Description

• Benign epithelial lesions are common findings in women and can be divided into nonproliferative and proliferative and with and without atypia.
• Fibrocystic changes (FCC) are not a disease but refers to a group of benign, nonproliferative histologic findings. It is the most frequent female benign epithelial lesion.
• FCC are seen clinically in up to 50% and histologically in up to 90% of women.
• 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
• The sensitivity may be associated with monthly hormonal fluctuations.
• 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 are 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

Epidemiology

FCC occur with great frequency in the general population. It affects women between the ages of 25 and 50 years, and it is rare below the age of 20 years.

Incidence
Unknown but very frequent

Prevalence
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.

Etiology and Pathophysiology

• FCC originate 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.

Risk Factors

• 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.