Fibrocystic Breast Changes

Some breast lumps turn out to be noncancerous (benign) changes in fibrous tissue (fibrosis). Other lumps turn out to be cysts. These together are known as fibrocystic changes. These changes used to be called fibrocystic disease, but they are common in many women.

Fibrocystic changes are most common in women of child-bearing age, but they can affect women of any age.

What is breast fibrosis?

Fibrosis refers to an area of fibrous tissue. This is the same tissue that scar tissue is made of. Areas of fibrosis can feel rubbery or firm to the touch.

What are breast cysts?

Cysts are fluid-filled, round or oval sacs within the breasts. They often feel like a round, movable lump (or lumps), which might be tender to the touch. They are most common in women in their 30s or 40s, but they can occur in women of any age. Monthly hormone changes can cause cysts to get bigger and become painful just before the menstrual period.

Cysts begin when fluid starts to build up inside the breast glands. They start as microcysts, which are very small cysts. These are too small to feel unless they are part of a cluster or group of microcysts. If fluid continues to build up, they can develop into macrocysts, or large cysts. These can often be felt and can be as large as 1 or 2 inches across.

Symptoms and diagnosis of fibrocystic changes

Most often, fibrocystic changes are diagnosed based on symptoms, such as:

• Breast lumps
• Swelling
• Tenderness or pain, although not all cysts are painful

These symptoms tend to be worse just before a menstrual period. They may change during different stages of a menstrual cycle. For example, the lumps may grow or shrink at different times during the cycle.

Some cysts might first be found on an imaging test such as a mammogram.

If there is a concern about a lump possibly being cancer, a breast ultrasound typically is done. This can show if the lump is solid or if it has fluid in it and is a cyst.

There are different types of cysts:

• A simple cyst is filled entirely with fluid. Simple cysts are not a cause for concern.
• A complicated cyst is similar to a simple cyst, but it has what looks like ‘debris’ floating in the fluid. Complicated cysts are unlikely to be cancer. However, in some cases a doctor might advise a follow-up exam or a procedure to remove and test the fluid with a thin, hollow needle. This is called a fine needle aspiration. It helps to diagnose the cyst.
• A complex cyst may be partially solid or have thick outer walls. This has a higher chance of being cancer. A core needle biopsy is usually needed to make a diagnosis.

How do fibrocystic changes affect breast cancer risk?

Neither fibrosis nor simple cysts increase your risk of developing breast cancer.

There is a very small chance complicated cysts might contain cancer. And there is a slightly higher risk that complex cysts might contain cancer or put you at higher risk of breast cancer. This depends on what is found on a biopsy.

Do fibrocystic changes need to be treated?

Fibrocystic changes in the breast are thought to be natural, so generally they don’t need to be treated unless they cause bothersome symptoms. Still, your doctor might recommend watching the changes closely rather than treatment.

Treating painful symptoms by draining the fluid or surgery

Cysts that are painful can be drained using a thin, hollow needle. The health care team can use this fluid to confirm the diagnosis. Removing the fluid may also reduce pressure and pain for some time. The fluid might come back later, but cysts may also go away over time.

Surgery might be an option to remove cysts that continue to come back and cause symptoms.

Treating painful symptoms using hormonal medicine

Some doctors might prescribe hormones, such as oral birth control pills, tamoxifen, or androgens to help treat painful symptoms. But these are usually given only to people with severe symptoms because they can have serious side effects.

If you have breast symptoms that aren't improving or are getting worse, it's important to talk to your health care team.

Other ways to manage symptoms

If you have mild discomfort, you may get relief from well-fitted, supportive bras, applying heat, or using over-the-counter pain relievers such as acetaminophen or ibuprofen.

Some women report that their breast symptoms improve if they avoid caffeine and other stimulants found in coffee, tea, chocolate, and many soft drinks.  While the research in this area isn’t clear, many women feel that avoiding these foods and drinks for a couple of months is worth trying.

It’s been suggested that some types of vitamin or herbal supplements might relieve symptoms. However, so far none have proven to be helpful. Some vitamins and supplements may have side effects if taken in large doses.