Breast Lump l Overview of Fibrocystic Breast Disease (FCD)

Fibrocystic breast disease (FCD) is a “nondisease” that includes nonmalignant breast lesions such as microcystic and macrocystic changes, fibrosis, ductal or lobular hyperplasia, adenosis, apocrine metaplasia, fibroadenoma, papilloma, papillomatosis, and other changes. Atypical ductal or lobular hyperplasia is associated with a moderate increase in breast cancer risk.

Fibroadenoma, the second most common tumor of the breast after carcinoma, is a benign neoplasm of glandular epithelium and is usually accompanied by a significant increase in connective tissue stroma. Both conditions present as palpable masses and warrant follow-up evaluation.

PHYSICAL FINDINGS AND CLINICAL PRESENTATION

  • Tender breasts
  • Nodular areas
  • Dominant mass
  • Thickening
  • Nipple discharge
  • Can vary with menstrual cycle

CAUSE

  • Although frequently seen and diagnosed, mechanism of development not understood.
  • Because found in majority of healthy breasts, regarded as nonpathologic process
  • With hormone replacement therapy, may be carried into menopausal age

DIFFERENTIAL DIAGNOSIS

  • If presenting as dominant mass or masses: exclude possible carcinoma.
  • Carcinoma: detection is difficult with FCD, particularly among premenopausal women.
  • If presenting with nipple discharge: differentiate from discharge of possible malignant origin (Paget’s disease of breast .

WORKUP

  • Exclude breast carcinoma if breast mass, thickening, discharge, and pain present.
  • Perform biopsy of suspected area for histologic confirmation.

 

IMAGING STUDIES

Mammography and ultrasound studies required:

  • For mammographic changes (suspicious densities, microcalcifications, architectural distortion): careful evaluation, including possibly biopsy to exclude breast cancer.
  • Ultrasound study: to establish cystic nature of clinical or mammographic mass lesion

TREATMENT

  • Not considered a “disease” and does not require treatment
  • Surgical intervention diagnostic to eliminate possibility of breast cancer
  • Periodic physician examination to follow patients with FCD who have pronounced nodular features
  • Aspiration for palpable cysts. (Note: Cysts often recur; repeat aspiration is not always required unless pain is a problem.)

For Breast Pain

  • Danocrine (Danazol): limited success reported.
  • Bromocriptine or tamoxifen: used less frequently.
  • Limited caffeine intake: generally not as successful in controlling pain or nodularity as originally suggested.

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