Fibrocystic Breast Disease (Fibrocystic Breast Changes)

What fibrocystic breast changes are

Breast tissue contains milk-producing lobules, ducts that carry milk to the nipple, and supporting fibrous and fatty tissue. Each month, rising and falling estrogen and progesterone make the glandular tissue swell and retain fluid, then settle again. In many women this response is pronounced, and over years it leads to:

• Fibrosis: areas of firmer, rubbery, fibrous tissue
• Cysts: small fluid-filled sacs, from tiny microcysts to lumps several centimeters wide (see breast cyst)
• Adenosis and hyperplasia: enlarged lobules or extra cells lining the ducts

Doctors stopped calling it a "disease" because it is so common that it is better seen as a variation of normal breast tissue. You will still see "fibrocystic breast disease" and "benign breast disease" on reports.

Symptoms

• Lumpiness or a cobblestone, rope-like or granular texture, most often in the upper outer part of the breast near the armpit
• Breast tenderness or a dull, heavy ache, usually in both breasts
• Swelling and fullness before a period, which improves once it starts
• Lumps that change size through the month
• Pain that spreads to the armpit or down the arm
• Nipple discharge: sometimes green, dark brown or milky, from several ducts, without squeezing being needed

Symptoms usually ease after menopause unless you take hormone therapy.

Does fibrocystic breast disease cause bleeding?

Fibrocystic changes do not usually cause bleeding from the nipple. Discharge linked to fibrocystic breasts is typically non-bloody, comes from several ducts in both breasts, and appears mainly when the nipple is squeezed. Bloody or clear, watery discharge from a single duct, especially if it happens on its own, needs a medical check. The most common cause is an intraductal papilloma, a small benign growth in a milk duct, but cancer must be excluded. See bleeding or discharge from the nipple.

Causes and risk factors

• Hormones: symptoms track the menstrual cycle and fade after menopause.
• Age: most common from the 20s to menopause.
• Hormone therapy after menopause can keep symptoms going.
• Caffeine: often blamed, but studies have not shown a clear link. Some women still notice that cutting back helps.

Fibrocystic lump or something else?

These features are only a guide. Imaging is the only reliable way to tell a lump's cause.

How it is diagnosed

1. Clinical breast exam: a doctor feels both breasts and the armpits. A follow-up exam after your next period helps show whether a lump is cyclical.
2. Ultrasound: the first test under about age 30 to 35, and the best way to show whether a lump is a fluid-filled cyst or solid.
3. Mammogram: for women over about 30 to 40, often with ultrasound.
4. Fine-needle aspiration: draining fluid from a cyst with a thin needle. If the fluid is not bloody and the lump disappears, no more tests are usually needed.
5. Core needle biopsy: for a solid lump or anything suspicious on imaging.

Treatment and relief

No treatment is needed if symptoms are mild. Options that help:

• A well-fitting support bra, and a soft sports bra at night when breasts are sore
• Pain relievers: acetaminophen (paracetamol) or ibuprofen at the label dose, or a topical NSAID gel rubbed on the sore area
• Warm or cold compresses
• Draining cysts that are large and painful
• Adjusting hormones: changing the type or dose of birth control or menopausal hormone therapy, if your doctor thinks it is contributing
• Prescription medicines such as tamoxifen or danazol for severe pain, rarely used because of their side effects

Evening primrose oil and vitamin E are popular, but trials have not shown that they work better than placebo. Surgery to remove fibrocystic tissue is not recommended.

Fibrocystic breasts and cancer risk

Ordinary fibrocystic changes, including fibrosis and simple cysts, do not raise breast cancer risk. Biopsy sometimes finds related features with different implications:

• Proliferative changes without atypia, such as usual ductal hyperplasia or sclerosing adenosis: slightly higher risk
• Atypical hyperplasia: abnormal-looking cells; risk is about 4 times higher, and enhanced screening and risk-reducing medicines may be offered

Lumpy tissue can make mammograms harder to read, and dense breasts are an independent risk factor. Ask whether additional imaging such as ultrasound or MRI is appropriate for you. Keep up with recommended breast cancer screening.

Frequently asked questions

What does a fibrocystic breast feel like?

It feels lumpy, granular or rope-like, often compared to a bag of peas or cobblestones, especially in the upper outer areas near the armpit. The lumps are usually in both breasts, can be tender, and become larger and more painful in the week or two before a period.

Can fibrocystic breast disease turn into cancer?

No. Fibrocystic changes are benign and do not turn into cancer. Simple fibrosis and cysts do not increase cancer risk. A biopsy that shows atypical hyperplasia is different and does raise future risk, so ask your doctor to explain any biopsy result.

Does fibrocystic breast disease cause bleeding from the nipple?

It does not usually cause bleeding. Discharge from fibrocystic breasts tends to be green, brown or milky and from several ducts. Bloody discharge from one duct, particularly without squeezing, needs an exam and imaging, because a duct growth or, less often, cancer may be the cause.

Does caffeine make fibrocystic breasts worse?

Research has not shown a clear link between caffeine and fibrocystic changes. Some women find that cutting back on coffee, tea, energy drinks and chocolate eases their tenderness, so it is reasonable to try reducing it for a few months and see.

Does fibrocystic breast disease go away after menopause?

Usually, yes. As estrogen and progesterone fall, the cyclical lumps and pain tend to fade. Women who take menopausal hormone therapy may continue to have symptoms. A new lump after menopause is less likely to be fibrocystic and should be checked promptly.