Fibrocytic disease

Question 1

Define fibrocystic disease.

Answer 1

Benign condition in which the breasts feel lumpy.

Question 2

What is the epidemiology of fibrocystic disease?

Answer 2

· Incidence increases with age, and then decreases from 49 years.
· Peak incidence is women in their 3rd and 4th decades.
· Women of childbearing age.

Question 3

What is the pathophysiology of fibrocystic disease?

Answer 3

· The association of fibrocystic breasts with reproductive and hormonal factors is the most likely explanation for the cyclical nature of symptoms.
· Patients who have fibrocystic changes with lumpy breasts do not have breast disease. These changes don’t correlate with an increased risk of breast cancer.
· Fibrocystic changes of the breast reflect a broad spectrum of conditions that carry different risks for future development of breast cancer.

Question 4

List some risk factors that may cause fibrocystic disease.

Answer 4

· Late-onset menopause.
· Age (30-50).
· Later age at first childbirth. 
· Nulliparity increases the risk. High parity decreases the risk. 
· Obesity. 
· Oestrogen-replacement therapy.

Question 5

What is the aetiology of fibrocystic disease?

Answer 5

· Higher cellular proliferation of the breast epithelium may contribute.
· Nulliparity and late menopause can increase the risk of fibrocystic breast disease.
· High parity can decrease the risk.
· Increased incidence with the use of oestrogen-replacement therapy.

Question 6

What are the common signs and symptoms of fibrocystic disease?

Answer 6

· Mastalgia (breast pain).
· Diffuse symmetrical lumpiness through both breasts.
· Breast tenderness.

Question 7

How can mastalgia present?

Answer 7

· May be cyclical. Precedes onset of menses and ceases after.
· Constant and dull. Can be throbbing or burning.
· Diffuse and bilateral.
· May also be non-cyclical.

Question 8

What is diffuse symmetrical lumpiness through both breasts and where are the lumps usually found?

Answer 8

· Non-cancerous breast lumps that can sometimes cause discomfort, often periodically related to hormonal influence from the menstrual cycle – diffuse symmetrical lumpiness through both breasts.
· Lumps are smooth with defined edges.
· Usually free moving in regards to surrounding tissue.
· Most often found in the upper, outer section of the breast.

Question 9

What investigations can be done to diagnose suspected fibrocystic disease?

Answer 9

· Mammography.

· Breast USS.

Question 10

List some differential diagnoses.

Answer 10

· Chest wall pain. Constant and non-cyclical.
· Costochondritis.
· Fibroadenoma.
· Breast cancer.

Question 11

What treatment options are available for mastalgia?

Answer 11

· 1st line - Supportive measures.
· Adjunct - Analgesia.
· Adjunct - Evening Primrose Oil.
· 2nd line - Hormonal therapy&raquo_space;> tamoxifen (primary), bromocriptine (secondary), danazol (tertiary)
· WITH symptomatic breast cyst - cyst aspiration.
· WITH atypical ductal hyperplasia - removal of lesion and risk reduction strategies.

Question 12

What complication can occur?

Answer 12

Breast cancer.