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Key Features

Essentials of Diagnosis

  • Painful breast masses; often multiple and bilateral masses

  • Rapid fluctuation in mass size is common

  • Pain often worsens premenstrually

General Considerations

  • Most frequent lesion of the breast

  • Estrogen hormone is considered a causative factor

  • Alcohol consumption may increase risk, especially in women aged 18–22 yrs

  • Encompasses a wide variety of benign histologic changes in the breast epithelium

  • Microscopic findings include

    • Cysts (gross and microscopic)

    • Papillomatosis

    • Adenosis

    • Fibrosis

    • Ductal epithelial hyperplasia

  • Only variants with component of epithelial proliferation (especially with atypia) or increased breast density on mammogram represent true risk factor for breast cancer

Demographics

  • Occurs most commonly in women age 30–50

  • Rare in postmenopausal women not receiving hormonal replacement therapy

Clinical Findings

Symptoms and Signs

  • Generally painful mass or masses but may be asymptomatic

  • Serous nipple discharge may be present

  • Rapid fluctuation in size of masses is common

Differential Diagnosis

  • Breast cancer

  • Fibroadenoma

  • Lipoma

  • Breast abscess

  • Intraductal papilloma

Diagnosis

Imaging Studies

  • Mammography may be helpful but is often limited due to radiodensity of breast tissue in young women

  • Breast ultrasonography is useful in differentiating cystic from solid mass

Diagnostic Procedures

  • Suspicious lesions should be biopsied

  • Core needle biopsy, rather than fine-needle aspiration (FNA), is the preferable technique

  • Excisional biopsy is rarely necessary but should be done for lesions with atypia or where imaging and biopsy results are discordant

Treatment

Medications

  • Gamolenic acid, 3 g orally twice daily

  • Vitamin E, 400 international units orally once daily (anecdotal data)

  • Danazol, 100–200 mg orally twice daily, for severe pain, but is rarely used due to side effects (acne, hirsutism, edema)

  • Tamoxifen reduces some symptoms but it is not useful in young women due to side effects, unless it is given to reduce risk of cancer

  • Postmenopausal women receiving hormone replacement therapy may stop hormones to reduce pain

Surgery

  • Total or subcutaneous mastectomy or extensive removal of breast tissue is rarely, if ever, indicated for fibrocystic breast disease

Therapeutic Procedures

  • Aspiration of a discrete mass suggestive of a cyst is indicated in order to alleviate pain and, more importantly, to confirm the cystic nature of the mass

  • Diet

    • Low-fat diet or decreasing dietary fat intake may reduce painful symptoms

    • The role of caffeine consumption remains controversial

    • Many patients report relief of symptoms after giving up coffee, tea, and chocolate

Outcome

Follow-Up

  • Reexamine at intervals

  • Women with proliferative or atypical epithelium on biopsy should be monitored carefully by physical examination and mammography for ...

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