Fibrocystic Changes in the Breast

Many breast lumps turn out to be non-cancerous (benign) changes in fibrous tissue (fibrosis) and/or cysts, which together are known as fibrocystic changes. These changes used to be called fibrocystic disease, but they are a normal finding in many women. 

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

Fibrosis

Fibrosis refers to an area of fibrous tissue, the same tissue that ligaments and scar tissue are made of. Areas of fibrosis can feel rubbery or firm to the touch.

Cysts

Cysts are fluid-filled, round or oval sacs within the breasts. They are often felt as 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 often cause cysts to get bigger and become painful and sometimes more noticeable just before the menstrual period.

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

Diagnosis of fibrocystic changes

Most often, fibrocystic changes are diagnosed based on symptoms, such as breast lumps, swelling, and/or tenderness or pain. These symptoms tend to be worse just before your menstrual period, and they may change (such as the lumps growing or shrinking) during different stages of your menstrual cycle. At times you may notice some nipple discharge.

If there is a concern about a lump possibly being cancer, a breast ultrasound typically is done to see if the lump is solid or if it has fluid in it (that is, if it's 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 very unlikely to be cancer, but in some cases a doctor might advise a follow-up exam or a procedure to remove the fluid with a thin, hollow needle, just to be sure.
• A complex cystic and solid mass has features such as a solid component or thick outer walls. These findings have a higher chance of being cancer, so a biopsy is usually needed to find out for sure.

How do fibrocystic changes affect your risk for breast cancer?

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

There is a small chance complicated cysts and complex cystic and solid masses might contain cancer or put you at higher risk of breast cancer later on, depending on what is found on a biopsy.

Treatment of fibrocystic changes

Fibrocystic changes in the breast are thought to be natural, so generally no treatment is needed unless they are causing discomfort.

Cysts that are painful can be drained using a thin, hollow needle, which might be done to confirm the diagnosis. Removing the fluid may reduce pressure and pain for some time. If removed, 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.

Most women with fibrocystic changes and without bothersome symptoms do not need treatment, but the doctor might recommend watching the changes closely. If you have mild discomfort, you may get relief from well-fitted, supportive bras, applying heat, or using over-the-counter pain relievers.

Some women report that their breast symptoms improve if they avoid caffeine and other stimulants found in coffee, tea, chocolate, and many soft drinks. Studies have not found a clear link between these stimulants and breast symptoms, but many women feel that avoiding these foods and drinks for a couple of months is worth trying.

Because breast swelling toward the end of the menstrual cycle is painful for some women, some doctors recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or other medicines. It’s been suggested that some types of vitamin or herbal supplements might relieve symptoms, but so far none have been proven to be helpful, and some may have side effects if taken in large doses. Some doctors prescribe hormones, such as oral contraceptives (birth control pills), tamoxifen, or androgens. But these are usually given only to women with severe symptoms because they also can have serious side effects.

If you have breast symptoms that aren't improving or are getting worse, it's important to see your doctor for further evaluation.