Fibrocystic Breast Changes

Fibrocystic Breast Changes is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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

Etiology

  • 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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Basics

Description

  • 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

Etiology

  • 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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