Fibrocystic Disease

Question 1

What is fibrocystic disease (aka fibrocystic change)?

Answer 1

Fibrocystic breasts = benign nodular/glandular change

Fibrocystic changes considered normal ; no longer a disease

Question 2

What are the signs and symptoms of fibrocystic breast?

Answer 2

=> Breast lumps or areas of thickening that blends into the surrounding breast tissue

=> Generalized breast pain or tenderness

=> Breast lumps that fluctuate in size with the menstrual cycle

=> Green or dark brown non-bloody 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 3

Who does breast change commonly affect?

Answer 3

Women 20-50yrs

Post-menopausal women only if they’re on hormonal therapy

Question 4

What are the causes of fibrocystic breast?

Answer 4

Exact cause = unknown but oestrogen is implicated

Fluctuating hormone levels during menstrual cycle => breast discomfort, lumpy breast tissue, tender, sore and swollen.

Fibrocystic breast changes => more bothersome before your period but the pain and lumpiness clear up or lessen once period starts

When examined under a microscope, fibrocystic breast tissue includes:

=> Fluid-filled cysts

=> Fibrosis

=> Hyperplasia of milk ducts epithelium or milk-producing lobules of the breast

=> Enlarged breast lobules (adenosis)

Question 5

Fibrocystic breast changes doesn’t increase risk of breast cancer.

Answer 5

INFO CARD

Question 6

How do you diagnose fibrocystic breast?

Answer 6

1. Breast exam + history:
   => if there is a new lump, suspected fibrocystic change = patient called back after periods for another breast exam
2. If the lump persists:
   => Mammogram

=> Ultrasound <30yrs (better for assessing younger women’s dense breast tissue)

=> Fine-needle aspirate (if suspected cyst)

=> Breast biopsy

Question 7

How do you treat fibrocystic change?

Answer 7

No treatment if asymptomatic or mild symptoms

If severe pain => over the counter pain relief i.e. NSAIDs / paracetamol or oral contraceptives to lower the levels of cycle-related hormones linked to fibrocystic changes

If large, painful cysts assoc. with fibrocystic changes:

=> Fine needle aspiration - fluid removed from cyst = relieve discomfort

=> Surgical excision for persistent cyst-like lump that doesn’t resolve after repeated aspiration