Breast Conditions: Cancer risk, Cyclic Fibrocystic, Mastalgia, Cysts and Benign Breast Lumps

Millions of women have been sent home from the doctor with a diagnosis of fibrocystic breast disease, unsure about what this means. The word disease sounds foreboding. Even though many of these women probably were also told not to worry about their “disease,” the psychological damage had been done.

Fibrocystic breast disease is just a convenient, albeit inaccurate, term that many doctors still use to describe the pain and any one of the various types of benign lumps or cysts that affect approximately 50% of women. In 1985, the American Cancer Society’s National Task Force on Breast Cancer Control announced that “fibrocystic breast disease” was an unacceptable term.

With the help of the College of American Pathologists, they decided on “benign breast changes” and divided the condition into three groups: breast changes with no increased risk for breast cancer, those with a slightly increased risk, and those with a moderately increased risk.

This method of grouping benign breast changes is not the only approach, however. Dr. Susan Love, author of Dr. Susan Love’s Breast Bookand Dr. Susan Love’s Hormone Book: Making Informed Choices About Menopause, and a well-known spokes-person on women’s health issues, developed a more precise way to explain benign breast changes. Her categories include:

● Normal physical changes, including swelling, lumps, cysts, and mild tenderness; commonly referred to as cyclic fibrocystic changes

● Severe breast pain (mastalgia)

● Inflammation and infections

● Nipple problems (including discharge and cracking)

● Abnormal amount of lumpiness

● Dominant benign lumps

This post explores the different benign breast conditions that can affect women of all ages. Although the breast problems discussed here are often painful and uncomfortable, and can occasionally make it difficult to detect breast tumors, they are not life-threatening. Knowledge is your best weapon against them. Here you will come to better understand your breast condition so that you will be better prepared to deal with it, using the suggestions provided with each explanation.

College of American Pathologists

Relative Risk of Breast Cancer According to Benign Change

RELATIVE RISK An estimate of the probability that a woman with a benign breast condition will develop breast cancer, as compared with a woman who has no known significant breast abnormality.

NO INCREASED RISK Conditions that have no signs of hyperplasia (excessive cell growth): apocrine metaplasia, duct ectasa, fibroadenoma, fibrocystic changes, mild hyperplasia, mastitis.

SLIGHTLY INCREASED RISK (1.5 TO2 TIMES) Moderate or severe hyperplasia, papilloma, sclerosing adenosis.

MODERATELY INCREASED RISK (5 TIMES) Atypical hyperplasia of the ductal or lobular type.

The Anatomy of Change

The breast is composed of two types of tissues: glandular and stromal (supporting). The glandular tissue includes the lobules, which produce milk; and the ducts, which are passageways that carry milk to the nipples. Each breast is divided into 15 to 20 sections, called lobes, which are cushioned by fat cells. Each lobe consists of several lobules, and each lobule has several tiny sacs called acini (or alveoli). These sacs extract needed substances from surrounding blood vessels to produce milk.

The stromal tissue includes fibrous connective tissues, which are the ligaments that support the breast (called Cooper’s ligaments) and fatty tissue. Any of the glandular or stromal tissues can react to fluctuations in hormone levels and hormonal messages that may result in either cancerous or benign breast conditions.  Benign breast problems are discussed below.

Cyclic Fibrocystic Change

According to the American Cancer Society, about 50% of women experience cyclic fibrocystic change sometime during their life. Some women say they can set their calendars by it. The “it” is the monthly occurrence of breast tenderness, pain, and swelling that many women of childbearing age experience before their menstrual cycle. This condition is referred to by various names: breast pain, cyclic fibrocystic changes, and cyclic breast changes are just a few of them. Call it what you like, but it is not a disease, nor is it dangerous.

Why Your Breasts Hurt

Throughout the menstrual cycle, and especially during the 2 weeks before the period starts, it is normal for the glandular tissue in the breasts to feel lumpy (nodular). Pain and tenderness often occur as well. These symptoms are the result of extra blood and other body fluids that accumulate in the breast tissue during this part of the menstrual cycle. Some women have more lumps, pain, or tenderness than others, depending on how sensitive their breast tissue is to hormonal changes, their age (women in their 30s often have more discomfort than younger women), and their hormone balance. After menopause, these symptoms stop, unless you take hormone therapy. Severe breast pain is called mastalgia and does not appear to be related to menstrual cycle changes in most cases (see below).

All of this pain and tenderness makes it difficult if not impossible to do a thorough breast examination. That’s one reason why women are encouraged to do their breast self-exams after their menstrual cycle, when the pain and tenderness are gone. Another reason is that during the 2 weeks before your period your breasts are especially lumpy, which makes it hard to detect any abnormalities.

Scientists have not found any significant relationship between fibrocystic change and breast cancer, and the condition rarely requires surgical treatment. Researchers know that hormones are involved in this cycle of breast pain, but they don’t know exactly how or why they cause symptoms. They can’t blame the high or low levels of any one particular hormone, because women with both high and low hormone levels experience symptoms. One popular theory is that the hormone receptors in the breast vary in their sensitivity, which ultimately depends on the level of essential fatty acids in the body.

Treatment

Until experts can more clearly identify the cause of cyclic fibrocystic changes, there will continue to be many different treatments offered. Several natural approaches that have proven effective in dealing with the pain and discomfort are elimination of caffeine, eating a low-fat diet, and maintaining a reasonable body weight. One study found that a low-fat (15% fat) diet significantly reduced breast tenderness, swelling, and nodularity in 60% of women compared with only 20% in a control group. Foods that contain hormones, such as beef, pork, chicken, and dairy products, also should be avoided. Foods that can help relieve symptoms include citrus, beets, carrots, celery, artichokes, spinach, and cucumbers.

Supplements that have proven helpful include vitamins A, B6, C, and E, and evening primrose oil. If fluid retention is causing the pain, herbal diuretics can be helpful. See below for an overview of treatment options for fibro-cystic breast changes.

TREATMENTS FOR FIBROCYSTIC BREAST CHANGES

● Wear an extra-support bra.

● Eliminate caffeine.

● Take pain relievers, such as ibuprofen or aspirin.

● Apply warm compresses to the breasts.

● Reduce your salt intake (helps reduce swelling).

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● Take oral contraceptives (this is controversial; nondrug approaches should always be tried before resorting to drugs).

● Take diuretics (herbal preferred).

● Take nutritional supplements.

● Take bromocriptine or danazol (prescription drugs for severe cases only. Both drugs can cause serious side effects, including nausea, dizziness, and fertility problems associated with bromocriptine; and weight gain, amenorrhea, and growth of facial hair with danazol.).

● Have the growth drained using fine-needle aspiration.

● Have breast lumps surgically removed (should be the last resort).

Mastalgia (Severe Breast Pain)

Approximately 8 to 10% of premenopausal women experience moderate to severe breast pain, or mastalgia, every month. For many of these women, the pain recurs every month for years, often until they reach menopause.

Mastalgia is a recognized symptom of premenstrual syndrome (PMS), even though not every woman who has PMS experiences severe breast pain. A recent study conducted at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, revealed that most women with mastalgia do not have PMS. Indeed, 82% of the women in the study who had cyclical mastalgia did not have PMS symptoms. Therefore, even though cyclical mastalgia seems to be associated with the menstrual cycle, the investigators report that it is “not simply premenstrual syndrome, and merits further investigation as a recurrent pain disorder.”

Women are encouraged to try natural approaches to relieve the pain of mastalgia.

Breast Cysts

A cyst is a type of lump that is filled with fluid. It can be microscopic (2 millimeters or smaller, called microcysts) or as big as a golf ball (3 millimeters or larger, called macrocysts). Cysts appear in women between the ages of 16 and 50 and are often tender or painful. The most common spot for cysts is the upper outer portion of the breast, where they can be surrounded by milk ducts, fatty tissue, and milk glands. It is not uncommon for women in their late 30s and 40s to regularly develop cysts, because their hormones are undergoing changes as they prepare for menopause. There is some evidence that a lack of iodine, which can cause symptoms of an underactive thyroid gland, can also cause breast cysts. Wearing a bra day and night, especially if it has underwires, may make you susceptible to breast cysts.

Cysts usually feel soft and smooth, or, if they are deep in the breast, they may feel hard. If the lump does not disappear within a menstrual cycle, it should be drained by your physician to determine if the lump is benign. This procedure is known as a fine-needle aspiration, and it is usually done in the doctor’s office.

Preventing and Treating Cysts

Eating a diet that’s rich in vegetables, fruits, and whole grains and that avoids meat and dairy products is helpful. Women who eat a plant-based diet eliminate two to three times more detoxified estrogens than women who eat meat, and thus reduce their risk of cyst formation. Products containing caffeine should be avoided.

Supplements shown to help improve the symptoms of breast cysts include vitamin E, kelp, beta-carotene, vitamin C, chaste tree, evening primrose oil, and B vitamins.

Drug treatment for breast cysts includes the only drug approved by the FDA for this purpose. Danazol (Danocrine) is derived from testosterone and works to block the release of two hormones, FSH (follicle-stimulating hormone) and LH (luteinizing hormone). The result is that estrogen production is blocked. Side effects include weight gain, acne, bloating, and irregular bleeding.

Cysts and Breast Cancer

The link between breast cysts and breast cancer is cloudy. Some studies suggest that women with macrocysts have a 2- to 4-fold increased risk of breast cancer, but other studies show little or no increased risk. One study analyzed the fluid of the cysts from more than 1000 women and found a 5-fold increased risk of breast cancer in those who had a high potassium:sodium ratio compared with a low ratio. This is an interesting theory, but its value has yet to be determined.

If after one or more aspirations the cyst recurs in the same location, your doctor may want to do a biopsy. Even if it is benign, such recurrence is suspicious and may warrant removing the growth to prevent possible cancer growth.

Benign Breast Lumps

Fibroadenomas

Young women in their teens and 20s are the most likely candidates for this type of benign breast tumor. When analyzed according to racial group, the American Cancer Society reports that black women develop these tumors more than any other ethnic or racial group. Fibroadenomas are firm, rounded, rubbery tumors that are nearly always benign and are unrelated to breast cancer. They are composed of structural (fibro) and glandular (adenoma) tissue and typically move around easily when felt. Usually, however, they are too small to be palpated. Some women have only one tumor whereas others develop several.

Women with fibroadenomas who become pregnant or who are breast-feeding may notice that the tumors enlarge during those times. This is normal and does not indicate that they are malignant. Fine-needle aspiration or core-needle biopsy can be used to make a definitive diagnosis of these tumors. Because fibroadenomas often stop growing or shrink without any treatment, physicians typically adopt a wait-and-see approach. If the tumors continue to grow or do not shrink, most surgeons recommend removing them.

Intraductal Papilloma

Intraductal papillomas are benign, wart-like tumors that grow into the breast ducts near the nipple. They can be solitary, which is common among women who are approaching menopause, or multiple. Papillomas are very sensitive to touch, and any slight bump near the nipple can cause the papilloma to bleed or to leak a sticky discharge from the nipple. In rare cases, the discharge becomes bothersome, in which case the damaged duct can be surgically removed. Physicians usually use a procedure called duct excision to diagnose these growths.

Multiple papillomas are common among younger women and usually occur in both breasts. These papillomas are more often associated with a lump than with nipple discharge. Generally, any woman who has multiple intraductal papillomas or any papilloma that is associated with a lump should have the growth(s) removed.

Fat Necrosis

Fat necrosis is a painless, round, firm lump that results from an injury to the breast or from disintegrating fatty tissue. It is common among women who are obese and who have very large breasts. The skin surrounding the lumps may be red or bruised. Most physicians recommend that fat necrosis be removed and a biopsy performed, because these lumps are easily mistaken for cancer.

According to the American Cancer Society, some women respond differently to a breast injury. Instead of scar tissue forming at the injured site, the fat cells die and release their contents, which then form an oil cyst. Oil cysts can be diagnosed using fine-needle aspiration, which can also be used to drain them.

Sclerosing Adenosis

The appearance of excessive tissue growth in the breast’s lobules is a benign condition known as sclerosing adenosis. The condition is characterized by minute, usually microscopic lumps that can be detected on mammography as calcifications, small deposits of calcium in the tissues. Calcifications are common in women older than 50 and are seen occasionally in younger women. More than 80% of them are benign.

Widely scattered calcifications in one or both breasts typically do not cause any concern, but a cluster in one breast may suggest intraductal cancer. Because a mammogram cannot distinguish between benign and malignant calcifications, a biopsy is necessary. If you are younger than 35, chances are very good that the deposits are benign, but it is still important to get a definite diagnosis as quickly as possible (within 4 to 6 weeks) because cancer in younger women generally grows faster than it does in older women.

Duct Ectasia

Also known as mammary duct ectasia, this disease affects women who are approaching menopause. This often painful condition occurs when the ducts beneath the nipple become clogged and inflamed. The result is a thick, sticky, gray-green discharge from the nipples. The nipple and the area surrounding it may be tender and red. Many cases of duct ectasia respond well to hot compresses. Physicians usually prescribe antibiotics and, in severe cases, may recommend surgical removal of the duct.

Mastitis

Mastitis is a bacterial infection of the breast ducts and nipple. It is most often seen in women who are breast-feeding, but it does occur in women who are not. Typical characteristics of mastitis include cracking of the skin around the nipple, swelling, and red, painful breasts that are warm to the touch. Mastitis occurs when bacteria, such as Staphylococcus aureusor Streptococcus, enter the breast duct through the skin cracks. Fever occurs in some women.

Many physicians prescribe an antibiotic, but other, natural options are available, including homeopathic remedies and application of hot compresses to relieve the pain. If an abscess containing pus forms, it needs to be drained. If your physician tells you that you have fibrocystic breast changes, ask for a detailed explanation. You are most likely experiencing symptoms caused by hormonal fluctuations or a benign breast change. An inaccurate diagnosis of fibrocystic breast disease on an insurance form can result in your insurance carrier refusing to cover your medical costs, as well as cause you additional coverage problems down the road.

Most benign breast problems can be resolved using homemade and nondrug treatments: herbs, massage, compresses, and homeopathic remedies.

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