Formerly called fibrocystic breast disease, this disorder affects about one-half of all women. If you have ever felt a lump in your breast, you know how frightening the experience can be—it’s only natural to worry that the lump could be a sign of breast cancer. Fortunately, most breast lumps are not cancer. Many women live a normal, active life with breasts that are tender and lumpy.
Fibrocystic breast conditions may include breast nodules, breast swelling, tenderness and pain. A woman may experience breast pain only, lumpiness only, or both. Although these breast conditions can be painful, and suspicious lumps can cause anxiety, most do not increase a woman’s risk of breast cancer.
The main symptoms of fibrocystic breast conditions are swelling and pain in the breasts, which waxes and wanes with the menstrual cycle. However, women who are severely affected by this condition complain of continuous discomfort. And up to 50 percent of women with breast pain report that it interferes with their sex life and physical activity. Occasionally, a woman may develop breast cysts that require medical attention.
What Causes Fibrocystic Breast Conditions?
The exact cause of this disorder is not known. Most women eventually develop some lumpiness in their breasts. Breast changes usually appear during the years a woman menstruates, and regress with the onset of menopause. In most cases, the small, round lumps appear in the breasts because of hormonal changes associated with menstruation. The hormones estrogen and progesterone that control your menstrual cycle trigger physical responses that make your breasts become lumpy, or fibrocystic, and painful. It’s thought that a deficiency of progesterone and an excess of estrogen in the last 14 days of a woman’s menstrual cycle are responsible for breast changes.
These symptoms are collectively referred to as fibrocystic breast conditions. You may also hear breast pain and tenderness called cyclic mastalagia or mastitis. Because fibrocystic breast conditions are influenced by hormonal cycles, a woman will find that her breasts become increasingly tender and painful as her body prepares for menstruation. The discomfort normally subsides once her period starts. Over time, breast lumps may develop into cysts, which fill with fluid, causing swelling and pain. Up to 20 percent of women with fibrocystic breast conditions say that their symptoms spontaneously improve over time.
Fibrocystic breast conditions are often associated with the symptoms of premenstrual syndrome (PMS). Some researchers believe that hormonelike compounds called prostaglandins are responsible for causing breast changes. A handful of studies indicate that the development of lumpy breasts may also be stimulated by a diet that includes higher levels of caffeine and dietary fat. Despite these other theories, most of the clues about the cause of fibrocystic breast conditions suggest that estrogen is the key.
Breast lumpiness is one of the main characteristics of fibrocystic breast conditions. A woman may discover only one lump, but it is more common to have multiple lumps. The lumps are tender, come in different sizes and usually move freely within the breast tissue. A woman may also experience some breast pain and swelling, which will become worse just before her menstrual period.
Who’s at Risk?
Fibrocystic breast conditions can affect women from puberty to old age. However, this condition affects approximately 50 percent of women between the ages of 30 to 50 years. Breast symptoms usually disappear with menopause, and it is quite rare to find the disorder in postmenopausal women unless they are taking hormone replacement therapy.
Up to 85 percent of breast lumps are found by patients through breast selfexamination. The American Cancer Society recommends that all American women over the age of 20 should be examining their breasts regularly every month. (Go to www.cancer.org for a detailed guide to breast self-examination.) The selfexamination should be done five to ten days after menstruation, at the same time each month. Using the pads of your fingers, you should examine all of your breast tissue and the tissue under your armpits. You should also examine your breasts visually, looking for physical changes or differences between your breasts. This practice should be continued even when you no longer menstruate. It’s also recommended that once a woman turns 40, she have a mammogram (specialized breast x-ray) once every two years to determine overall breast health.
Fibrocystic breast conditions can sometimes imitate the symptoms of true breast cancer or can hide the presence of cancerous growths. Fibrocystic breast lumps and cysts normally feel soft or slightly firm, tender and painful. This distinguishes them from cancerous growths, which tend to be hard and don’t usually cause tenderness and pain. However, if a woman’s fibrocystic breast condition becomes more advanced, chronic inflammation may cause the soft, fluid-filled cysts to harden and thicken. When this happens, it becomes increasingly difficult to tell the difference between non-cancerous and cancerous growths.
To distinguish hardened cysts from breast cancer, your doctor may order some specific diagnostic tests. He or she will begin by taking a medical history and conducting a physical examination. Your doctor may then order radiological tests, such as a mammogram or an ultrasound (sound wave picture), which are useful in identifying breast cysts. Or your doctor may perform a simple procedure called a needle aspiration. In this test, fluid is removed from the lump using a small, hollow needle. Needle aspiration is also used to drain the contents of large, fluid-filled cysts, in an attempt to relieve pressure on surrounding breast tissue.
In some cases, your doctor may feel that a biopsy is necessary. A small piece of tissue from the lump will be surgically removed and sent to a laboratory for microscopic examination. This procedure will determine if the cells in the lump are benign (non-cancerous) or malignant (cancerous).