FIBROCYSTIC DISEASE

Question 1

Is it common or uncommon?

Answer 1

Common

Question 2

Is it malignant or benign?

Answer 2

Benign

Question 3

What does it often present with?

Answer 3

pain and nodularity

Question 4

When are the symptoms greatest?

Answer 4

one week before menstruation and decrease when it starts.

Question 5

What might you find on examination?

Answer 5

Examination may reveal an area of nodularity or thickening, poorly differentiated from the surrounding tissue and often in the upper outer quadrant of the breast.

Question 6

When would you see a patient?

Answer 6

If there is asymmetry it is acceptable to review the patient after one of two menstrual cycles, seeing her mid-cycle.

Question 7

How do you investigate - in older and younger patients?

Answer 7

Mammography is often used in older patients; however, for younger ones with denser breasts, ultrasound is usually better.

Question 8

What is the treatment?

Answer 8

analgesia and a good, well-fitting bra.

Question 9

Histologically how is it characterised?

Answer 9

overgrowth of both fibrous stroma, and of epithelial elements i.e. ducts and lobules, in differing proportions. These changes may be considered as abberations of normal breast involution and not part of a disease process. The condition may be due to a disordered or imbalanced response to endogenous sex hormones.

Question 10

Is the risk of breast cancer increased?

Answer 10

Only in those cases showing marked epithelial hyperplasia - epitheliosis - is the risk of breast carcinoma thought to be increased.

Question 11

How many people does it affect?

Answer 11

10% of women experience palpable fibrocystic change, but autopsy studies state that around
50% of women exhibit some sort of change which isn’t discernible upon examination.

Question 12

Which age group does it affect most?

Answer 12

All women. This usually affects women aged 20-50 (of reproductive age) and appears to be hormonal in aetiology. Inc. –> menopausal age (51, average starting age, decreases after this point ~60 yrs)

Question 13

What is thought to cause it?

Answer 13

As the peak incidence occurs when ovulation fails, It is thought that the balance (discrepancy) between oestrogen and progesterone levels when ovulation ceases is a contributing factor.

Question 14

Signs and symptoms

Answer 14

• swelling
• tenderness
• pain
• a thickening of tissue
• lumps in one or both breasts

• Breast lumps or areas of thickening that tend to blend into the surrounding breast tissue
• Generalized breast pain or tenderness
• Breast lumps that fluctuate in size with the menstrual cycle
• Green or dark brown nonbloody nipple discharge that tends to leak without pressure or squeezing
• Breast changes that are similar in both breasts
Monthly increase in breast pain or lumpiness from midcycle (ovulation) to just before your period

Question 15

What would you see under a microscope?

Answer 15

Fluid-filled round or oval sacs (cysts)
A prominence of scar-like fibrous tissue (fibrosis)
Overgrowth of cells (hyperplasia) lining the milk ducts or milk-producing tissues (lobules) of the breast
Enlarged breast lobules (adenosis

Question 16

What investigations would you do?

Answer 16

Physical breast examination
Radiology: Mammogram, USS, MRI
If worried about anything then FNA might be needed

Question 17

Management/treatment?

Answer 17

OTC: Ibuprofen (advil) and acetaminophen (Tylenol) - pain and discomfort
Well-fitting, supportive bra - to reduce pain and tenderness
Warm or cold compresses
(Dietary changes: Dec caffeine, low-fat, essential fatty acid supplements)

Question 18

Prognosis?

Answer 18

Symptoms usually just cease when you hit the menopause, as it to do with oestrogen