Fibrocystic breasts are characterized by lumpiness and usually discomfort in one or both breasts. The condition is very common and benign, meaning that fibrocystic breasts are not malignant (cancerous). Fibrocystic breast condition (FCC) is the most common cause of "lumpy breasts" in women and affects more than 60% of women. The condition primarily affects women between the ages of 30 and 50 and tends to become less of a problem after menopause.

Is there a difference between fibrocystic breast condition and fibrocystic breast disease?

No. In the past, fibrocystic breast condition was often called fibrocystic breast disease. However, it is not a disease, but a condition. Most women tend to have some lumpiness in their breasts. Therefore, it is now being more appropriately termed fibrocystic breast condition. The abbreviation is FCC (an acronym derived from FibroCystic breast Condition).

Other names that have been applied to FCC include mammary dysplasia, chronic cystic mastitis, diffuse cystic mastopathy, and benign breast disease (a term that includes other benign breast disorders, including infections).

What causes fibrocystic breasts?

FCC involves the glandular breast tissue. The sole known biologic function of these glands is the production, or secretion, of milk. Occupying a major portion of the breast, the glandular tissue is surrounded by fatty tissue and support elements. The glandular tissue is composed of different types of cells: (1) clusters of secretory cells (cells that produce milk) that are connected to the milk ducts (tiny tubes); and (2) the cells that line the surfaces of the secretory cells, called the epithelial cells.

The most significant contributing factor to FCC is a woman's normal hormonal variation during her monthly cycle. Many hormonal changes occur as a woman's body prepares each month for a possible pregnancy. The most important of these hormones are estrogen and progesterone. These two hormones directly affect the breast tissues by causing cells to grow and multiply.

Many hormones aside from estrogen and progesterone also play an important role in FCC. Prolactin, growth factor, insulin , and thyroid hormone are some of the other major hormones that are produced outside of the breast tissue, yet act in important ways on the breast. In addition, the breast itself produces hormonal products from its glandular and fat cells. Signals that are released from these hormonal products are sent to neighboring breast cells. The signals from these hormone-like factors may, in fact, be the key contributors to the symptoms of FCC. These substances may also enhance the effects of estrogen and progesterone and vice versa.

The same cyclical hormones that prepare the glandular tissue in the breast for the possibility of milk production (lactation) are also responsible for a woman's menstrual period. However, there is a major difference between what happens in the breast and uterus.

In the uterus (the womb), these hormones promote the growth and multiplication of the cells lining the uterus. If pregnancy does not occur, this uterine lining is sloughed off and discharged from a woman's body during menstruation.

In the breast, these same hormones stimulate the growth of breast glandular tissue and increase the activity of blood vessels, cell metabolism, and supporting tissue. All this activity may contribute to the feeling of breast fullness and fluid retention that women commonly experience before their menstrual period.

When the monthly cycle is over, however, these stimulated breast cells cannot simply slough away and pass out of the body like the lining of the uterus. Instead, many of these breast cells undergo a process of programmed cell death, called apoptosis. During apoptosis, enzymes are activated that start digesting cells from within. These cells break down and the resulting cellular fragments are then further broken down by scavenger cells (inflammatory cells) and nearby glandular cells.

During this process, the fragments of broken cells and the inflammation may lead to scarring (fibrosis) that damages the ducts and the clusters (lobules) of glandular tissue within the breast. The inflammatory cells and some of the breakdown fragments may release hormone-like substances that in turn act on the nearby glandular, ductal, and structural support cells.

The amount of cellular breakdown products, the degree of inflammation, and the efficiency of the cellular cleanup process in the breast vary from woman to woman. These factors may also fluctuate from month to month in an individual woman. They may even vary in different areas of the same breast in a woman.

Which women are more likely to develop FCC?

FCC is said to primarily affect women age 30 and older. The reason for this is that the condition results from a cumulative process of repeated monthly hormonal cycles and the accumulation of fluid, cells, and cellular debris within the breast. The process starts with puberty and continues through menopause. After menopause, FCC becomes less of a problem.

Can FCC affect just one breast?

Not usually. As a rule, FCC tends to be symmetrical (bilateral) and affects both breasts. A woman can have more fibrocystic involvement in one breast than in the other. The less affected breast, however, often "catches up" over the years and eventually both breasts become almost equally fibrocystic.

Why is it important to diagnosis fibrocystic breasts?

The basic problem with FCC is the threat of breast cancer . FCC is itself benign (non-cancerous) and exceedingly common. Additionally, breast cancer is a common malignancy in women. Both conditions, one benign and the other a leading cause of cancer deaths in women, involve the same organ -- the breast.

Fibrocystic lumps in the breast can closely mimic those found in breast cancer. They can also sometimes make breast cancer difficult to detect. Therefore, FCC often makes both the patient and her physician quite concerned about the possibility of breast cancer. If a woman's breasts are fibrocystic, additional diagnostic tests may be necessary in order to rule out an underlying breast cancer.

How is FCC diagnosed?

A common indicator of FCC is breast pain or discomfort. This discomfort may include a dull, heavy pain in the breasts, breast tenderness, nipple itching, and a feeling of fullness in the breasts. These symptoms may be persistent or intermittent (coming and going), especially appearing at the onset of each menstrual period and going away immediately afterwards.

The primary method of diagnosing FCC is physically touching and feeling (palpation) the lumpy areas in the breast(s). These lumps may be detected by a woman on self-examination or by her physician. This lumpiness is most commonly found in the upper outer quadrant of the breast. (The breast is conventionally divided into quadrants or quarters. The upper outer quadrant is the one closest to the armpit.) The lumps are typically mobile (they are not anchored to overlying or underlying tissue). They usually feel rounded, have smooth borders, and may feel rubbery or somewhat changeable in shape. Sometimes, the fibrocystic areas may feel irregular, ridge-like, or like tiny beads. These characteristics all vary from one woman to another.

Breasts that are extremely fibrocystic can be very difficult to examine by palpation (touching and feeling). Even mammograms of such extremely fibrocystic breasts may be difficult to interpret. In these cases, specialized breast ultrasound exams and other tests can be very helpful. It may sometimes be necessary to obtain a sample (biopsy) of breast tissue with a needle or by surgery in order to make an accurate diagnosis and differentiate between FCC and breast cancer.

Is there more than one type of FCC?

Yes. When biopsies (samples) of breast tissue are studied under the microscope, it is possible to identify different types of FCC. Some cases of FCC show little disturbance of the breast tissue. Other cases involve a large number of cysts, along with fibrous (scar) tissue, in the breast tissue. Additionally, in some cases of FCC, the breast cells do not have a normal appearance.

Cysts and fibrosis: Usually, even when the breast is not stimulated to produce milk, some secretions are produced by the secretory glandular cells. These secretions are normally reabsorbed "downstream" in the ducts. However, when there has been tissue damage and scarring (fibrosis) in the breast, these secretions may be trapped in the glandular portions of the breasts, thereby leading to the formation of fluid-filled sacs called cysts. In some areas of the breasts, there may be excessive fluid secretions due to stimulation by hormone-like substances. The resulting cysts may remain microscopic or enlarge until they contain several teaspoons or even tablespoons of fluid. These larger cysts may be felt as palpable (capable of being detected by touching) breast lumps. Even microscopic cysts may sometimes be felt as palpable lumps if many cysts are clustered together and there is a buildup of fibrous (scar) tissue around the cysts.

Hyperplasia and atypical breast cells: With repeated stimulation from normal hormones, and possibly the effects of many of the hormone-like substances produced in the breast, a few of the epithelial cells (cells that line the ducts in the breast) may eventually lose some of their genetic controls, which normally limit their multiplication (cell division). When this happens, these cells begin to appear abnormal and to look different from one another. They are now described as "atypical." As other more normal cells continue to cycle, die and break down, these atypical cells can move in, spread out, and accumulate. This extensive overgrowth and accumulation of atypical cells is called hyperplasia.

Why can FCC be associated with an increased risk of breast cancer?

FCC that involves atypical appearing cells and hyperplasia is associated with an increased risk of breast cancer. This is because genetic errors (mutations) have begun to accumulate in cells that no longer respond normally to the signals that usually control cell growth and division. These cells may also have an impaired ability to repair any genetic damage. As the atypical cells increase in number, they accumulate additional genetic errors.

Environmental, dietary, and metabolic toxins may also interact with a woman's complex hormonal system to increase the risk of mutations and thus, breast cancer. It has been demonstrated that individuals differ significantly in their ability to break down and remove toxins from the body. Some of this varied response to toxins may be due to inherited differences. The potential for DNA damage (leading to genetic errors or mutations), which can be caused by a variety of damaging agents combined with the stimulation of cell division, is what ultimately leads to the risk of breast cancer that is associated with some cases of FCC. The ability to recognize and repair DNA damage, a process that cells must continuously perform, varies from person to person.

Why don't all women with FCC have breast biopsies?

One reason to undergo a breast biopsy is to diagnose breast cancer. Another reason is to identify those women with FCC who are at an increased risk of developing breast cancer in the future. However, the severity of a woman's symptoms and clinical signs of FCC (pain and lumpiness) do not necessarily correlate with the cellular findings under the microscope. Therefore, it is difficult to single out every woman with FCC for whom a breast biopsy would be useful.

Additional reasons why breast biopsies are not done on every women with FCC include: (1) the invasive nature of the biopsy procedure; (2) the necessity of anesthesia; and (3) cost-benefit considerations. Instead, most women with FCC are followed over time as if they all are at an increased risk for developing breast cancer. The woman herself must ensure that her clinician is appropriately monitoring her on a regular basis.

What is the recommended follow-up for women with FCC?

Generally, the following measures are recommended for women with FCC:

How is the risk of breast cancer in FCC patients calculated?

Assessing the statistical risk for any individual woman requires a careful assessment of all her relevant health issues. The best estimates of cancer risk relate specifically to the microscopic tissue types of fibrocystic disease. Other factors such as family history are also taken into account. However, unless a woman with FCC has a breast biopsy, it is not possible to calculate her specific risk of developing breast cancer.

Only 5% of women with FCC have the type of cellular changes, namely cellular hyperplasia, that represents a risk factor for breast cancer. When compared to a "normal population" of women, these patients have a 2 to 6 fold increased risk of breast cancer. The exact risk depends on the degree of the hyperplasia and whether atypical-appearing cells are also present.

It is critical for the patient with FCC to understand that this figure represents her total risk accumulated over a lifetime. This means that her actual increased risk of breast cancer in any given year is rather low.

What are the treatments for FCC?

The treatments for FCC are directed at the individual components of the condition, including the relief of symptoms (such as breast pain and tenderness) and the correction of hormonal irregularities:

Are there any dietary or life style factors associated with FCC?

Caffeine has been implicated as contributing to both the symptoms and scarring (fibrocystic) changes in FCC. However, when the scientific evidence is reviewed, the results are conflicting. Additionally, there appears to be no evidence that caffeine increases the risk of breast cancer. However, in women with FCC, it might still be worth a trial of caffeine restriction. (Note that coffee is not the only source of caffeine. Tea, chocolate, and certain soft drinks also contain caffeine.) There is no harm in trying caffeine avoidance and there may be a few FCC patients for whom it is beneficial.

At this time, there is a great deal of circumstantial evidence that dietary and hormonal factors can affect FCC and its associated risk of breast cancer. It has been shown that many foods contain natural chemical compounds known as "antioxidants." Antioxidants can reduce the cellular damage that is produced by environmental and metabolic processes. Other compounds in these foods can also help stimulate the detoxifying enzyme systems in the body. Since there are many potentially toxic agents that are consumed or acquired from the environment, any assistance to the normal detoxifying systems is likely to reduce the risk of accumulated genetic damage. Some of these antioxidant compounds are contained in tea, especially green tea. These chemicals, called polyphenols, have recently been found to actually modify and suppress tumor cell function.

The major substances that are thought to be beneficial and their primary sources include:

Many vitamins and some minerals function as antioxidants or are involved in the critical processes that control or protect gene function. These include vitamins B12, C, E, and D, folate, beta carotene, and the minerals selenium and zinc. Most of these vitamins are obtained in adequate amounts from the same vegetable sources noted above. For women who cannot, or do not, eat adequate amounts of fruit and vegetables, it is reasonable to take these vitamins as supplements. In all likelihood, these agents will not reverse FCC, but they may help to stabilize the condition and prevent it from worsening.

Massive doses of antioxidants or vitamins, however, can actually be harmful by impairing other important bodily functions, particularly the immune system. For women on medication, it is important to discuss any supplement, or even an abrupt dietary change, with their physicians because there can be unanticipated interactions between the medication and dietary supplements.

Fibrocystic Breast Condition At A Glance