Fibrocystic breast changes can be broadly defined as benign (noncancerous) changes in the breast. Originally referred to as fibrocystic breast disease, fibrocystic changes alone are no longer considered a disease, in part because they are so common. In fact, the National Institutes of Health (NIH) reports that more than 60 percent of premenopausal women will experience fibrocystic breast changes over the course of their lifetime. The most common breast changes that women experience include:

• Nipple discharge
• Lumpiness
• Cysts (sacs filled with fluid)
• Swelling
• Breast pain or tenderness

These changes may create a temporary discomfort that peaks as a woman’s menstrual cycle approaches. However, some women experience more intense changes that can result in severe or even debilitating pain.

The majority of breast conditions are benign and not an indication of cancer. In fact, fibrocystic breast changes do not appear to increase a woman’s risk of developing breast cancer. When a patient seeks medical care for pain, tenderness or a lump that may have been discovered during a monthly breast self-examination, fibrocystic breast changes are often responsible.

Although a clinical breast examination may be adequate to diagnose fibrocystic changes in a woman’s breast, additional tests such as a mammogram, breast ultrasound or biopsy may be necessary to definitely rule out cancer.

Although strongly linked to the fluctuations of hormones during a woman’s menstrual cycle, the causes of fibrocystic breast changes are unknown. Therefore, treatment typically focuses on minimizing the discomfort associated with any breast changes, and options range from lifestyle changes to prescription medication to oral contraceptives. In some cases (e.g., fibroadenomas), surgical removal of the benign tumor may be recommended.

Fibrocystic breast changes are any benign (noncancerous) changes within the breast. According to estimates by the National Institutes of Health (NIH), more than 60 percent of all women experience fibrocystic breast changes during their lifetime. Most fibrocystic changes occur in premenopausal women.

Originally called fibrocystic breast disease, fibrocystic breast changes are not a disease at all. Rather they are a wide variety of symptoms that are closely linked to fluctuations within a woman’s hormone levels. Also called benign breast conditions or benign breast changes, fibrocystic breast changes generally do not appear to increase a woman’s risk of developing breast cancer.

Some of the more common breast changes include:

• Nipple discharge
• Cysts (sacs filled with fluid)
• Swelling
• Pain (mastalgia)
• Tenderness
• Lumpiness (nodularity)

Numerous small cysts and possibly an increasing level of breast pain are considered common once a woman reaches her 30s. Larger cysts can also develop, but this is uncommon in women before the age of 35. Because these changes are associated with a woman’s menstrual cycle, the condition is most often found in women between the ages of 30 and 50. It is rare in postmenopausal women because they no longer menstruate and produce fewer hormones.

During a woman’s menstrual cycle, the breasts respond to the ebb and flow of the hormones estrogen and progesterone. When hormone levels rise immediately prior to and during menstruation, the blood vessels in the breast swell and the alveoli and mammary ducts expand. This in turn causes increased cell growth.

This cell growth within breast glands prevents secretions from draining properly. In addition, possible overgrowth of fibers within the breast tissue may block the ducts. These two actions can lead to the development of fluid-filled cysts. At the same time, fluid retention within the breast tissue can cause the breasts to swell.

Following menstruation, this process is reversed. After years of repeating this cycle, it is possible for areas of dense, fibrotic tissue to develop within the breast. However, the precise causes of fibrocystic breast changes are unknown.

Fibroadenomas, which contain both glandular and fibrous tissue, are another type of benign change in the breast. These noncancerous tumors are most commonly found in young women. From the teenage years into their 20s, women can develop single or multiple fibroadenomas in either one or both breasts.

Fibroadenomas have no known cause. However, they may be linked to a diet that is high in fat. They are also linked to hormonal levels as most fibroadenomas persist during the reproductive years. Excess formations of lobules, which are the milk-producing glands in the breast, often lead to fibroadenomas. Many physicians advocate the removal of fibroadenomas in certain situations, as the tumors do not resolve on their own and may continue to grow, particularly during pregnancy and breastfeeding.

Benign breast disease has been studied at great length as a risk factor for breast cancer. A study published in a July 2005 issue of the New England Journal of Medicine reported that certain factors affect a woman’s chance of developing breast cancer after being diagnosed with benign breast disease.

In the study, researchers discovered that proliferative benign lesions (those that affect the inner lining of the milk glands) placed a woman at higher risk for breast cancer. Nonproliferative lesions did not increase the woman’s risk. In addition, a woman’s family history of breast cancer increased the risk.

In the future, researchers hope that women with benign breast disease will be placed in a high-risk or low-risk category depending on these factors. Additional research is necessary to definitively understand the link between benign breast disease and breast cancer.

The causes of fibrocystic breast changes are not completely understood. However, these changes and the resulting symptoms are often linked to fluctuations in a woman’s hormone levels. This is evidenced by the fact that fibrocystic breast changes vary in relation to a woman’s menstrual cycle. During menopause these symptoms normally disappear unless the woman chooses to take hormone replacement therapy (HRT).

In addition, there is a lower incidence of fibrocystic breast changes among women who take oral contraceptives. This is yet another clue that fibrocystic breast changes are hormone-related. In fact, birth control pills are sometimes prescribed to treat fibrocystic changes. This common form of contraception suppresses the body’s natural hormone production by replacing it with a controlled amount of synthetic female hormones, usually both estrogen and progesterone.

Although the reports are inconclusive, diet may also play a role in the occurrence or severity of fibrocystic breast changes. Some physicians may recommend that a woman reduce her dietary fat intake, as well as her caffeine consumption to lower the risk of developing the condition. Still, the main cause of fibrocystic breast changes appears to be a hormonal imbalance involving estrogen and progesterone.  

There are many signs and symptoms commonly associated with fibrocystic breast changes, especially breast pain. Often, the pain that is associated with fibrocystic breast changes radiates from the breast up into the shoulders or upper arms. At times, it can be localized, as in the case of a rapidly expanding cyst. Some of the more common breast changes include:

• Nipple discharge, possibly including sensation changes or even itching
  
• Cysts (sacs filled with fluid) that form and then resolve within a few weeks
  
• A dense, cobblestone consistency to the breasts
  
• Full feeling in breasts with tenderness or swelling
  
• Breast pain (mastalgia) in one or both breasts
  
• Lumpiness (nodularity)
  
• Breast engorgement (painful overfilling of breasts with milk)

These symptoms can range from mild to debilitating. Many women report that fibrocystic breast changes are cyclical, with a worsening of symptoms as the menstrual cycle approaches.

Symptoms of fibroadenomas can differ from other types of benign breast changes. The most common symptoms include:

• A moveable, painless lump that feels firm or rubbery
  
• A lump that may grow larger, particularly during pregnancy
  

Although rare in older women, fibroadenomas often get smaller after menopause unless the woman takes hormone replacement therapy.

Many women first identify fibrocystic breast changes when they perform their monthly breast self-examination. Other times, these changes are noticed during a bath or shower, or they are detected by a physician during a clinical breast examination. These changes may be due to:

• Pregnancy
• Menstrual cycle
• Aging
• Menopause
• Birth control pills or other hormones

Any unusual changes in a woman’s breast, particularly lumps, cysts or nipple discharge, should be evaluated by a qualified physician.

The result may be a diagnosis of fibrocystic breast changes, a benign (noncancerous) breast condition. To rule out a more serious condition, such as breast cancer, the physician will take a detailed medical history of the patient and review the symptoms she is experiencing.  A physical examination will be completed with focus on the breasts and surrounding areas, including the lymph nodes.

The clinical breast exam, which takes about five minutes, is performed by a physician who feels the breasts with the pads of the fingers. Using this method, the physician checks the entire breast area, including under the arms, around the collarbone area and nearby lymph nodes. To obtain more detailed information, the physician may order a mammogram.

If the results from the mammogram are inconclusive, a physician may send the patient for a breast ultrasound. The ultrasound test works by sending and receiving high-frequency sound waves to create images of internal organs or tissues. Sound waves pass through the tissues of the area being examined. These sound waves are recorded and displayed on a computer screen or television-type monitor or printed out for a physician to review. They are useful to help differentiate fluid-filled lumps from solid lumps

If the clinical breast exam, mammogram or ultrasound shows a simple, fluid-filled cyst, then a needle aspiration is performed. This procedure involves inserting a needle into the center of the lump or cyst and withdrawing the fluid contained inside of it. Once the fluid is withdrawn, the cyst typically disappears.

If the cyst does return following repeated aspirations, or if it does not seem normal in appearance, the physician may perform a biopsy to rule out cancer. This is particularly true for fibroadenomas because they appear as a firm lump. A biopsy is the removal of cells or tissues of concern so that they can be viewed under a microscope by a pathologist. The pathologist will determine whether or not the cells are benign, precancerous or cancerous.

However, breast masses shown on imaging tests that are diagnosed as "probably benign" may be safely managed with ultrasound follow-up rather than biopsy, according to a new study. The American Cancer Society reports that 80 percent of breast lesions biopsied are found to be benign.

The treatment and prevention of fibrocystic breast changes are limited, and range from lifestyle changes to medication. Most treatments focus on minimizing the discomfort associated with any breast changes. Many physicians will recommend that women who have fibrocystic breast changes perform monthly breast self-examinations and note any changes.

In addition, some physicians may suggest that women do the following:

• Wear a firm bra with adequate support
• Take oral contraceptives to alleviate symptoms
• Limit or avoid caffeine consumption
• Reduce dietary fat and salt intake
• Use over-the-counter pain medications
• Take vitamin E or B-6 supplements
• Take evening primrose oil supplements
• Use mild diuretics (only for severe cases)
• Undergo a needle aspiration of a cyst (if necessary)
• Have lumps in the breast surgically removed

Some supplements and herbal preparations are considered controversial. Patients are advised to speak with their physician prior to using these methods.

In addition to over-the-counter pain relievers, or possibly oral contraceptives, a few patients may be prescribed a synthetic drug that is similar to the male hormone testosterone. Recommended use of this medication is rare because the side effects are severe, including weight gain, growth of facial hair, acne, fertility problems, nausea, dizziness, hot flashes and possible menstrual irregularities.

In very rare cases, severe fibrocystic breast pain fails to respond to other treatments and the pain and discomfort reaches debilitating levels. In such cases, a bilateral mastectomy (the surgical removal of both breasts) may be recommended, although this is considered extreme.

In the case of fibroadenomas, another type of benign change in the breast, many physicians advocate the surgical removal of the tumors. This is because fibroadenomas do not resolve by themselves and may continue to grow, particularly during pregnancy and breastfeeding.

Fibrocystic breast changes do not appear to be associated with an increased breast cancer risk; however, this area continues to be studied. Certain benign lesions may have a higher risk of breast cancer, especially if the woman has a history of breast cancer in her family. Some women with benign breast changes may require additional screening or follow-up care. Fibrous or lumpy breasts can make it more difficult to detect a benign (noncancerous) or malignant (cancerous) tumor. If a woman has a family history of cancer, this condition will require closer observation. A woman should discuss the need for any additional screening tests with her physician.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about fibrocystic breast changes:

1. Are my breast changes normal?
   
   
2. What could be causing my breast changes?
   
   
3. What types of tests may be performed to determine the cause of my breast changes?
   
   
4. Will my breast changes require treatment, and if so, what type of treatment?
   
   
5. Can I improve my condition by wearing a firmer bra or making dietary changes?
   
   
6. Do these changes place me at higher risk for breast cancer?
   
   
7. How do I know if a lump is abnormal?
   
   
8. Will the changes affect my ability to breastfeed?
   
   
9. Do fibrocystic changes get worse over time?
   
   
10. Which medications can help alleviate my discomfort?