Fibrocystic changes include a range of changes within the breast in both the glandular (lobules and ducts) and stromal tissues. In the past, this was called "fibrocystic disease." Because this condition affects at least half of all women at some point, it is better defined as a change rather than a disease. You may hear fibrocystic changes called FCCs for short.
Fibrocystic changes are most common in women of childbearing age, but they can affect women of any age. FCCs are the most common benign condition of the breast. They may be found in different parts of the breast and in both breasts at the same time.
Types of fibrocystic changes
Many different changes can be found when fibrocystic breast tissue is looked at under the microscope. Most of these changes reflect the way the woman's breast tissue has responded to monthly hormone changes and have little other importance.
As the term fibrocystic suggests, the 2 main features of this tissue are fibrosis and cysts.
Fibrosis: Fibrosis refers to a large amount of fibrous tissue, the same material that ligaments and scar tissues are made of. Areas of fibrosis feel rubbery, firm, or hard to the touch. Fibrosis does not increase your breast cancer risk and does not need any special treatment.
Cysts: Cysts are fluid-filled, round or oval shaped sacs within the breasts. They are most often found in women in their 40s, but they can be seen at any age. A clinical breast exam often cannot tell the difference between a cyst and a solid mass, so an ultrasound or fine needle aspiration (FNA) biopsy is needed to be sure.
Cysts start out with a build-up of fluid inside breast glands. Microcysts (microscopic cysts) are too small to feel and are found only when tissue is looked at under the microscope. If fluid continues to build up, macrocysts (large cysts) are formed. These can be easily felt and may reach 1 or 2 inches across. As they grow, the breast tissue around the cyst may stretch and be painful.
A round, movable lump, especially one that is tender to the touch, suggests a cyst. Cysts often get bigger and become painful and more noticeable just before the menstrual period. This is due to the effect of monthly hormone changes.
FNA biopsy can confirm the diagnosis of a cyst and, at the same time, drain the cyst fluid. Removing the fluid may reduce pressure and pain for some time, but it is not necessary to remove the fluid unless it is causing discomfort. If removed, the fluid may come back later. Having 1 or more cysts does not increase your risk of later developing breast cancer.
Diagnosing fibrocystic changes
In most cases, symptoms of fibrocystic changes include breast pain and tender lumps or thickened areas in the breasts. These symptoms may change as the woman moves through different stages of the menstrual cycle. Sometimes, one of the lumps may feel firmer or have other features that lead to a concern about cancer. When this happens, a needle biopsy or a surgical biopsy may be needed to make sure that cancer is not present.
Treating symptoms of fibrocystic change
Most women with fibrocystic changes and no bothersome symptoms do not need treatment, but closer follow-up may be advised. Women with mild discomfort may get relief from supportive bras or over-the-counter pain relievers.
For a very small number of women with painful cysts, draining the fluid with a needle can help relieve symptoms.
Some women report that their breast symptoms improve if they avoid caffeine and other stimulants (called methylxanthines) found in coffee, tea, chocolate, and many soft drinks. Studies have not found those stimulants to have a significant impact on 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 that women reduce salt in their diets or take diuretics (drugs to remove salt and fluid from the body). But studies have not found diuretics to be better than pills that do not have any medicine in them (placebos).
Many vitamin supplements have been suggested, but so far none are proven to be of any use, and some may have dangerous side effects if taken in large doses.
Some doctors recommend hormones, such as oral contraceptives (birth control pills), tamoxifen, or androgens. But these are usually used only in women with severe symptoms because they can have serious side effects.
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