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Diseases

Fibrocystic breasts

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Fibrocystic breasts are characterized by "lumpy" breasts associated with pain and tenderness that fluctuate with the menstrual cycle.

  • Diagnosis often involves exclusion of other significant breast diseases.

  • Assessment of risk for the development of breast cancer is important and is useful in patient reassurance or to design risk reduction strategies.

  • Cyclic mastalgia is treated symptomatically with lifestyle modification, analgesics, and hormonal therapy.

  • Mastalgia and breast cysts run a chronic relapsing course throughout life with improvement at menopause.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Ultrasound image of a breast cyst (note the characteristic smooth and sharp margins of the anechoic

            Ultrasound image of a breast cyst (note the characteristic smooth and sharp margins of the anechoic lesion with posterior acoustic enhancement)

          • Ultrasound image of a fibroadenoma; in contrast to the breast cyst, some internal echoes are seen

            Ultrasound image of a fibroadenoma; in contrast to the breast cyst, some internal echoes are seen

          Citations

            Key Articles

            • Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002 Mar;29(1):1-20.[Abstract]

            • Santen RJ, Mansel R. Benign breast disorders. N Engl J Med. 2005 Jul 21;353(3):275-85.[Abstract]

            • Love SM, Gelman RS, Silen W. Sounding board. Fibrocystic "disease" of the breast--a nondisease? N Eng J Med.1982 Oct 14;307(16):1010-4.[Abstract]

            • Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985 Jan 17;312(3):146-51.[Abstract]

            • Fisher B, Constantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998 Sep 16;90(18):1371-88.[Abstract][Full Text]

            Referenced Articles

            • 1. Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002 Mar;29(1):1-20.[Abstract]

            • 2. Santen RJ, Mansel R. Benign breast disorders. N Engl J Med. 2005 Jul 21;353(3):275-85.[Abstract]

            • 3. Goehring C, Morabia A. Epidemiology of benign breast disease, with special attention to histologic types. Epidemiol Rev. 1997;19(2):310-27.[Abstract][Full Text]

            • 4. Gopalani SV, Janitz AE, Martinez SA, et al. Trends in cancer incidence among American Indians and Alaska natives and non-Hispanic whites in the United States, 1999-2015. Epidemiology. 2020 Mar;31(2):205-13.[Abstract]

            • 5. Sarnelli R, Squartini F. Fibrocystic condition and "at risk" lesions in asymptomatic breasts: a morphologic study of postmenopausal women. Clin Exp Obstet Gynecol. 1991;18(4):271-9.[Abstract]

            • 6. Rohan TE, Miller AB. Hormone replacement therapy and risk of benign proliferative epithelial disorders of the breast. Eur J Cancer Prev. 1999 Apr;8(2):123-30.[Abstract]

            • 7. Wang DY, Fentiman IS. Epidemiology and endocrinology of benign breast disease. Breast Cancer Res Treat. 1985;6(1):5-36.[Abstract]

            • 8. Love SM, Gelman RS, Silen W. Sounding board. Fibrocystic "disease" of the breast--a nondisease? N Eng J Med.1982 Oct 14;307(16):1010-4.[Abstract]

            • 9. Roger P, Sahla ME, Makela S, et al. Decreased expression of estrogen receptor beta protein in proliferative preinvasive mammary tumors. Cancer Res. 2001 Mar 15;61(6):2537-41.[Abstract][Full Text]

            • 10. Duffy SW, Roberts MM, Elton RA. Risk factors relevant to cystic breast disease: a case-control study. J Epidemiol Community Health. 1983 Dec;37(4):271-3.[Abstract][Full Text]

            • 11. Cole P, Elwood JM, Kaplan SD. Incidence rates and risk factors of benign breast neoplasms. Am J Epidemiol. 1978 Aug;108(2):112-20.[Abstract]

            • 12. Rohan TE, Negassa A, Chlebowski RT, et al. Conjugated equine estrogen and risk of benign proliferative breast disease: a randomized controlled trial. J Natl Cancer Inst. 2008 Apr 16;100(8):563-71.[Abstract][Full Text]

            • 13. Cady B, Steele GD Jr, Morrow M, et al. Evaluation of common breast problems: guidance for primary care providers. CA Cancer J Clin. 1998 Jan-Feb;48(1):49-63.[Abstract]

            • 14. Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J. 2004 Mar-Apr;10(2):111-7.[Abstract]

            • 15. Davies EL, Gateley CA, Miers M, et al. The long-term course of mastalgia. J R Soc Med. 1998 Sep;91(9):462-4.[Abstract][Full Text]

            • 16. Mohallem Fonseca M, Lamb LR, Verma R, et al. Breast pain and cancer: should we continue to work-up isolated breast pain? Breast Cancer Res Treat. 2019 Oct;177(3):619-27.[Abstract]

            • 17. Kushwaha AC, Shin K, Kalambo M, et al. Overutilization of health care resources for breast pain. AJR Am J Roentgenol. 2018 Jul;211(1):217-23.[Abstract][Full Text]

            • 18. Tang SS, Twelves DJ, Isacke CM, Gui GP. Mammary ductoscopy in the current management of breast disease. Surg Endosc. 2011 Jun;25(6):1712-22.[Abstract]

            • 19. Newman HF, Klein M, Northrup JD, et al. Nipple discharge. Frequency and pathogenesis in an ambulatory population. N Y State J Med. 1983 Jun;83(7):928-33.[Abstract]

            • 20. Cady B, Steele GD Jr, Morrow M, et al. Evaluation of common breast problems: guidance for primary care providers. CA Cancer J Clin. 1998 Jan-Feb;48(1):49-63.[Abstract]

            • 21. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985 Jan 17;312(3):146-51.[Abstract]

            • 22. United States Preventive Services Task Force (USPSTF). Screening for breast cancer recommendation statement. January 2016 [internet publication].[Full Text]

            • 23. Gemignani ML. Breast cancer screening: why, when, and how many? Clin Obstet Gynecol. 2002 Mar;29(1):1-20.[Abstract]

            • 24. Harvey JA, Mahoney MC, Newell MS, et al. ACR appropriateness criteria: palpable breast masses. J Am Coll Radiol. 2016 Nov;13(11S):e31-e42.[Abstract]

            • 25. Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015 Oct 20;314(15):1599-614.[Abstract][Full Text]

            • 26. Saslow D, Boetes C, Burke W, et al; American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007 Mar-Apr;57(2):75-89.[Abstract][Full Text]

            • 27. Horrobin DF, Manku MS. Premenstrual syndrome and premenstrual breast pain (cyclical mastalgia): disorders of essential fatty acid (EFA) metabolism. Prostaglandins Leukot Essent Fatty Acids. 1989 Sep;37(4):255-61.[Abstract]

            • 28. Pruthi S, Wahner-Roedler DL, Torkelson CJ, et al. Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study. Altern Med Rev. 2010 Apr;15(1):59-67.[Abstract]

            • 29. Fentiman IS, Caleffi M, Hamed H, et al. Dosage and duration of tamoxifen treatment for mastalgia: a controlled trial. Br J Surg. 1988 Sep;75(9):845-6.[Abstract]

            • 30. Parlati E, Polinari U, Salvi G, et al. Bromocriptine for treatment of benign breast disease. A double-blind clinical trial versus placebo. Acta Obstet Gynecol Scand. 1987;66(6):483-8.[Abstract]

            • 31. Mansel RE, Wisbey JR, Hughes LE. Controlled trial of the antigonadotropin danazol in painful nodular benign breast disease. Lancet. 1982 Apr 24;1(8278):928-30.[Abstract]

            • 32. Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc. 2004 Mar;79(3):353-72.[Abstract]

            • 33. Rosolowich V, Saettler E, Szuck B, et al. Mastalgia. J Obstet Gynaecol Can. 2006 Jan;28(1):49-57.[Abstract][Full Text]

            • 34. Basch E, Bent S, Collins J, et al. Flax and flaxseed oil (Linum usitatissimum): A review by the natural standard research collaboration. J Soc Integr Oncol. 2007 Summer;5(3):92-105.[Abstract]

            • 35. Murshid KRA. Review of mastalgia in patients with fibrocystic breast changes and the non-surgical treatment options. J Taibah Uni Med Sci. 2011;6(1):1-18

            • 36. Vargas HI, Vargas MP, Gonzalez KD, et al. Outcomes of sonography-based management of breast cysts. Am J Surg. 2004 Oct;188(4):443-7.[Abstract]

            • 37. The American Society of Breast Surgeons. Benign breast disease. Five things physicians and patients should question. Jan 2018 [internet publication].[Full Text]

            • 38. Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005 Jul 21;353(3):229-37.[Abstract][Full Text]

            • 39. Fisher B, Constantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998 Sep 16;90(18):1371-88.[Abstract][Full Text]

            • 40. Vargas HI, Romero L, Chlebowski RT. Management of bloody nipple discharge. Curr Treat Options Oncol. 2002 Apr;3(2):157-61.[Abstract]

            • 41. Srivastava A, Mansel RE, Arvind N, et al. Evidence-based management of Mastalgia: a meta-analysis of randomised trials. Breast. 2007 Oct;16(5):503-12.[Abstract]

            • 42. Vargas HI, Vargas MP, Eldrageely K, et al. Outcomes of clinical and surgical assessment of women with pathological nipple discharge. Am Surg. 2006 Feb;72(2):124-8.[Abstract]

            • 43. Kessler JH. The effect of supraphysiologic levels of iodine on patients with cyclic mastalgia. Breast J. 2004 Jul-Aug;10(4):328-36.[Abstract]

            • 44. Ghent WR, Eskin BA, Low DA, et al. Iodine replacement in fibrocystic disease of the breast. Can J Surg. 1993 Oct;36(5):453-60.[Abstract]

            • 45. Bevers TB. Breast awareness: a shift in the paradigm of breast self-examination. J Natl Compr Canc Netw. 2009 Nov;7(10):1042-3.[Abstract]

            • 46. Thornton H, Pillarisetti RR. 'Breast awareness' and 'breast self-examination' are not the same. What do these terms mean? Why are they confused? What can we do? Eur J Cancer. 2008 Oct;44(15):2118-21.[Abstract]

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