Fibrocystic Breast Changes

Basics

Generalized term for benign breast changes that are poorly defined
No longer considered a pathologic disease process as they are found in the majority of healthy women
Most common of all benign breast conditions
Changes include:
- Benign cysts
- Breast pain (mastalgia or mastodynia), which may or may not be cyclic
- Diffuse and focal nodularity
- Palpable fibroadenomas
- Nipple discharge—may be green or brownish, though usually nonbloody
Spontaneous, persistent discharge warrants further evaluation
Occurs in ∼60% of women
Symptoms of pain and tenderness become progressively worse until menopause
Pain is often most prominent during the premenstrual phase and improves with the onset of menses
- Breast pain alone is a rare symptom of cancer and accounts for only 0.2–2% of cases
Synonyms: Adenosis, benign breast disease, cystic mastitis, cystic disease of the breast, fibroadenosis, fibrocystic disease, mammary dysplasia

Mechanism of development not well understood
Likely an enhanced or exaggerated reaction of breast tissue to cyclic levels of female reproductive hormones:
- May be caused by imbalance of the estrogen to progesterone ratio
- Increased estrogen receptor sensitivity
- May occur secondary to increased daily prolactin production
Most common in women 30–50 yr old
Pain is most likely caused by rapid expansion of simple cysts
Symptoms may continue into menopause secondary to hormone replacement therapy
Incidence is decreased in women taking oral contraceptives
Risk factors include:
- Family history of fibrocystic changes
- Oral contraceptives
- Hormone replacement therapy (controversial)
- Increasing age
- Diet (high fat intake; caffeine/methylxanthines)

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