Detection of Benign Breast Conditions | Benign Breast Tumors | Breast Inflammation or Infection | Fibrocystic Changes

Fibrocystic change is a generalized term used to describe a variety of benign changes in the breast that affect both glandular and connective tissue. Symptoms of this condition are breast swelling or pain, as well as nodules, lumpiness, or nipple discharge. At least half of all women will be affected by fibrocystic changes at some point in their life. Women of childbearing age are affected most commonly, but women of all ages can develop fibrocystic changes. Most of these symptoms stop after menopause, unless hormone replacement therapy is used.

Many fibrocystic changes are a reflection of the response of breast tissue to monthly hormonal changes. Even though these changes are very common and are not life threatening, some of the symptoms are similar to those of breast cancer, so it is important to evaluate the cause of the symptoms to rule out the possibility of cancer. In addition, some fibrocystic changes may indicate that a woman has an increased risk of later developing breast cancer. A definitive diagnosis will lead to a better understanding of breast cancer risk and the appropriate screening programs for a woman to follow.

The severity of fibrocystic changes can be extremely variable; some women experience only minor discomfort, while others suffer severe symptoms. Although much research has gone into finding methods for treating these symptoms, little progress has been made in developing effective treatments. Some women have reported relief of symptoms by avoiding the use of caffeine, reducing salt intake or using diuretics (fluid pills), and taking vitamin supplements; however, studies to date have not clearly established the effectiveness of any of these methods.

Other specific forms of fibrocystic change are adenosis, cysts, epithelial hyperplasia, and fibrosis.

Adenosis is an enlargement or excessive growth of lobule tissues (the outer end of the ducts). Sclerosing adenosis refers to a form of adenosis caused by distortion of the enlarged lobule by fibrous tissue. If a number of enlarged lobules are found near one another, the collection of lobules may be detected by touch; otherwise, the condition is detected by mammography. Whether detected by touch or by mammography, these lesions can be mistaken for cancer, so fine needle aspiration or core needle biopsy is needed to determine whether cancer cells are present. In some instances, a surgical biopsy is required for a definitive diagnosis.

Women with adenosis have about 1.5 to 2 times the risk of the general population for developing breast cancer.

Cysts are fluid-filled sacs that begin as an accumulation of fluid inside breast glands. Cysts are variable in size, ranging from microcysts, which are too small to be felt, to macrocysts, which can measure one to two inches in diameter. As cysts grow, the surrounding breast tissue stretches and can cause pain, especially before the menstrual period. Breast ultrasound can be used to confirm that the abnormality is a cyst; however, fine needle aspiration can confirm the diagnosis and at the same time drain the fluid and relieve the symptoms. Once drained, cysts can recur and may need to be drained again. Cysts are so rarely associated with breast cancer that aspirated fluid is seldom tested for cancer. However, if the woman is older than 35 years and/or the fluid drawn from the cyst is bloody, the doctor will usually send some of the specimen to the pathologist in order to determine whether or not the lesion is cancerous. Breast cysts are not associated with increased breast cancer risk.

Epithelial hyperplasia is a condition in which there is an increase in the number of normal cells that line either the ducts (ductal hyperplasia) or lobules (lobular hyperplasia) of the breast. This condition is also referred to as proliferative breast disease. Epithelial hyperplasia can be diagnosed by core needle biopsy or surgical biopsy.

When examined under a microscope, hyperplasia may be classified as:

• Usual type, meaning there is an increase in the number of cells, but the cells look normal; or
• Atypical, meaning there is an increase in the number of cells and the cells are not quite normal appearing.

On average, about 70% of biopsy specimens do not contain any hyperplasia. About 26% have usual hyperplasia and only 4% have atypical hyperplasia.

Diagnosis	Breast Cancer Risk
Usual Epithelial Hyperplasia	1.5 to 2 times greater than women in the general population
Atypical Epithelial Hyperplasia	4 to 5 times greater than women in the general population
Atypical Ductal Hyperplasia	About 10% of women with this diagnosis will develop breast cancer within 10 years of their biopsy

Fibrosis refers to the formation of fibrous tissue. Fibrous tissue is the material that composes ligaments and scar tissue. Fibrous breasts have areas that feel firm or hard to the touch. No special treatment is required for this condition.

Fibrosis is not associated with an increased breast cancer risk.