Fibrocystic change is an all-encompassing diagnosis used by both primary care providers and breast radiologists. The term may be used to explain certain symptoms in the breast, certain imaging findings in the breast, AND/OR pathology results from a breast biopsy.
Terms Used to Describe Fibrocystic Change
There are many terms used to describe fibrocystic change:
- Fibrocystic breast disease
- Diffuse cystic mastopathy
- Fibrosclerosis of the breast
- Chronic cystic mastitis
No matter the term used…this is a benign (non-cancerous) condition.
Symptoms of Fibrocystic Change
- breast pain
- lumps in one or both breasts
- breast swelling
- breast tenderness
- breast thickening
For the primary care provider, the diagnosis is used to explain breast symptoms and physical exam findings that are consistent with fibrocystic change. These symptoms are generally related to the normal hormonal stimulation of breast tissue most often seen during puberty, throughout the menstrual cycle, and during perimenopause/menopause. Although the diagnosis can be made without breast imaging, ALL new breast symptoms should be fully evaluated by your primary care provider and with possible diagnostic breast imaging depending on the clinical breast examination findings to ensure that there is not a more serious cause of the symptoms.
Breast radiologists are looking for the following breast imaging findings to diagnose fibrocystic change of the breast:
- Dense breast parenchyma as seen on mammography
- Breast cysts of varying sizes may or may not be visible by mammography
- Cysts of varying sizes, sometimes with small clusters of tiny cysts noted in one area of the breast or in clusters throughout the breast as seen on breast ultrasound
Biopsy IS NOT necessary to confirm the diagnosis of fibrocystic change. A biopsy is only performed if there is an imaging finding that is not conclusively fibrocystic change and the breast radiologist feels that a biopsy is warranted to ensure that the abnormality does not represent breast cancer.
Not all women who experience significant breast symptoms related to hormone stimulation of the breast tissue have fibrocystic changes seen by breast imaging. As mentioned before, this is a catch-all term that is used to explain the patient’s breast symptoms OR to explain the breast imaging findings. Having both the symptoms and imaging findings of fibrocystic change are not necessary to make the diagnosis.
Conversely, not all women with dense breast parenchyma have fibrocystic change. To make the diagnosis of fibrocystic change with breast imaging, the following should be seen:
- dense breast parenchyma as seen by mammography
- breast cysts are best seen by breast ultrasound
It is important to be familiar with how your breast tissue normally feels by performing a monthly self-breast examination, as most women feel lumps or differences in breast thickness in the normal breast. In theory breast lumps and pain should be more prominent in women who have a higher concentration of glandular tissue. This is because hormones stimulate glandular tissue, leading to the symptoms of fibrocystic change. The more glandular tissue in the breast, the more likely it is you will experience breast symptoms related to fibrocystic change. However, I see plenty of women who report lumps and pain in the breast whose breast tissue is predominantly fatty with little to no glandular tissue.
No matter how the diagnosis is made, fibrocystic change is a benign condition that does not increase the patient’s lifetime risk of developing breast cancer. However, it is important to be familiar with the lumps in your breast by performing a monthly self-breast exam and to be aware of normal times when breast pain is most prominent. Often breast pain can be related to the menstrual cycle, with symptoms most noticeable the week prior to menses. If you are comfortable with the breast symptoms that are normal for you, you will be more likely to seek appropriate medical attention when any new breast symptoms develop.