Fibrocystic disease

Question 1

What is it?

Answer 1

Non-cancerous (benign) condition in which a woman has painful lumps in her breasts.
They are not harmful, but may bother some women.
They also make cancerous lumps more difficult to detect.

Question 2

Who does it affect:

Answer 2

women of childbearing age normally
over 50% of women will develop it at some point in their lives.
Frequency increases close to menopause and incidence decreases after menopause.

Question 3

what are the causes?

Answer 3

breast tissue changes in response from different hormonal levels from the ovaries.

Question 4

Risk factors:

Answer 4

• Oestrogen: incidence decreases after menopause when oestrogen levels decrease.
• Hormone therarpy - increases risk.
• Contraceptive pill - decreases risk.

Question 5

symptoms?

Answer 5

• Swelling
• Tender/painful breast lumps
• thickening of tissue
• green/dark brown nipple discharge.

Question 6

Signs on examination:

Answer 6

Most common in upper, outer section of breasts (nearest to armpit).

Cysts:

• Round/oval
• Movable lumps
• Tender to touch

Fibrosis:

• Rubbery, firm, hard to touch.
• Free-moving.

Lumps are smooth with defined edges, and are usually free moving in regards to surrounding tissue.

Question 7

What are the breast lumps made of?

Answer 7

fibrous tissue - collection of fibrous tissue in an area of the breast.
Fibrous tissue is the same tissue that ligaments and scar tissue are made of.

Fluid - cysts.

Question 8

Investigations?

Answer 8

Physical examination
Mammography, ultrasound, MRI
Biopsy

Question 9

Treatment

Answer 9

If no symptoms - no treatment
OTC pain relief to get rid of any discomfort - ibuprofen.
wear a well fitting and supportive bra to reduce tenderness.
Dietary changes - reducing caffeine and decreasing fatty foods helps.
Post-menopause symptoms tend to go - as they are linked to hormone changes.

Question 10

Complications?

Answer 10

• Breast cancer risk

- Cancerous tumours may be more difficult to detect in women with fibrocystic changes.

Question 11

Differential diagnosis

Answer 11

Breast cancer
papilloma
fibroadenoma.

Question 12

How you gonna explain it to patient?

Answer 12

Fibrocystic breasts are characterised by lumpiness and usually discomfort in one or both breasts. The lumps are due to small masses or cysts that are benign (i.e. not cancerous). The condition is very common. It’s thought to be due to responses of the breast tissue to oestrogen.

Ductal hyperplasia, apocrine change, sclerosing adenosis