The Facts

Fibrocystic breasts, a condition causing breast pain, cysts, and noncancerous breast lumps, affects many women. It may also be called fibroglandular changes, fibrocystic changes, chronic cystic mastitis, mammary dysplasia, or benign breast disease. Fibrocystic breasts s is a condition that commonly affects women between the ages of 25 and 50 years. It may involve finding one lump or several in both breasts.

The vast majority (almost 85%) of breast lumps are not malignant (i.e., they are not cancerous). Nevertheless, some are, so if a woman notices a lump, she should have it examined by her doctor. Most women have some general lumpiness in their breasts, usually in the upper, outer area. This kind of lumpiness is quite common and does not mean that she has an increased risk of developing breast cancer.

Beyond the occasional discomfort, if a breast lump is not malignant, it's not considered harmful. Although early studies showed a higher risk of breast cancer in women with lumpy breasts, recent studies have shown that most types of fibrocystic changes are not associated with higher cancer risk.

Causes

Many breast lumps are actually cysts (fluid-filled sacs) that may grow bigger towards the end of a woman's menstrual cycle when her body is retaining more fluid. However, not all breast lumps are cysts. They may also be benign tumours called fibroadenomas (this condition is usually found in younger women). Infection or severe injury can also cause lumps in the breast. Lumps may also be the result of a tumour made up of fatty tissues (called a lipoma) or even a blocked milk duct (called an intraductal papilloma). None of these conditions are malignant or cancerous.

No one knows the cause of cysts. They usually disappear after menopause, so it's suspected that female hormones may be involved.

Symptoms and Complications

The signs and symptoms of fibrocystic breasts include:

• one or more lumps in your breasts, which may or may not be painful
• nipple discharge
• breast tenderness or sensitivity

Some cysts are very small, but others can be as large as a hen's egg. If you apply pressure, larger cysts may change shape slightly and can be moved around a bit under your skin.

Most fibroadenomas have a firm, smooth, rubbery feeling and a well-defined shape. They also tend to move around under your skin.

Making the Diagnosis

If a woman has a lump in her breast, her doctor's chief concern is to make sure the lump is not cancerous. Her doctor will first take a medical history, and perform a breast examination.

If she has a single lump that feels like a cyst, her doctor may try to aspirate it by removing fluid from the cyst with a thin needle. This procedure is usually done right in a doctor's office or with the help of an ultrasound. Most women may not even need a local anesthetic for this procedure. If the fluid from a lump can be removed through aspiration, the lump should disappear and not return, indicating that it was a cyst. If the fluid is bloody or appears abnormal in any way, a sample of the fluid will be sent to a lab for examination.

If a lump doesn't feel like a cyst, or no fluid can be drawn from it, the doctor will likely send the woman for a mammogram, which is a special X-ray of the breast. Ultrasound may also be used, as it is proving to be quite useful in diagnosing breast lumps.

If the ultrasound shows a solid area rather than a hollow cyst, the next step is usually a biopsy. This procedure involves surgically removing a small sample of tissue from the breast lump so that it can be examined under a microscope. Needle biopsies are being used more and more as a method for obtaining the tissue sample instead of surgical biopsies that remove the entire lump. Surgical biopsies are usually done at a hospital under local or general anesthetic.

Treatment and Prevention

The discomfort caused by breast lumps may be treated by medication. Usually, mild pain relievers such as acetaminophen* or ibuprofen are quite effective. In addition, a well-fitted bra that provides good support may also be effective. The bra can even be worn at night. Some women say vitamin E helps, but there is no solid evidence for this type of treatment. Other women find warm compresses, ice packs, and gentle massage to be helpful.

If medication doesn't alleviate the discomfort, your doctor may try to treat cysts by removing the fluid through aspiration. If the cyst persists and continues to cause discomfort, it may be removed surgically. Other breast lumps may also be removed by surgery.

Proper nutrition may help in the treatment of breast lumps. If a woman smokes or drinks caffeine, she may want to reduce her consumption or eliminate these altogether. Although the evidence is inconclusive, some women have reported that their lumps subsided after they stopped smoking or gave up caffeine.

Regular breast examinations are extremely important. The Canadian Cancer Society recommends that women in all age groups become familiar with their breasts and know what is normal for their breasts and notify their doctors about any detected changes. Breast self-exams are no longer recommended for women to screen for breast cancer, as research shows that this form of screening is not necessary. However, women aged 40 to 49 should talk to their doctor about their risk of breast cancer and whether they should get a mammogram. Women aged 50 to 74 should have a mammogram every two years.