Fibrocystic Breast Changes

Fibrocystic change describes the normal changes occurring in a woman's breast from puberty through menopause. Fibrocystic changes are caused by your breast tissue responding to varying levels of hormones (estrogen and progesterone). The term "fibrocystic disease" is an older term that is more appropriately called fibrocystic changes.

Fibrocystic Changes Refer to and May Include:

• Lumpiness:Normal breast tissue can feel lumpy due to the combination of the different breast tissues changing in response to hormonal stimulation. This can create a more prominent feeling. The breasts are made up of glandular tissue (milk ducts more prominent during pregnancy and breast feeding), fibrous tissue, fat tissue, underlying chest wall muscles, and ribs. Any of these areas of the breast may feel like a lump on breast examination.
• Cysts: Pockets of fluid may develop due to hormonal stimulation and constriction of a milk duct. They may change in size from month to month and usually require no treatment. You may or may not be able to feel a cyst but if it becomes large enough to be uncomfortable, it can easily be drained.
In the event of a new lump or discharge, inform your health care provider who will evaluate these changes.
• Pain: Fibrocystic changes often cause breast pain. Breast cancer almost never presents with pain. Breast discomfort is often more apparent approximately two weeks before a menstrual period or in women who are taking hormones after menopause. It can also be caused by irritation of chest wall muscles, ribs or cartilage which can be relieved by anti-inflammatory medications. Pain is rarely a symptom of breast cancer.
• Nipple secretions: Tiny droplets of fluid may appear on the nipple surface or on clothing from squeezing the nipple, sexual stimulation, a warm shower, or other stimulation to the breast. There is normally fluid in the milk ducts, (produced by hormonal stimulation of the breast tissue) even if a woman is not pregnant or nursing. Further diagnostic testing should be done if the discharge comes out of one opening of one breast without any stimulation or squeezing.

Significant discharge is from one duct on one breast and occurs without stimulation. Often this discharge is associated with tiny growths in the milk duct called papillomas which are seldom cancerous. Green, gray, milky, opaque secretions from multiple nipple openings in one or both breasts are indicative of fibrocystic change.

Helpful Suggestions

Pain

Remember that pain is almost never an early symptom of breast cancer.

• Wear a supportive bra especially during strenuous exercise.
• Minimize caffeine, ie: coffee, tea, soft drinks.
• Restrict the use of salt 1 week before a menstrual period.
• Exercise regularly at least 2 hours a week.
• Low fat diet.
• Vitamin E – 100 IUs daily.
• Evening Primrose Oil capsules (7-10% GLA content) – 1000-3000 mg per day or other omega 3s. Not recommended for patients with schizophrenia and/or those receiving drugs for epilepsy.
• Vitamin B6 100 mg daily.
• Anti-inflammatory medications (ibuprofen 200-600 mg by mouth 2-3 times a day for 1 – 2 weeks).
• Moist heat to chest 2-4 times a day.

Some or all of the above mentioned suggestions may help. Try one at a time and if something alleviates the breast tenderness, there is no need to try the other suggestions.

Nipple Secretions

Observe carefully. Don't squeeze the nipple trying to get secretions out. Check with you health care provider if you experience any of the following:

• The secretions come out with no stimulation or squeezing and lasts for more than one month.
• The secretions come from one nipple opening of one breast.
• Significant secretion color may be clear, yellow, or bloody. Place a white tissue on the secretion to check the color.
• If the secretions are milky, your doctor may order some hormone function testing.

Breast Lumpiness

As women progress toward menopause, breast tissue often feels softer and overall less lumpy. However, with Hormone Replacement Therapy, the lumpiness and tenderness may continue.

General Recommendations

• Always perform monthly Breast Self Examination, commonly during the week after your menses. Report any changes in your breasts to your health care provider.
• Get mammograms starting at age 40 every 1-2 years.
• Eat well, exercise regularly, manage stress, and enjoy life!