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fibrocystic disease of the breast
The most common benign breast condition in women.
Includes: mammary dysplasia, chronic cystic mastitis, fibrocystic mastopathy, fibroadenosis, cystic epithelial hyperplasia.
Etiology:
1) unknown
2) hormone dependent (estrogen & progesterone)
Epidemiology:
1) most commonly occurs in:
a) nulliparous women, not using oral contraceptives
b) women with early menarche & late menopause
c) women also suffering from premenstrual syndrome
d) premenopausal women age 40-50 years [3]
3) seldom seen in menopausal women not on hormone replacement therapy
Pathology:
1) fibrocystic changes begin in mid 20's to 30's
2) peak before menopause
3) cyclic changes during menstrual cycle
Clinical manifestations:
1) generally asymptomatic
2) smooth, discrete, sometimes tender breast lumps noted as nodules
3) over time, breast feels more nodular & more painful
4) painful solitary or multiple nodules generally in upper-outer quadrant of breast in premenopausal women
5) skin dimpling may occur
6) nipple discharge may occur
7) breast lumpiness, pain & tenderness most severe in the premenstrual phase of the cycle, especially in women approaching menopause
Laboratory:
1) generally not helpful
2) fine needle aspiration or large needle aspiration
a) suspected cyst
b) blood-tinged cystic fluid is indication for mammogram
3) excisional biopsy
- needle aspiration unsuccessful or non-diagnostic
Radiology:
1) mammography
- recommended for any woman over 35 with dominant breast lump suspicious for cancer
2) ultrasound
- may be necessary to distinguish a cyst from a solid mass especially in a younger woman
Differential diagnosis:
1) breast cancer
2) costochondritis
3) Herpes zoster
4) cervical or dorsal radiculitis
Management:
1) mild premenstrual breast pain
a) non-steroidal anti-inflammatory agents
b) diuretics
2) severe symptoms
a) oral contraceptives
b) bromocryptine 5-7.5 mg PO QD for perimenopausal women
c) tamoxifen 10 mg PO BID for perimenopausal women
d) Provera 10 mg on days 15-25 of menstrual cycle
e) danazol 50-300 mg PO QD
3) aerobic exercise
a) 3-4 times/week for 30 minutes
b) well-fitting support bra
4) diet
a) abstain from coffee, chocolate, cola
- no evidence that methylxanthine-free diet improves symptoms [2]
b) vitamin E
c) vitamin B complex
d) selenium
Related
breast cancer
General
breast neoplasm; mammary gland neoplasm
chronic breast disease; chronic mammary gland disease
cyst
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 402-404
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17.
American College of Physicians, Philadelphia 1998, 2015
- NEJM Knowledge+