Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 17-01: Fibrocystic Condition + Key Features Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ Follow-Up ++ Reexamine at intervals Women with proliferative or atypical epithelium on biopsy should be monitored carefully by physical examination and mammography for development of breast cancer; consider tamoxifen chemoprevention The patient should be advised to examine her own breasts each month just after menstruation and to inform her physician if a mass appears Excisional biopsy should be performed If no fluid is obtained or if fluid is bloody on aspiration If a mass persists after aspiration If at any time during follow-up a persistent lump is noted +++ Complications ++ Risk of breast cancer in women with proliferative or atypical changes in the epithelium or papillomatosis is higher than in women in general +++ Prognosis ++ Exacerbations of pain, tenderness, and cyst formation may occur at any time until menopause After menopause, symptoms usually subside, except in patients receiving hormone replacement therapy +++ Prevention ++ Avoid trauma Avoid caffeine (anecdotal data) Wear supportive bra night and day + References Download Section PDF Listen +++ + +Chetlen AL et al. Mastalgia: imaging work-up appropriateness. Acad Radiol. 2017 Mar;24:345–9. [PubMed: 27916596] + +Groen JW et al. Cyclic and non-cyclic breast pain: a systematic review on pain reduction, side effects, and quality of life for various treatments. Eur J Obstet Gynecol Reprod Biol. 2017 Dec;219:74–93. [PubMed: 29059585] + +Neal L et al. Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc. 2014 Apr;89(4):536–47. [PubMed: 24684875] + +Qu P et al. Detection rate is not higher for women with BBD history in breast cancer screening. J Public Health (Oxf). 2019 Nov 28;fdz147. [PubMed: 31774529] + +Tice JA et al. Benign breast disease, mammographic breast density, and the risk of breast cancer. J Natl Cancer Inst. 2013 Jul 17;105(14):1043–9. [PubMed: 23744877]