Also, the lymph nodes located in the axilla and lower neck are examined. During this examination, the doctor looks for unusual breast areas, both visually and manually. įibrocystic breast disease is primarily diagnosed based on the symptoms, clinical breast exam and physical exam. Biopsy or fine needle aspiration are rarely warranted. Nipple fluid aspiration can be used as a classification cyst type method (and to some extent improve breast cancer risk prediction) but is rarely used in practice. This is an exclusion diagnosis, mostly done based on the clinical presentation after ruling out breast cancer. There is evidence that iodine deficiency contributes to fibrocystic breast changes by enhancing breast tissue sensitivity to estrogen. Adenosis involves an abnormal count and density of lobular units, while other lesions appear to mainly arise from ductal epithelial origins. Several variants of fibrocystic breast changes may be distinguished and may vary in cause and genetic predisposition. Over time, presumably driven by aberrant growth signals, such lesions may accumulate epigenetic, genetic and karyotypic changes such as modified expression of hormone receptors and loss of heterozygosity. Larger cysts usually do not occur until after the age of 35. By the age of 30, multiple small cysts and breast pain may arise. Chronic hormonal fluctuations eventually produce small cysts and/or areas of dense or fibrotic tissue over the years. Other hormones such as TSH, insulin, growth hormone and growth factors such as TGF-beta exert both direct and indirect effects by amplifying or regulating cell growth. These hormones directly affect the breast tissue by causing cells to grow and multiply. The most important of these hormones include estrogen, progesterone and prolactin. This condition is an accumulative process, partly caused by the normal hormonal variation during a woman's monthly cycle. Post-menopausal women under hormone replacement therapy have also reported symptoms of fibrocystic breast changes, indicating hormones may play a major role. The exact mechanism of the condition is not fully understood, though it is known to be tied to hormone level fluctuation the condition usually subsides after menopause and is closely related to the menstrual cycle. Pathophysiology Micrograph showing apocrine metaplasia associated with FCC. No complications related to breastfeeding have been found. At peak, breasts may feel full, heavy, swollen, and tender to the touch. Symptoms tend to peak in the days to weeks before each period and decrease afterwards. Symptoms follow a periodic trend closely tied to the menstrual cycle. Breasts and nipples may also be tender or itchy. Women with fibrocystic changes may experience a persistent or intermittent aching or breast tenderness related to periodic swelling. They are often found in the upper, outer sections of the breast (nearest to the armpit), but can be found throughout the breast. These lumps can sometimes be obscured by irregularities in the breast associated with the condition. These lumps are smooth with well defined edges, and free-moving regarding adjacent structures. The changes in fibrocystic breast disease are characterised by the appearance of fibrous tissue and a lumpy, cobblestone texture in the breasts. It is estimated that up to 60% of women are affected, most commonly between the ages of 30 and 50 years. Occasionally danazol or tamoxifen may be used for pain. Management may involve education about the condition, using a well fitting bra, and pain medication, if needed. Fibrocystic changes include fibroadenomas, fibrosis, and papillomas of the breast. Diagnosis involves ruling out breast cancer. It is not a disease but represents normal breast changes. Risk factors include an early age at first menstrual period and either having children at a late age or not at all. These are normal breast changes, not associated with cancer. Symptoms may worsen during certain parts of the menstrual cycle due to hormonal stimulation. The breasts may be described as "lumpy" or "doughy". Periodic examination, possibly medical imaging or breast biopsy Įducation about the condition, a well fitting bra, pain medication įibrocystic breast changes is a condition of the breasts where there may be pain, breast cysts, and breast masses. Medical condition Fibrocystic breast changesįibrocystic change, fibrocystic breast disease, fibrocystic breast conditionīenign fibrous breast growths (highlighted in yellow).īreast pain, breast cysts, breast masses Įarly age at first menstrual period, having children late or not having children
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