Fibrocystic Changes of the Breast
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- Fibrocystic changes (FCC) is not a disease but refers to a constellation of benign histologic findings. It is the most frequent female benign clinical breast finding.
- FCC may also be described as aberrations of normal development and evolution.
- The most common symptoms are cyclic pain, tenderness, swelling, and fullness.
- The breast tissue may feel dense with areas of thicker tissue having an irregular, nodular, or ridge-like surface.
- Women may experience sensitivity to touch with a burning sensation. For some, the pain is so severe that it limits exercise or the ability to lie prone. Usually affects both breasts, most often in the upper outer quadrant where most of the milk-producing glands are located.
- Histologically, in addition to macrocysts and microcysts, FCC may contain solid elements, including adenosis, sclerosis, apocrine metaplasia, stromal fibrosis, and epithelial metaplasia and hyperplasia.
- Depending on the presence of epithelial hyperplasia, FCC is classified as nonproliferative, proliferative without atypia, or proliferative with atypia (1).
- Nonproliferative lesions are generally not associated with an increased risk of breast cancer.
- System(s) affected: endocrine/metabolic, reproductive
- Synonym(s): diffuse cystic mastopathy; fibrocystic disease; chronic cystic mastitis; or mammary dysplasia
FCC occurs with great frequency in the general population. It affects women between the ages of 25 and 50 years, and it is rare at age <20 years.
Unknown but very frequent
Up to 1/3 of women aged 30 to 50 years have cysts in their breasts (1). It most commonly presents in the 3rd decade, peaks in the 4th decade when hormonal function is at its peak, and sharply diminishes after menopause.
- With hormone replacement therapy, FCC may extend into menopause.
- Less common in East Asian races
Etiology and Pathophysiology
- FCC originates from an exaggerated response of breast stroma and epithelium to a variety of circulating and locally produced hormones (mainly estrogen and progesterone) and growth factors.
- Cysts may form due to dilatation of the lobular acini possibly due to imbalance of fluid secretion and resorption or due to obstruction of the duct leading to the lobule.
- In many women, methylxanthine-containing substances (e.g., coffee, tea, cola, and chocolate) can potentiate symptoms of FCC, although a direct causality has not been established.
- Diet high in saturated fats may increase risk of FCC.
Commonly Associated Conditions
FCC categorized as proliferative with atypia confers a higher risk of breast cancer.