If you happen to detect a lump during your self-breast exam, there is no cause for immediate alarm. Because not all lumps are cancerous, it could just be your hormones acting up and your breast undergoing some changes.
Fibrocystic breast, previously known as fibrocystic breast disease, refers to lumpy, sometimes painful changes that occur in your breast tissues. It is otherwise called ‘fibrocystic breast changes’ and is experienced by millions of individuals assigned female at birth globally.
These changes are normal and harmless, commonly affecting an individual's health and are often associated with your menstrual cycle. Though it can be experienced at any point in a person's life, it is more common before menopause. Hence, any person assigned female at birth, usually between 20 to 50 years of age (childbearing age), can be affected.
When your breasts undergo fibrocystic change, the tissues feel rope-like, thick, or lumpy in texture and are referred to as glandular breast tissues. This results in the development of round or oval sacs filled with liquids known as cysts. It could also lead to the thickening of the softer fatty tissue in the breasts (fibrosis), and both can be felt during breast examination.
A cyst is formed in your breast when there is a buildup of fluid in the breast glands. Although not entirely dependent on age, it may naturally appear as you get older due to your hormonal level variations.
It could appear in the following ways:
- As a simple cyst that is small to feel (microcyst)
- As a complicated cyst that could be made up of a bunch of cysts with particles suspended in the fluid
- As a complex breast cyst that is often large and easy to detect with its thicker mass
Formation of the cysts leads to a collection of fibrous tissues in an area of the breast, giving rise to fibrocystic breast changes. These breast changes can come with or without symptoms that are often evident just before menstruation and lessening afterwards.
According to the Canadian Cancer Society, the chances of developing breast cancer might be slightly higher amongst a person assigned female at birth (AFAB) with fibrocystic breast, especially if they have a family history of breast cancer too.
Although fibrocystic breast changes are not directly indicative of an increased malignancy (cancer) risk of breast disease, it has been discovered that under specific clinical and histopathological settings, there is a 50% risk of developing breast cancer.1
Causes of fibrocystic breast
The major parts of the breast, including the ducts, lobules, and stroma, are more susceptible to fibrocystic change during hormonal fluctuations. The glandular tissue of a person assigned female at birth (AFAB) during the childbearing age is directly related to the surges of progesterone and estrogen during their cycle.2
Hence, it is postulated that these hormones are responsible for fibrocystic breast tissue changes. They are more frequent during your periods and often result in tender breasts or lumpy breasts that may be painful.
Also, in young persons (AFAB) aged 18 to 22 years, alcohol consumption may heighten the risk of developing these breast changes.3 Though caffeine is suspected to worsen the condition, research is still ongoing to confirm the probability of caffeine being a risk factor.
Signs and symptoms of fibrocystic breast
A person assigned female at birth (AFAB)with fibrocystic breasts often experiences symptoms in both breasts, and it commonly occurs around 30 to 50 years of age. This could be because, at this age, your hormonal levels begin to vary more. Some symptoms include:
- Lumps or thick areas in the breast (can change in size with the menstrual cycle)
- Breast tenderness, breast pain, or discomfort majorly at the outer part of the breast
- Breast swelling or heaviness
- Itchy nipple.
- Slight similar changes that are obvious in both breasts
- Nipple discharge that is dark brown or green
- Pain or discomfort under the arms
The degree of these symptoms varies from one person to another. For some, they feel discomfort before, after, or during their period, while some experience pain or tenderness all the time.
Again, some have a lump in a particular area of their breasts that grows bigger just before the start of their menstrual cycle. The lump is usually in the form of free-moving masses and returns to its original size after the menstrual period.
Young people (AFAB) are encouraged to practice breast-self awareness to quickly identify any of the above symptoms.
Management and treatment for fibrocystic breasts
In the majority of cases, there is no need to panic when you develop fibrocystic breasts. The changes are not abnormal, and the lumps are benign (not cancerous).
You can apply the following home therapies to manage these fibrocystic breast symptoms
- Wear a good, supportive bra
- Apply cold or warm compressions whenever the pain becomes intense. You can equally place a warm water bottle on your breast intermittently to help reduce pain.
- Avoid activities that could be harmful to the breast
- Although there is no proven evidence that reduction of caffeine intake has an effect on fibrocystic breast, some people report that limiting their coffee consumption, as well as other stimulants like soda, energy drinks, and chocolate, aid in alleviating their pain.
- Reduce your dietary intake of salt and saturated fats
- Include flaxseed in your diet, as well as other sources of omega-3 fatty acids.4
Other treatment options include:
- The resulting pain can be managed by taking over-the-counter pain reliefs such as Ibuprofen or Acetaminophen.
- Taking Vitamin E or primrose supplements has been claimed to relieve the symptoms.5
- Some doctors also recommend hormonal therapy. This involves drugs like Tamoxifen, Bromocriptine, and low-estrogen oral contraceptives (birth control pills)
In severe cases, your doctor might carry out a procedure known as Fine Needle Aspiration (FNA). This involves using a thin, hollow needle to drain fluid from a cyst, thereby relieving your pain.
Also, surgery could be performed if the cyst is large and extremely painful.
Conducting a breast-self examination every month, 7 to 10 days after your menstrual cycle is encouraged. Doing this regularly will enable you to notice changes in your breasts, such as lumpy and tender breasts, before your menstrual period, which may go back to normal after your period. People assigned female at birth, during their post-menopausal stage, should examine theirs at the same time each month.
In most cases, a fibrocystic breast change is suspected when you experience symptoms such as tenderness, swelling, breast lumpiness, or even nipple discharge. It is important to note that symptoms of your breast condition might worsen just before your menstrual period.
If you observe any change, such as a lump that remains larger than usual, even after your period, it should be reported to your healthcare provider who will then carry out a breast exam..
To rule out the possibility of breast cancer, the doctor could run the following imaging tests to determine if the growth is merely indicative of noncancerous benign breast conditions(cancer-free).
- Ultrasound: uses sound waves to detect breast changes. It is the most preferred choice of diagnosis because it reveals cysts that may be harder to find with a mammogram. Breast ultrasound is commonly used for younger individuals.
- Mammogram: involves getting an X-ray of the chest and is often used on individuals over 30 years old.
- Biopsy: if the above tests point out abnormality, the doctor may go ahead and carry out a breast biopsy to get a sample of the suspected tissue. This procedure particularly determines if the lump is a cyst or cancerous.
How can I prevent fibrocystic breast?
Studies are yet to back up this proposition, but it is believed that the reduction of caffeine-containing beverages, chocolates, and other stimulants plays a significant role in preventing fibrocystic breast.
Other dietary measures that may help to prevent fibrocystic breast changes, as well as breast cancer prevention, are reducing large quantities of fat and salt in your food.
How common is fibrocystic breast?
Fibrocystic breast is the most common type of benign breast disease and affects more than half the people assigned female at birth all over the world.
Who is at risk of fibrocystic breast?
Though it can occur at any age, people assigned females at birth who are between 20 to 50 years of age (childbearing age) are more likely to develop fibrocystic breast changes. Postmenopausal individuals who are undergoing hormone replacement therapy consisting of estrogen could also be at risk.
In addition, a study carried out in Taiwan revealed that excessive body fat could increase the levels of estrogen in the body, thereby increasing your chances of developing fibrocystic breast condition.6,7
When should I see a doctor?
You should see your healthcare provider when you notice any of the following;
- The changes continue after your menstruation
- The pain becomes intense and persistent
- A drained cyst reappears
- A new or unmoving lump or thickened breast tissue forms.
According to the American Cancer Society, fibrocystic breast changes are not life-threatening. Because they are a normal occurrence in persons assigned to females at birth, they are no longer regarded as fibrocystic breast diseases. The changes may become less frequent after menopause and rarely develop into cancer.
- McMullen ER, Zoumberos NA, Kleer CG. Metaplastic breast carcinoma: update on histopathology and molecular alterations. Archives of Pathology & Laboratory Medicine [Internet]. 2019 Dec 1 [cited 2023 Aug 7];143(12):1492–6. Available from: http://meridian.allenpress.com/aplm/article/143/12/1492/433835/Metaplastic-Breast-Carcinoma-Update-on
- Fibrocystic Breast Disease [Internet] [cited 8th June 2023] Available from: https://www.ncbi.nlm.nih.gov/books/NBK551609/
- Liu Y, et al. Alcohol intake between menarche and first pregnancy: a prospective study of breast cancer risk. J. Nat. Cancer Inst. 2013;105:1571–1578. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797023/
- Fibrocystic Breast Disease - an overview | ScienceDirect Topics [Internet] [Cited 8th June 2023] Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/fibrocystic-breast-disease#:~:text=What%20Is%20It%3F,half%20of%20all%20American%20women
- Haynes BP, Ginsburg O, Gao Q, Folkerd E, Afentakis M, Buus R, Quang LH, Thi Han P, Khoa PH, Dinh NV, To TV. Menstrual cycle-associated changes in hormone-related gene expression in oestrogen receptor-positive breast cancer. NPJ breast cancer. 2019 Nov 15;5(1):42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858333/
- Campbell KL, Foster-Schubert KE, Alfano CM, Wang CC, Wang CY, Duggan CR, Mason C, Imayama I, Kong A, Xiao L, Bain CE. Reduced-calorie dietary weight loss, exercise, and sex hormones in postmenopausal women: randomized controlled trial. Journal of Clinical Oncology. 2012 Jul 7;30(19):2314. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675691/
- Chen YY, Fang WH, Wang CC, Kao TW, Chang YW, Yang HF, et al. Examining the associations among fibrocystic breast change, total lean mass, and percent body fat. Sci Rep [Internet]. 2018 Jun 15 [cited 2023 Aug 7];8:9180. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003905/