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Fibrocystic Breast Disease

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Fibrocystic Breast Disease

Basics

Description

Any suspicious breast mass should be referred to a breast surgeon.

Evening primrose: 1-3 g/day

Women rarely undergo breast reduction surgery for relief of symptoms.

Reduction in caffeine intake has never been proven to decrease the incidence of fibrocystic changes.

A properly fitting bra may help reduce pain and swelling associated with fibrocystic breasts.

1Miltenburg DM, Speights VO. Benign breast disease. Obstet Gynecol Clin North Am. 2008;35(2):285-300. [View Abstract]2Santen R, Mansel R. Current concepts: Benign breast disorders. N Engl J Med. 2005;353:275-285. [View Abstract]

1Hartmann LC, Sellers TA, Frost MH. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353:229-237. [View Abstract]2Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002;29(1):1-20. [View Abstract]3Smith M, Kent K. Breast concerns and lifestyles of women. Clin Obstet Gynecol. 2002;45:1129-1139. [View Abstract]4http://nccam.nih.gov/health/eveningprimrose/

27431007 fibrocystic breast changes (finding)

  • Benign breast state that may include the signs and symptoms of swelling, pain, lumpiness, and nipple discharge.
  • Fibrocystic breast change is the histologic term for the benign variations in breast tissue.
  • Fibrocystic breast is the radiographic term for dense breast tissue found on imaging.
  • There is a natural variation in the morphology and histology of the female breast through the life stages.
  • After age 55, there is a greater risk of cancer associated with the signs and symptoms of fibrocystic breasts.

Epidemiology

  • Estimated 50-60% of all women
  • Lower in women taking birth control pills

Risk Factors

  • Atypical histologic features
  • Increased age at biopsy
  • Family history for breast cancer

Pathophysiology

  • The female breast is made up of ducts, lobules, and stroma.
  • Cyclical and age-related changes to these tissue types are manifested as benign fibrous changes and cysts.

Associated Conditions

  • Cyclical mastalgia (pain occurring prior to onset of the menstrual cycle)
  • Benign breast discharge

Diagnosis

History

  • The signs and symptoms of fibrocystic breast disease fluctuate with menstrual cycle and are typically worse just prior to menstruation.
  • Patients may describe swollen, tender, and lumpy breasts.

Physical Exam

  • The upper outer breast is the area most typically associated with fibrocystic changes.
  • In a woman <35 years of age without a focal nodule, repeating an exam after menstruation may be of value, as vague nodularity may have decreased or resolved (1)[A].
  • Any lump, mass, or nipple discharge deemed suspicious for malignancy should be evaluated as per standard of care.

Tests

  • Mammography
  • Ultrasound
  • MRI
  • Biopsy or aspiration
  • Atypical ductal hyperplasia on aspiration or biopsy requires excision (2)[A].

Differential Diagnosis

  • Simple cysts (benign)
  • Fibroadenoma (benign)
  • Malignancy
  • Extramammary causes of breast pain include myocardial ischemia, pneumonia, irritation of the pleura, esophageal spasm, costochondritis, rib fracture, and shingles (1)[A].

Treatment

Medication

  • Treatment for the pain associated with fibrocystic changes include:Acetaminophen, aspirin, and other NSAIDs
  • Acetaminophen, aspirin, and other NSAIDs
  • Tamoxifen: 10 mg/day for 3-6 months
  • Danazol: 200 mg/day (during luteal phase only)

Additional Treatment

Complementary and Alternative Medicine

Surgery

Ongoing Care

Follow-Up Recommendations

  • Assurance
  • Re-examination
  • For focal lesions, serial ultrasounds every 6 months for 2 years and then once yearly thereafter (2)[A]

Diet

Patient Education

References

Additional Reading

Codes

ICD9

ICD10

  • N60.11 Diffuse cystic mastopathy of right breast
  • N60.12 Diffuse cystic mastopathy of left breast
  • N60.19 Diffuse cystic mastopathy of unspecified breast

SNOMED

Clinical Pearls

  • Fibrocystic breast "disease"¯ is a misnomer as it is not a disease state, but a broad classification of benign breast tissue variations.
  • Very commonly described
  • Histology, age, and family history increase risk for malignancy.