Breast health

What is fibrocystic breast condition?

by Dixie Mills, MD, FACS

Fibrocystic breast condition is a benign (not cancerous) but sometimes uncomfortable or painful condition. It’s been called all sorts of things over the years, so you may already know a little bit about it under a different name, like mammary dysplasia, fibrocystic breast changes, diffuse cystic mastopathy, or fibrocystic breast disease (our least favorite term). It’s also incredibly common.

In general, the term is a bit of a misnomer because if women were to have a biopsy, and have their breast tissue looked at under the microscope, not even half with fibrocystic breast condition would have actual breast cysts. As I’ve said before, it’s unfortunate that in medical school we do not spend much time on the normal, resting breast or even the typical non-malignant symptoms. When we better understand what is normal, perhaps everything other than cancer won’t get lumped (that is an attempt at a pun) into the category of fibrocystic.

In the meantime, the word fibrocystic technically means “increased fibrosis and cystic spaces especially in the glandular tissue,” and part of the reason it sounds so serious is that when you hear of “fibro” or “cystic,” you might think of cystic fibrosis, a very serious, inherited glandular (mostly lung) disease discovered usually at childbirth. There is no correlation — only in name. But although the term “fibrocystic” can sound a little scary or misleading, it’s really just a wastebasket term for all types of noncancerous breast issues: lumps, swelling, pain, discharge, and it is not related to anything functionally or anatomically in the breast. (Doctors usually need such medical terms to mystify the public — for years, they called fibrocystic breast condition a disease until it was declared neither a disease, nor a risk factor for breast cancer. Unfortunately it is a label many women have been given and carry around as a stigma — and, even worse, some insurance companies code some women as having a “precondition”).

So it’s important to keep the condition of fibrocystic breasts in a healthy perspective — it’s really no more a disease than hairy chests are in men. But some women do experience more severe symptoms than others.

Fibrocystic breast condition is known to be genetic: in other words, if your mother’s breasts or father’s sister’s breasts were lumpy, yours may be too — but as you now know, breast lumps can be very subjective. If you’re comfortable with the idea, I’d encourage you to talk about it — we can at least share information with our teenaged or adult daughters, if not our older female relatives.

But I also noted in Africa, where I was working a couple of weeks ago, that most of the women’s breasts I examined were much less lumpy than the Caucasian women’s breasts I had seen over the last two decades in practice. Now, some of this could be genetics, but I also noted that their diets were very different, with much less red meat and processed foods and very little white sugar.

How do I know if my breasts are fibrocystic? — the symptoms of fibrocystic breast condition

It’s been reported that fibrocystic breasts affect over 60% of women, usually between the ages of 30–50. Because the condition is typically related to the normal hormonal fluctuations in a woman’s body, with lumps appearing and disappearing along the normal menstrual cycle — commonly the week before the period or in perimenopause from ovulation to menses — fibrocystic breast condition tends to wane after menopause. But symptoms can be managed well through hormonal balance and some key nutritional changes which I’ll talk about in a little bit.

I’ve spoken with many women at the clinic with fibrocystic breast condition who complained that they didn’t feel one specific lump, but that their breasts just “felt different.” So to be able to identify something “foreign” in your breasts, you can examine them regularly and be better equipped to know what to look for. Since each breast is unique, your symptoms of fibrocystic breast condition might differ from someone else’s, and there is no one hard and fast way to identify the condition. But what follows is a list of what most women report when they have fibrocystic breasts:

• Irregular, dense, rubbery, or bumpy “cobblestone” consistency of the breast tissue
• Usually more noticeable in the outer upper part of the breast(s)
• Generalized lumpiness which comes and goes
• Breast discomfort (usually in both breasts) may be persistent or it may come and go
• A feeling of fullness in the breast(s)
• Dull, heavy pain and tenderness
• Tenderness and swelling increases premenstrually
• Occasional nipple discharge

I advise women to exercise caution when they find breast lumps, but not to go right into panic mode. Remember that a lumpy, bumpy breast doesn’t immediately mean that the lump is malignant, and the best thing to do if you find an unusual breast lump or texture that’s out of the ordinary is to speak with your healthcare practitioner. If they themselves cannot distinguish fibrocystic breast condition from something more serious, they will refer you to someone who can, and there are many possible ways they can do this.

How your healthcare practitioner may evaluate fibrocystic breast condition — ruling out other problems

Usually when your healthcare practitioner is setting out to evaluate fibrocystic breast condition, there will be an initial breast exam, which can lead to a mammogram, the most frequently used diagnostic tool for breast lumps. If your provider has examined your breasts before, he or she may be able to tell by another examination whether there is a change or not. But usually an imaging test is recommended.

If there are no clear answers when the mammogram is read, you may be referred for an ultrasound to outline a part of the breast. Ultrasounds are not just for examining pregnancies; they’re useful to further evaluate possible abnormalities found during mammograms or physical examinations. They are also recommended for women too young to have a mammogram — those under 40 years. And different types of breast tissue, solid areas, and fluid-filled cysts have distinctive appearances on an ultrasound screen.

But if there is still uncertainty whether a breast lump or unusual texture is a cyst or something else, your practitioner may recommend a biopsy. The good news is that many more procedures are available to women today, so the word “biopsy” doesn’t immediately mean surgery. Here are four types of preliminary biopsy procedures:

• Fine-needle aspiration (FNA) biopsy extracts fluid from the cyst for further analysis, and can essentially “drain the lump.” This can be a fairly unsettling experience for some women since a very thin needle has to be inserted into the breast tissue. But thankfully the procedure is essentially painless because nerves are located primarily in the skin, not in the breast tissue itself (a topical anesthetic can be applied to diminish sensation). Even if no fluid is obtained, some small cells can be sent to a cytopathologist, who can look at them and say if they look benign or not. In the field of breast health there is a term called the triple test: a doctor’s exam, a mammogram, and a fine needle aspiration. If all three are negative there is a nearly 99% chance that the lump is also benign.
• Another type of biopsy is called a core-needle biopsy, which uses a larger needle than the type employed with FNAB to examine not just fluid and cells but also a bit of breast tissue — for this, again, your practitioner will most likely be using a local anesthetic for the breast area to be biopsied.
• Ultrasound–guided biopsy and stereotactic biopsy are two newer approaches in which images (either ultrasound or x-rays) of the breast from different angles are used to better guide a large core needle directly to the site of the mass, or something questionable seen on mammography. Both of these types of biopsies are usually done by radiologists in an imaging center.
• Finally, a conventional surgical biopsy is an option, but having surgery carries its own complications, and the recommendation today is that for diagnosis, the majority (if not all lumps or questionable areas in the breast) should be biopsied noninvasively, or with a needle in an outpatient setting, before resorting to the operating room. While surgery has its place, knowing your full range of options is a good way to protect yourself from undergoing an unnecessary procedure and longer recovery.

The important thing is that it’s vital not to “dismiss” a breast lump as fibrocystic breast condition — especially if you’ve been living with the condition for a long time. Having regular breast exams by a clinician you trust is just as important for a woman with fibrocystic breast condition as for women without, and I recommend regular mammograms if you’re over 40.

So if you find a one particular lump: breathe. Wait until after a period if you are having them, and if you can, see your healthcare provider then. But even if the mammogram is normal and you are still worried, follow up on it — see a breast specialist for their opinion and/or ask about getting a needle biopsy.

But always bear in mind that you are your own best breast health advocate! So here are a few pieces of advice I like to first share with women who come to me concerned about a lump in their breast:

• There is no reason to worry or be anxious — find out what it is — worry and stress aren’t good for anyone.
• High-risk women — those with a family history of breast cancer or a history of a biopsy with atypical cells — should be followed at a high-risk clinic with regular exams and ultrasounds and perhaps even MRI’s (magnetic resonance imaging).
• There is no way to tell proliferative breast disease or atypia except on a biopsy. Keep in mind that there is some concern that having biopsies increases a woman’s risk, so it is best to try to determine the nature of a lump noninvasively if possible — ultrasound, MRI, needle, or waiting through a cycle.
• Have a lump removed if your intuition is telling you to.

Just spending time to learn about breast health can teach us so much, and each woman should know her breasts better than anyone. So in that light, I think it’s time we all looked at the self breast exam a little differently. Getting to know your breasts can really mean just that — spend a bit more time than your healthcare practitioner or gynecologist would when giving yourself an exam, and don’t worry about being clinical about it! Women can examine their own breasts in whatever way they want, and it does not have to be done just once a month. While there are certain methods we can all use to examine our breasts, there is no one “correct” way — self-exam is something each woman does at her own pace, and it shouldn’t be stress-inducing.

Our Personal Program is a great place to start

The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.

• To learn more about the Program, go to How the Personal Program works.
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References & further reading on fibrocystic breast condition

 

Original Publication Date: 05/25/2009
Last Modified: 09/01/2009
Principal Author: Dixie Mills, MD