Fibrocystic breast disease

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VOL 114 / NO 4 / OCTOBER 2003 / POSTGRADUATE MEDICINE

Your breasts feel thick, lumpy, and tender, particularly right before and during your menstrual period. You wonder if these symptoms are something to worry about. Your doctor tells you that you have fibrocystic breast disease, a scary name for a common, noncancerous condition that is believed to affect more than 60% of women.

What is fibrocystic breast disease?
This condition, which is also called mammary dysplasia, benign breast disease, and diffuse cystic mastopathy, is really not a disease at all. Rather, these terms refer to changes in a woman's breasts that become more noticeable just before and during her menstrual period. These changes, which may include lumps, tenderness, and heaviness, often occur even in women who do not have fibrocystic breast disease. It appears that most women with this condition are not at increased risk for breast cancer. However, only a doctor can tell whether the changes are due to fibrocystic breast disease or another problem. This may be determined with just a manual examination, but sometimes an ultrasound, mammogram, or biopsy is needed.

What causes fibrocystic breast disease?
Its cause is unclear, but fibrocystic breast disease is believed to result from the normal changes in hormone levels that occur each month with a woman's menstrual cycle. Some experts think that women who have a family history of this condition or a diet high in fat, salt, or caffeine may be at higher risk.

What are the symptoms?
A woman who has fibrocystic breast disease may notice that her breasts feel dense and lumpy and may even appear bumpy, especially around the time of her period. The lumps seem to be free-floating rather than anchored to one spot. The breasts may feel swollen, heavy, and painful, and the nipples may feel itchy. These symptoms, which range from mild to severe, usually get better after her period ends.

Who is most likely to have fibrocystic breast disease?
Women aged 30 to 50 years are most likely to experience these breast changes. Women who take birth control pills or who have gone through menopause are less likely to have symptoms. Sometimes symptoms disappear completely after menopause.

How is fibrocystic breast disease treated?
Your physician may recommend that you keep the amount of fat in your diet to less than 25% of total calories, reduce your consumption of salt, and avoid caffeine (in, for example, coffee, tea, soft drinks, and chocolate). A good support bra can help relieve discomfort. Your doctor may suggest that you start taking birth control pills. Some experts believe that supplements of vitamin E, vitamin B₆, or certain herbs, such as evening primrose, may help. However, be sure to discuss these remedies with your doctor before you start taking them, because their use is somewhat controversial.

It is very important to perform a monthly breast self-examination, which your doctor can show you how to do, so that you are aware of how your breasts normally feel and can notice any changes that occur over time and could indicate a problem. Call your doctor if you notice a larger-than-average or new lump, puckering or dimpling of the skin of the breast, scaly skin around the nipple, nipple discharge, or unusual changes in the shape of the breast or if you are having a lot of pain. All women also should have a breast examination by their doctor every year, and women over 40 should have regular mammograms to help detect breast cancer.

How to perform a breast self-examination

Examine your breasts right after your period or, if you have irregular periods, on the same day each month. This makes it easier to detect any changes, which should be reported to your doctor.

1. Lie down, place a pillow under your right shoulder, and put your right arm behind your head.

2. Use the finger pads of the three middle fingers of your left hand to feel for lumps in your right breast. Use a firm yet comfortable amount of pressure.

3. Move your finger pads over your entire breast in a circular pattern.

4. Repeat this procedure on your left breast using your right finger pads.

5. Repeat the examination on both breasts while standing to feel for any changes in the upper and outer parts of the breasts. The shower is a good place to do this part of the examination because the skin is slippery and any lumps are easier to feel.

Adapted from the American Cancer Society, www.cancer.org.

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste