Fibrocystic Disease of the breast - Most common cause of painful breast mass

This condition is characterized by painful, frequently multiple and typically bilateral masses in the breast. Rapid variation in the size of the masses is characteristic. Usually pain starts and / or, get worse and the size increases preceding the menstruation. Commonly women of 30 to 50 years are affected. This condition is rare after menopause unless on hormone replacement therapy.

Fibrocystic disease of the breast is the commonest lesion of the breast. Estrogen is considered a contributory factor. There may be an enhanced risk in those who consume alcohol, especially young women between 18 and 22 years of age. Fibrocystic condition presents a wide range of histologic changes. These lesions are constantly show benign changes in the breast epithelium, those are so commonly found in normal breasts. Most likely they are only the variants of normal breast histology. Only some variety of histopathological changes showing proliferation and atypical cells are said to have increased incidence of breast carcinoma.

Symptoms and Signs of fibrocystic disease of the breast

Usually a mass in the breast remain asymptomatic and sudden pain and tenderness brings attention and the mass is recognized by the concerned woman. Discharge from the nipple may sometimes be present. Mostly uneasiness starts or worsens preceding the menstruation, at which time the cysts increase in their sizes too. Changes in size and rapid emergence or disappearance of mass from the breasts typical with this disease. Multiple or bilateral masses are usual findings, and many patients will give a history of cyclical breast pain and transient formation of mass in the breasts.

How fibrocystic disease of the breast is diagnosed?

Pains, multiplicity of the mass, rapidly changing size are the most helpful features in differentiating fibrocystic disease from breast carcinoma. If a persistent mass is there, the diagnosis of cancer should be suspected unless nullified by a biopsy. Ultimate diagnosis depends on histopathologic examination of the excisional biopsy specimen. Mammography may help, but the breast tissue is usually radiodense in these young women is usually much radiodense and proper study is difficult at times. Sonography can differentiate cystic mass from a solid mass. The solid mass points more towards carcinoma.

Treatment of fibrocystic disease of the breast

After diagnosis of fibrocystic disease has been established either by histopathologic study or by the classical history; aspiration of the discrete cyst can be done to ease pain. This procedure also helps to verify the cystic nature of the mass. The patient is reviewed at intervals subsequently. If no fluid is recovered by aspiration or, if fluid is blood stained or, if the mass remains after aspiration, or if in subsequent follow-up a constant or recurrent mass is noted, biopsy is done to exclude carcinoma.

Breast pain due to fibrocystic disease is best managed by wearing a good supportive brassiere for 24 hours and avoiding any kind of trauma. Hormone therapy is not indicated as it does not cure the disease and produce undesirable side effects. Danazol, a synthetic androgen in a dosage of 100–200 mg orally twice daily sometimes prescribed to alleviate severe pain in some patients. This acts by suppressing pituitary gonadotropins, but androgenic side effects like acne, edema, hair loss and hirsutism is not acceptable to many of the women.
Tamoxifen, an antiestrogen and anti cancer drug also reduces some symptoms of fibrocystic disease, but due to its side effects it is not prescribed for young women except it is prescribed to lessen the risk of carcinoma.

Postmenopausal women on hormone replacement therapy (HRT) usually get relief after stopping the hormones. Evening primrose oil, a natural form of gamolenic acid is found effective to reduce pain in around 50% of the users and can be tried for treatment. The dose of gamolenic acid is 3 g twice daily orally.

Reducing the fat in diet, lowering caffeine consumption in the form of tea coffee or chocolate are found helpful to reduce pain in several studies. Vitamin E in a dose of 400 IU daily also help some patients to get rid of the symptoms at least partly. None of these treatments are proved to to be effective beyond doubt till date.