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Fibrocystic Breast Disease

Once referred to as Fibrocystic Breast Disease, this condition is now known to represent normal variation of hormonally sensitive breast tissue responding to physiologic fluctuation of female hormones throughout the menstrual cycle. This realization led to a change in terminology to the current correct name of Fibrocystic Breast Change. FBC lost its status as a disease when it was recognized to be almost universally present in women during their childbearing years. Approximately half of women manifest clinically detectable cysts that grow during the luteal phase of their cycle – the time between ovulation and the start of menstruation. Those without palpable cysts still harbor microcysts too small to be felt by clinical examination and often unable to be detected by mammography or ultrasound. Lesions begin appearing in women during the late teens to early thirties and progress until the menopause. Symptoms typically include pain, usually intermittent, but some women experience constant dull or achy tenderness. One or more nodules may be detected in one or both breasts. Although the masses grow during the later half of the cycle, they tend to regress after the menses. FBC may be associated with nipple discharge in a relatively large number of women. The fluid tends to be scant and milky or alternatively may be green, gray or black. Affected breasts may feel lumpy and have a cobblestone texture, but the masses themselves remain smooth edged, freely movable and not attached to underlying structures. Most cysts are discovered by the woman rather than her physician. Retraction of the skin, bloody nipple discharge or eczema around the nipple unresponsive to a short course of topical cortisone should encourage prompt medical consultation. Whether caffeine predisposes to FBC has engendered controversy since the subject initially appeared in the early 1980s. Most medical reports discount any relationship. In general no association exists between caffeine, chocolate, tea or any other food. For those women who believe a correlation exists, avoidance seems wise even in the absence of an established cause and effect relationship. Each year more than 1 million women undergo breast biopsy for FBC. When necessary or appropriate, treatment of the condition customarily involves minimizing symptoms with a well fitting bra and perhaps an over-the-counter analgesic such as acetaminophen, ibuprofen or naproxen. Some find a heating pad or cool compress soothing. Other women notice hormone manipulation with oral contraceptives or similar agents alleviate the issue entirely. FBC is neither cancerous nor pre-cancerous.