Basics
Description
- 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
Incidence
- Estimated 50-60% of all women
- Lower in women taking birth control pills
Risk Factors
Increased cancer risk with:
- 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
Imaging
For suspicious lumps or discharge:
Surgery
For suspicious lumps or discharge:
- 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
First Line
- Treatment for the pain associated with fibrocystic changes include:
- Acetaminophen, aspirin, and other NSAIDs
Second Line
- Tamoxifen: 10 mg/day for 3-6 months
- Danazol: 200 mg/day (during luteal phase only)
Additional Treatment
Issues for Referral
Any suspicious breast mass should be referred to a breast surgeon.
Complementary and Alternative Medicine
Evening primrose: 1-3 g/day
Surgery
Women rarely undergo breast reduction surgery for relief of symptoms.
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
Reduction in caffeine intake has never been proven to decrease the incidence of fibrocystic changes.
Patient Education
A properly fitting bra may help reduce pain and swelling associated with fibrocystic breasts.
References
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]
Additional Reading
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/
Codes
ICD9
610.1 Fibrocystic breast
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
27431007 fibrocystic breast changes (finding)
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.