Fibrocystic Breast Changes: Lumps That Are Normal
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Fibrocystic Breast Changes: Lumps That Are Normal

Do your breasts feel lumpy? It may be that you’re experiencing fibrocystic breast changes—a benign condition that occurs in at least 60% of all women of childbearing age.

It sounds very unglamorous, but the human breast is no more than a lumpy gland made up of milk glands and ducts and the tissues that separate and support them. Most breasts have at least one or two lumps; however, if your breast feels especially lumpy and uncomfortable, you're probably experiencing fibrocystic breast changes.

"The vast majority of women have [fibrocystic changes]...and are no worse for it," reports Dr. Carolyn Kaelin, a gynecologist and director of the breast clinic at Brigham & Women's Hospital in Boston.

What Are Fibrocystic Changes?

Fibrocystic changes are benign breast changes. The medical literature used to refer to them as "fibrocystic disease." That was before fibrocystic changes were found to be no more a disease than menstruation or menopause. The breast tissue may feel dense with an irregular area of thicker tissue having a lumpy or ridge-like surface. You might also feel tiny bead-like masses scattered throughout the breasts.

Your breasts may feel tender, swollen, and full with a dull, heavy pain. They may be sensitive to touch with a burning sensation. This discomfort is normal and does not indicate the presence of disease. For some women the pain is so severe that they cannot exercise or lie on their stomachs. Fibrocystic changes usually occur in both breasts. Most often in the upper outer quadrant and the underside of the breast where most of the milk-producing glands are located.

Why Does This Happen?

Fibrocystic changes are associated with hormonal shifts in estrogen and progesterone, which affect the breast tissue. During the menstrual cycle, the breasts swell as the milk glands and ducts enlarge and the breasts retain water. After menstruation, the breast swelling goes down and the breasts return to normal.

Fibrocystic changes generally begin when women are in their twenties or thirties and usually last until menopause. For a small number of women, the condition worsens over the years, causing constant pain and lumpiness. In general, some of the lumps become permanent and may or may not shrink after menopause.

Breast Cysts

Some women with fibrocystic changes develop cysts in their breasts. A cyst is a fluid-filled sac that is usually smooth, firm, movable, and sometimes tender—like a water balloon without the water. The cyst will generally enlarge before the menstrual period and shrink afterwards. A large cyst may be round and feel like an eyeball when pressed with the eyelid closed.

If you are concerned about a lump, your healthcare provider can determine whether or not it warrants further attention. Determining whether a lump is a cyst or something more serious can be determined by a simple office procedure known as fine needle aspiration. A fine-gauge needle is inserted into the lump and fluid is withdrawn.

If the lump is a cyst, as is the case 95% of the time, it will collapse once the fluid is removed. If it's a complex cyst, the next step is an ultrasound-guided fine needle aspiration that would likely cause the cyst wall to collapse.

"If we were concerned that there was something in the cyst wall, we would proceed with a biopsy," says Kaelin.

Treatment

While there is no definitive, medically proven treatment for breast pain caused by fibrocystic changes, there are various remedies that can be helpful.

  • Foods and Supplements
  • For some women, avoiding foods and beverages containing caffeine, such as coffee, tea, chocolate, and soft drinks, may decrease water retention and help to alleviate the discomfort. Reducing fat in the diet may also be helpful. However, this has not been proven in clinical trials.
  • In clinical trials, the herb chasteberry has shown promise for reducing cyclic breast pain. Other natural treatments commonly proposed include evening primrose oil, vitamin B6, and vitamin E. However, the two vitamins lack supporting evidence, and studies suggest that evening primrose is not effective. Before you embark on a self-prescribed regimen of supplements, you should discuss your plans with your doctor.
  • Women who stop smoking may notice that their lumps decrease.
  • Medication
  • Aspirin and other pain relievers, as well as heat application can relieve uncomfortable symptoms, as does wearing a bra that provides firm support. In worse case scenarios, oral contraceptives—which change the hormonal balance in your body—can lessen fibrocystic changes. For severe cases, Danazol, a synthetic form of the hormone androgen, may be prescribed. However, many women find that the side effects of Danazol, including weight gain, hair growth, and voice changes, are more distressing than the fibrocystic discomfort.

"Finding out what works for individual women is a trial and error process. If there was one good way to treat the discomfort, everyone would be treated that way. Not every remedy works for everyone but hopefully, at least something works for everyone," Kaelin observes.

Fibrocystic Changes and Breast Cancer

There is no correlation between fibrocystic changes and breast cancer. However, fibrocystic changes can make it more difficult to detect breast cancer. The best way to alleviate concerns about these cyclic changes is to examine your breasts every month seven days after your period when hormone levels are lowest and there is less texture (lumpiness). That way you'll know what degree of texture and lumpiness is normal for your breasts and be able to detect changes. It's also a good idea to keep a diagram of the more textured or lumpy areas, says Kaelin.

Kaelin strongly advises women to have a clinician examine their breasts once a year; this should be done in addition to mammograms.

How to Examine Your Breasts

It is normal to have some lumpiness or thickening in the breasts. By examining your breasts once each month, you will learn what is normal for you and notice when any changes do occur. Some women find that doing a weekly self-exam works better for them. They learn how their breasts feel at all phases of their menstrual cycles. The more regularly you can examine your breasts, the better you can learn what is normal for you. Your job isn't just to find lumps, but to notice if there are any changes.

  • In the Shower
  • With your fingers flat, move gently over every part of each breast. Use your right hand to examine the left breast and your left hand to examine the right breast. Check for any thickening, hard lumps, or knots.
  • In Front of a Mirror
  • Check your breasts with your arms at your sides. Then raise your arms overhead. Look for any changes in the shape of each breast, swelling, dimpling, or changes in the nipples.
  • Lying Down
  • To examine your right breast, put a pillow under your right shoulder. Place your right hand behind your head. Then with the flat fingers of your left hand, press gently in small circular motions around an imaginary clock face. Begin at the outermost top of your right breast for 12 o'clock, then move to 10 o'clock, etc. until you get back to 12 o'clock. Each breast will have a normal ridge of firm tissue. Then move in one inch toward the nipple. Repeat this process until you have examined every part of your breast including the nipple.
  • Move the pillow so that it's under your left shoulder, place your left hand behind you head, and repeat the procedure on the left breast. Finally, squeeze the nipple of each breast gently between the thumb and index finger. Any clear or bloody discharge should be reported to your physician immediately.

RESOURCES:

Womens health
http://www.4woman.gov

Y-ME National Breast Cancer Organization
http://www.y-me.org/index.php

CANADIAN RESOURCES:

The Canadian Women's Health Network
http://www.cwhn.ca/indexeng.html

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Fibrocystic breasts: a non-disease. American Cancer Society website. Available at: http://www.fwradiology.com/fibrobrst.htm.

Love, SM, Gelman, RS, Silen, W. Sounding board. Fibrocystic "disease" of the breast--a nondisease?. N Engl J Med 1982; 307:1010.

Smith, RL, Pruthi, S, Fitzpatrick, LA. Evaluation and management of breast pain. Mayo Clin Proc 2004; 79:353.

Understanding fibrocystic changes of the breast. College of American Pathologists website. Available at: http://www.cap.org/apps/cap.portal.



Last reviewed March 2008 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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