lumps. Imaging tests such as mammograms and ultrasound can help in this. If the cysts are complex, meaning they contain both liquid and solid elements, a biopsy is needed. When dealing with solid lumps, their testing involves guided core biopsy, which uses a specialized needle to remove a small tissue sample.
Core excision biopsy is a procedure in which a special spring-loaded needle is used to remove a sufficient amount of tissue to be examined and to understand its nature and characteristics.
Fine-needle aspiration (FNA) allows the collection of cell samples, which are then examined under a microscope by a cytopathologist, a specialist in studying diseases at the cellular level. But, FNA doesn’t always retrieve enough material to make a definitive diagnosis. So, in about one-third to one-half of cases, it is followed by a core biopsy.
Examining fluid from the nipple is not a very effective way to detect cancer—it works only 35% to 47% of the time. After all these tests, if the results are found to be non-cancerous, follow-ups consisting of physical exam, ultrasound, and a mammogram at a 6- to 12-month interval, are recommended.
In a Japanese study involving 156 patients who had a benign (non-cancerous) breast biopsy, about 13% needed a re-biopsy within two years. On the other hand, in a different study, no cancer developed amongst 104 patients regularly monitored over six-month intervals.
In yet another study, thousands of women in Japan went under routine ultrasound screening. Out of these, just one case of a tiny, early-stage invasive cancer was diagnosed in the following year. This result emphasizes the effectiveness of the triple-testing method and regular monitoring in maintaining breast health and catching any potential issues early.
Treatment Options for Fibrocystic Breast Disease
Fibrocystic breast changes can sometimes be managed by medication like metformin, that’s used to lessen the overgrowth of cells caused by certain hormones. However, these changes can also cause breast pain, known as mastalgia.
For breast pain, the first options to consider are to make lifestyle changes and to wear a supportive bra for comfort. It’s important to note that reducing caffeine doesn’t necessarily improve breast pain or fibrocystic breast changes. There’s no solid scientific proof to support this.
Painkillers like aspirin and ibuprofen can also be used to manage this pain. It’s been suggested that prostaglandin E and gamma-linolenic acid (GLA), which are found in evening primrose oil, might be able to reduce the sensitivity of the breasts at certain times in the menstrual cycle.
Even though the effectiveness of evening primrose oil is still not established by research, it might be worth trying if the pain refuses to subside with other treatments. It usually takes about 3 to 6 months to see any effects from using this.
If the pain is severe and interferes with daily activities for over six months, other medications like tamoxifen, bromocriptine, or danazol may be considered. These treatments typically need to be taken for several months due to the persistent and long-lasting nature of the symptoms.
If fluid is removed from breast cysts to relieve symptoms, this fluid usually doesn’t need to be tested, unless a physical lump continues to appear after the fluid is removed or the fluid is blood-stained. If any of these situations occur, the fluid should be tested.
Surgery might also be required for cysts that keep coming back even after fluid has been removed multiple times. Cysts that appear solid on ultrasound or that contain irregular cells when the fluid is tested might also necessitate surgical intervention.
What else can Fibrocystic Breast Disease be?
If a woman discovers a lump in her breast, it might be due to several reasons including:
- A lump in the breast
- A breast abscess, which is a collection of pus that forms due to infection
- Fibrocystic changes, which are noncancerous changes in the breast tissue
- Fibroadenomas, benign (not harmful) tumors in the breast
- Infections
- Trauma or injury to the breast
- Fat necrosis, the death of fatty tissue in the breast
- Papilloma, a noncancerous, wart-like growth
- Phyllodes tumor, a rare, usually benign lump that develops in the breast
- Breast ectasia, a condition where the milk ducts in the breast become blocked
What to expect with Fibrocystic Breast Disease
Lesions of the proliferative type carry a 1.3 to 1.9 times higher risk of cancer in both breasts.
If there is any increase in irregularly shaped calcium deposits – known as pleomorphic calcifications – on your mammograms, it’s recommended to schedule follow-ups every six months. This is to ensure any potential harm is caught and addressed early.
Possible Complications When Diagnosed with Fibrocystic Breast Disease
If a random sample is taken from a fibrocystic breast condition, it can often show fibrosis (scar-like tissue) if examined with a Magnetic Resonance (MR) guided procedure. If the results are inconsistent, further examinations might be needed for confirmation.
Preventing Fibrocystic Breast Disease
Here are some useful tips for preventing and treating fibrocystic breast disease:
* Consider using pain killers that you can buy without a prescription, like acetaminophen or ibuprofen. These can help manage the pain.
* If your breasts are particularly painful, you can apply either warm or cool compresses.
* Wearing a comfy, snug bra can provide support and help relieve some of the discomfort.
* Some women find that limiting the amount of salt or fat in their food improves their symptoms, so that could be something to try.
* Oral contraceptives—commonly known as birth control pills—could help too.
There might also be a connection between this condition and your thyroid levels. Iodine could be suggested by your doctor.
Other natural supplements like vitamin E, evening primrose oil, and B vitamins might also be beneficial for some women. However, always speak to your doctor before beginning any new supplements or treatments. They can help guide your decision and ensure the treatment is safe and suitable for your specific needs.