Fibrocystic Disease

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Fibrocystic Disease, also known as fibrocystic breast changes, is a benign condition characterised by lumpy, painful breasts, often associated with cyst formation, fibrosis, and changes in breast tissue. It is most common in women of reproductive age.

Aetiology

The exact cause of fibrocystic disease is unknown, but it is believed to be related to hormonal fluctuations, particularly the effects of oestrogen and progesterone during the menstrual cycle. These hormonal changes can lead to the development of cysts and fibrosis in the breast tissue.

Pathophysiology

Fibrocystic changes result from the cyclical hormonal influences on the breast tissue. During the menstrual cycle, the breast tissue may become engorged and develop small fluid-filled cysts. Over time, repeated cycles of hormonal stimulation can lead to fibrosis, cyst formation, and the development of nodules within the breast.

Risk Factors

• Age: Most common in women aged 30-50.
• Hormonal factors: Menstrual cycle fluctuations, hormone replacement therapy, and oral contraceptive use may influence the development of fibrocystic changes.
• Family history: A family history of fibrocystic disease or breast cancer may increase risk.
• Diet: High caffeine intake has been suggested as a potential risk factor, though evidence is not conclusive.

Signs and Symptoms

• Lumpy, dense breast tissue that may be tender or painful, particularly before menstruation.
• Multiple small, mobile cysts that fluctuate in size with the menstrual cycle.
• Breast discomfort or a sense of fullness, often bilateral.
• Thickened areas of breast tissue or nodules that may be more prominent during certain times of the menstrual cycle.

Investigations

• Clinical Examination: Palpation of the breast to assess for lumps, nodules, and areas of tenderness.
• Ultrasound: Often used to evaluate cystic changes in the breast, particularly in women with dense breast tissue.
• Mammography: May be used in older women or when the clinical examination raises concern about potential malignancy.
• Fine-Needle Aspiration (FNA): May be performed to confirm the diagnosis of a cyst and to differentiate it from solid masses.

Management

• Primary Care:
  • Reassurance: Provide reassurance about the benign nature of fibrocystic changes and educate on self-monitoring.
  • Supportive Care: Advise on wearing a well-fitting bra to reduce breast discomfort. Over-the-counter pain relief such as NSAIDs may be recommended.
  • Lifestyle Modifications: Reducing caffeine intake may be beneficial for some women, though evidence is limited.
• Specialist Care:
  • Fine-Needle Aspiration (FNA): Used to drain larger cysts that cause significant discomfort or anxiety.
  • Hormonal Therapy: In some cases, oral contraceptives or hormone therapy may be prescribed to manage symptoms, though this is usually reserved for severe cases.
  • Follow-Up: Regular follow-up may be advised, particularly if there are changes in breast symptoms or the development of new lumps.

References

1. NHS (2024) Fibrocystic Breast Disease. Available at: https://www.nhs.uk/conditions/fibrocystic-breast-changes/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Benign Breast Diseases: Assessment and Management. Available at: https://cks.nice.org.uk/topics/benign-breast-disease/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Fibrocystic Breast Changes: Diagnosis and Management. Available at: https://www.bmj.com/content/350/bmj.h4600 (Accessed: 24 June 2024).
4. American College of Obstetricians and Gynecologists (2024) Management of Benign Breast Conditions. Available at: https://www.acog.org/womens-health/benign-breast-disease (Accessed: 24 June 2024).

Back to Top