FAQ: Fibrocystic Breast Disease

In summary, fibrocystic tendencies are very common. The signs and symptoms are cyclic breast pain, tenderness, lumps, and nipple discharge. Only a physician can tell if this is due to fibrocystic tendencies or a specific problem. Most women with fibrocystic tendencies do not appear to be at increased risk for breast cancer.

How should a woman with this condition do a search for breast disease? Is it impossible?
Women with a fibrocystic disease should continue to do breast self-examination. By getting to know the texture of your own breast, whether they are lumpy, or nodular, and the location of the areas of tenderness, are all important points. When you do breast self-examination, you are feeling for a change. The analogy that another a physician has used for this is like looking for a rock or a boulder in a gravel road.
Will this eventually or inevitably lead to breast cancer?
No, it does not inevitably or eventually lead to breast cancer. Most fibrocystic conditions are completely benign. There is a very small subset of women with fibrocystic problems who are predisposed to breast cancer. This can be identified by breast biopsy or sometimes by mammography.
What age should you be checked for this condition?
It would be more accurate to say when should you see a doctor. The Answer is if your breasts are bothering you, or if you find a lump in your breast. The fibrocystic tendency itself doesn't need any specific treatment. The issue is to determine whether the lump, nipple discharge, tenderness or other problem might be due to fibrocystic disease or may be a sign of something more serious. So, if you are having a problem with your breast, you should see your physician.
What foods contribute to this condition?
Some studies have shown that caffeine may worsen the tenderness and pain that is associated with fibrocystic condition. Some women may find that chocolate may worsen the pain. Neither caffeine nor chocolate cause fibrocystic problems.
What is the best method to examine yourself?
You can get some really good information on this from your local chapter of the American Cancer Society. The best time for breast self-examination is right after your period stops. Your breast should be least lumpy and least tender at that point. Start by looking at your breast, and face a mirror. Look for dimpling of the skin, redness, or any change in the contour of your breast. Examine your breast lying down. If you have large breasts, put a pillow under your back to flatten your breasts. Use your left hand to examine you right breast and vice versa. Use the flat part of your fingers to check for lumps or unevenness in texture. Some women start at the nipple and work outwards in, increasing circles. Other women prefer to go up and down, starting at one side and working towards the other. The diagram that comes with the material from the American cancer Society is very helpful, and I would recommend getting the information from them.
How is the fibrocystic disease diagnosed?
Sometimes it is diagnosed just by the characteristics history and examination. Sometimes an ultra sound or, in older women, a mammogram may be performed. We start using mammograms in women in their mid thirties and up. A breast biopsy is sometimes performed or a needle biopsy.
What is the treatment for this condition?
The treatment is symptomatic. Some women find that avoiding caffeine, sticking to a low salt diet, or taking aspirin or mild analgesics may help. Some women find vitamin E helpful, and women with irregular periods find that their symptoms are relieved when they take oral contraceptives. Other agents that have been used include evening primrose oil which has been studied in Europe.
Is it common to experience breast pain following menstruation, continuing until the next period?
Many women have cyclic breast pain. If this is severe, I would encourage you to see your physician for a breast pain evaluation.
Do you have to go to a doctor who specializes in this condition for the examination?
No, most physicians who take care of women, that is gynecologists or family physicians, could be able to do the initial exam and determine if referral to a breast clinic is necessary.
Does caffeine really aggravate this condition?
There are several studies that suggest that cutting caffeine out completely may improve pain or tenderness - most women that I have suggested this to decide to stick to the caffeine.
If you find these lumps do they have to be surgically removed?
No, most lumps can be evaluated without surgical removal. Breast specialists use ultra sound, fine needle aspiration, and sometimes mammography to determine whether a lump needs to come out.
Are we at higher risk for breast cancer?
Most women with fibrocystic tendencies are not at increased risk for breast cancer. There are some relatively rare conditions that can increase your risk. And only an evaluation by a physician can tell the difference.
What about nipple discharge, is it serious?
Nipple discharge is fairly common with fibrocystic problems; it is occasionally a sign of a more serious problem. If you are having discharge from one of your nipples, particularly if it the kind of discharge that stains your bra or your clothes, you should see a physician and have it evaluated.
Is there any way to prevent recurring mastitis in a postpartum woman? I am on IV rocephin once daily for 3 bouts w/in a week.
The best way to prevent mastitis is keep the breast empty of milk. The other important think it meticulous cleansing of the nipple. That with antibiotics should take care of it. Sometimes a different antibiotic is needed, if the one you are on does not seem to be working.
Is an infected papilloma the same as fibrocystic disease?
A papilloma is a specific kind of growth. Papillomas usually occur in the ducts right under the nipple. They are usually benign. Some people consider it a part of fibrocystic tendency, but most physician consider it a separate benign problem.
How is the fibrocystic condition affected by estrogen?
It depends on the dose of estrogen and the purpose for which it is being taken. Oral contraceptives contain estrogen and yet many young women find fibrocystic tendencies less pronounced while on oral contraceptives. On the other hand, older postmenopausal women may experience flair up of their fibrocystic tendencies when they start taking hormone replacement therapy.
Are fibroids connected to this condition by any relationship?
There are benign breast tumors called fibroadenomas (some women call the "fibroids"), which are part of the fibrocystic tendencies. Uterine fibroids are not related to this condition, to my knowledge.

Carol Scott-Conner, MD
Department of Surgery
University of Iowa Hospitals and Clinics