fibrocystic disease of the breast
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Introduction
The most common benign breast condition in women.
Includes: mammary dysplasia, chronic cystic mastitis, fibrocystic mastopathy, fibroadenosis, cystic epithelial hyperplasia.
Etiology
- unknown
- hormone dependent (estrogen & progesterone)
Epidemiology
- most commonly occurs in:
- nulliparous women, not using oral contraceptives
- women with early menarche & late menopause
- women also suffering from premenstrual syndrome
- premenopausal women age 40-50 years[3]
- seldom seen in menopausal women not on hormone replacement therapy
Pathology
- fibrocystic changes begin in mid 20's to 30's
- peak before menopause
- cyclic changes during menstrual cycle
Clinical manifestations
- generally asymptomatic
- smooth, discrete, sometimes tender breast lumps noted as nodules
- over time, breast feels more nodular & more painful
- painful solitary or multiple nodules generally in upper-outer quadrant of breast in premenopausal women
- skin dimpling may occur
- nipple discharge may occur
- breast lumpiness, pain & tenderness most severe in the premenstrual phase of the cycle, especially in women approaching menopause
Laboratory
- generally not helpful
- fine needle aspiration or large needle aspiration
- excisional biopsy
- needle aspiration unsuccessful or non-diagnostic
Radiology
- mammography
- recommended for any woman over 35 with dominant breast lump suspicious for cancer
- ultrasound
- may be necessary to distinguish a cyst from a solid mass especially in a younger woman
Differential diagnosis
Management
- mild premenstrual breast pain
- severe symptoms
- oral contraceptives
- bromocryptine 5-7.5 mg PO QD for perimenopausal women
- tamoxifen 10 mg PO BID for perimenopausal women
- Provera 10 mg on days 15-25 of menstrual cycle
- danazol 50-300 mg PO QD
- aerobic exercise
- 3-4 times/week for 30 minutes
- well-fitting support bra
- diet