Fibrocystic Breast Change

Introduction

• Description: Fibrocystic breast changes are characterized by stromal and ductal proliferation that results in cyst formation, diffuse thickening, cyclic pain, and tenderness. The term fibrocystic change encompasses a multitude of different processes and older terms, including fibrocystic disease. It is the most common of all benign breast conditions, accounting for its linguistic demotion to “change” from the designation “disease.”

• Prevalence: 60%–75% of all women.

• Predominant Age: Most common between the ages of 30–50 years; 10% of women younger than 21 years.

• Genetics: A family history of fibrocystic change is often present, but causality is difficult to establish.

Etiology and Pathogenesis

• Causes: The cause or causes of fibrocystic change are unknown, but it is postulated to arise from an exaggerated response to hormones. A role for progesterone has been suggested based on the common occurrence of premenstrual breast swelling and tenderness. Other proposed sources for fibrocystic changes are altered ratios of estrogen and progesterone or an increased rate of prolactin secretion, but none of these has been conclusively established.

• Risk Factors: Methylxanthine intake has been proposed, but hard data are lacking. There is no evidence that oral contraceptive use increases the risk of these changes. Postmenopausal estrogen therapy, however, has been associated with a 70% increased risk of fibrocystic change, whereas antiestrogen therapy results in a 28% reduction.

Signs and Symptoms

• Asymptomatic (50%)

• Cyclic, diffuse, bilateral pain and engorgement, with worst symptoms that occur just before menses (the pain associated with fibrocystic change often radiates to the shoulders or upper arms)

• Multiple cysts and nodules intermixed with scattered bilateral nodularity typical, ropy thickening, especially in the upper outer quadrants of the breast

Diagnostic Approach