What is fibrocystic breast condition?

Causes and Symptoms

Fibrocystic breast change is the most common type of noncancerous breast condition. Its incidence rate in females is estimated to be more than 60 percent. Therefore, although once classified as a disease, it is now considered to be a normal physiologic variant. It occurs more commonly in females between the ages of thirty and fifty. Its cause is hypothesized to be an excess of circulating estrogen.

Female breast development begins at puberty, triggered by an increase in estrogen level. The four main components of the mature female breast are adipose tissue (fat), ducts (milk ducts and collecting ducts), groups of lobules (referred to as lobes), and connective tissue consisting of a matrix of suspensory ligaments (strong fibrous bands). Each breast contains approximately fifteen to twenty lobes that radiate from the nipple area in a spokelike pattern, with the highest distribution being in the upper outer quadrant of each breast. Breast lobe consistency tends to be firm and slightly nodular, but may vary by breast or by individual, while breast fat is almost always soft. Breasts of younger women primarily consist of glandular tissue. Aging changes result in shrinkage of glandular tissue and replacement with fat, which causes the breast to become softer and less well supported.

Symptoms of fibrocystic breast change result from hormone-induced alterations in the stromal (deeper layer) tissue, glands (lobules) and ducts within the breast. Those changes include possible fibrosis (formation of fibrous tissue like that of scar tissue ) and/or formation of cysts, as fluid accumulates inside the glands. Small amounts of accumulated fluid result in microscopic cysts (microcysts); larger amounts of accumulated fluid result in palpable macrocysts that may grow to an inch or more in size. The two major types of breast cysts are type I, characterized by high concentrations of androgen and estrogen conjugates, epidermal growth factor, and potassium and low concentrations of sodium and chloride; and type II, characterized by high concentrations of sodium and chloride and lower concentrations of androgen and estrogen conjugates, epidermal growth factor, and potassium.

Symptoms of fibrocystic breast change include dense and irregular lumpiness in breast tissue, discomfort, dull pain, localized edema (swelling) and feeling of fullness, tenderness, and possible nipple discharge. Symptoms may vary in intensity throughout the menstrual cycle, peak just prior to menstruation, and range from mild to severe. Symptoms and signs of fibrocystic change may remit after menopause because of decreased amounts of glandular tissue in the breast and decreased levels of estrogen and progesterone.

Treatment and Therapy

Treatment is not for the condition itself but rather for the symptoms. For those women who are asymptomatic, no treatment beyond monitoring via breast self-examination is required. For those women who are symptomatic, treatment options range from use of a properly fitting support bra to use of hormone therapy—via oral contraceptives, androgens, or tamoxifen (a drug that blocks estrogen activity)—which has the potential to cause side effects. Cysts may require fine needle aspiration or ultrasonogrphy to determine whether a biopsy is needed.

Anecdotal evidence suggests that avoidance of methylxanthine-containing items such as coffee, tea, chocolate, and certain sodas; reduction in sodium intake; use of vitamin supplements; and/or use of herbal supplements may ameliorate symptoms caused by fibrocystic changes. However, these findings have not been clinically proven.

Perspective and Prospects

The preferred term for fibrocystic breast disease is now “fibrocystic breast changes” or “fibrocystic breast condition.” It may also be referred to as benign breast disease, benign breast lesions, diffuse cystic mastopathy, mammary dysplasia, or nonmalignant breast neoplasms. Cohort studies of risk factors associated with this condition have been conducted for up to thirty years. A family history of fibrocystic breast condition is believed to be the highest risk factor. Consumption of a high-fat diet may be a cofactor. No association has been found between incidence rate of this condition and alcohol consumption or cigarette smoking.

Breast tissue changes as a result of fibrocystic breast condition may make breast examination and mammography interpretation more difficult. However, while presence of type I macrocytes—a fibrocystic change characterized by high concentrations of androgen and estrogen conjugates, epidermal growth factor, and potassium—may be linked to a moderate increase in breast cancer risk, most fibrocystic changes associated with fibrocystic breast condition (fibrosis, microcysts, and type II macrocysts) are not associated with an increased risk of breast cancer.

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