Fibrocystic breast disease, a condition causing breast pain, cysts, and noncancerous breast lumps, affects many women. It may also be called fibroglandular changes, fibrocystic changes, chronic cystic mastitis, mammary dysplasia, or benign breast disease.
Fibrocystic breast disease is really not a disease, but rather a condition that commonly affects women between the ages of 25 and 50 years. It may involve finding one lump or several in both breasts.
The vast majority (almost 85%) of breast lumps are not malignant (i.e., they are not cancerous). Nevertheless, some are, so if a woman notices a lump, she should have it examined by her doctor.
Most women have some general lumpiness in their breasts, usually in the upper, outer area. This kind of lumpiness is quite common and does not mean that she has an increased risk of developing breast cancer.
Beyond the occasional discomfort, if a breast lump is not malignant, it’s not considered harmful.
Although early studies showed a higher risk of breast cancer in women with lumpy breasts, recent studies have shown that most types of fibrocystic changes are not associated with higher cancer risk.
Fibrocystic breast disease is a common way to describe painful, lumpy breasts.
The exact cause of the condition is not known. Hormones made in the ovaries may make a woman’s breasts feel swollen, lumpy, or painful before or during menstruation each month.
Up to half of women have this problem at some time during their life. It is most common between the ages of 20 and 45. It is rare in women after menopause, unless they are taking estrogen.
Many breast lumps are actually cysts (fluid-filled sacs) that may grow bigger towards the end of a woman’s menstrual cycle when her body is retaining more fluid.
However, not all breast lumps are cysts. They may also be benign tumours called fibroadenomas (this condition is usually found in younger women). Infection or severe injury can also cause lumps in the breast.
Lumps may also be the result of a tumour made up of fatty tissues (called a lipoma) or even a blocked milk duct (called an intraductal papilloma). None of these conditions are malignant or cancerous.
No one knows the cause of cysts. They usually disappear after menopause, so it’s suspected that female hormones may be involved.
In most cases, symptoms get better after menopause. If you take birth control pills, you may have fewer symptoms. If you are on hormone therapy, you may have more symptoms.
Symptoms are more often worse right before your menstrual period. They tend to get better after your period starts.
The signs and symptoms of fibrocystic breast disease include:
- one or more lumps in your breasts, which may or may not be painful
- nipple discharge
- Pain that commonly comes and goes with the period, but may last through the whole month
- Breasts that feel full, swollen, and heavy
- Pain or discomfort under the arms
- You may have a lump in the same area of the breast that becomes larger before each period and shrinks afterward. This type of lump moves when it is pushed with your fingers. It does not feel stuck or fixed to the tissue around it. This lump is common with fibrocystic breasts.
Some cysts are very small, but others can be as large as a hen’s egg. If you apply pressure, larger cysts may change shape slightly and can be moved around a bit under your skin.
Most fibroadenomas have a firm, smooth, rubbery feeling and a well-defined shape. They also tend to move around under your skin.
Exams and Tests
Your health care provider will examine you. This will include a breast exam. Tell your doctor or nurse if you have noticed any breast changes.
If you are over 40, ask your doctor or nurse how often you should have a mammogram to screen for breast cancer. For women under 35, a breast ultrasound may be used to look more closely at breast tissue.
You may need further tests if a lump was found during a breast exam or your mammogram result was abnormal. Another mammogram and breast ultrasound may be done.
Women who have no symptoms or only mild symptoms do not need treatment.
Your health care provider may recommend the following self-care measures:
- Take over-the-counter medicine such as acetaminophen or ibuprofen
- Apply heat or ice on the breast
- Wear a well-fitting or sports bra
Some women believe that eating less fat, caffeine, or chocolate helps with their symptoms. But there is no evidence that these measures help.
The discomfort caused by breast lumps may be treated by medication. Usually, mild pain relievers such as acetylsalicylic acid* (ASA) or ibuprofen are quite effective. In addition, a well-fitted bra that provides good support may also be effective.
The bra can even be worn at night. Some women say vitamin E helps, but there is no solid evidence for this type of treatment. Other women find warm compresses, ice packs, and gentle massage to be helpful.
If medication doesn’t alleviate the discomfort, your doctor may try to treat cysts by removing the fluid through aspiration. If the cyst persists and continues to cause discomfort, it may be removed surgically. Other breast lumps may also be removed by surgery.
Proper nutrition may help in the treatment of breast lumps. If a woman smokes or drinks caffeine, she may want to reduce her consumption or eliminate these altogether.
Although the evidence is inconclusive, some women have reported that their lumps subsided after they stopped smoking or gave up caffeine.
Vitamin E, thiamine, magnesium, and evening primrose oil are not harmful in most cases. Studies have not shown these to be helpful. Talk with your health care provider before taking any medicine or supplement.
For more severe symptoms, your health care provider may prescribe hormones, such as birth control pills or other medicine.
Take the medicine exactly as instructed. Be sure to let your provider know if you have side effects from the medicine.
Surgery is never done to treat this condition.
If your breast exams and mammograms are normal, you do not need to worry about your symptoms. Fibrocystic breast changes do not increase your risk of breast cancer. Symptoms usually improve after menopause.
When to Contact a Medical Professional
Call your health care provider if:
- You find new or different lumps during your breast self exam
- You have new discharge from the nipple or any discharge that is bloody or clear
- You have redness or puckering of the skin, or flattening or indentation of the nipple