Fibrocystic breast disease
Mammary dysplasia or fibrocystic breast disease (FBD) is the most common cause of breast nodules in women aged 30 to 50 years. It is described as a benign (non-cancerous) condition of the breast currently affecting over 60% of women.
FBD is an association between fibrosis and cysts in the breast tissue. Its cystic component is formed when mammary ducts lock and fill with fluid. The area around the blocked duct then tends to form fibrotic tissue, which is the fiber component.
The causes of this disease are not fully elucidated; it is considered a result of the monthly change in estrogen and progesterone levels. The effect of hormones on the breast tissue is in the increase of lobules and ducts leading to fluid retention in the breast. As a consequence, breasts become sensitive and even painful; the skin nodules may be felt beneath. Such unpleasant feelings usually pass after menstruation, as nodules and tenderness disappear. Therefore, the best time to perform a breast exam is during the first 7-10 days after the start of the menstrual cycle, when breast tissue is in its normal state.
Risk factors for mammary dysplasia include:
- Endocrine diseases: obesity, diseases of the thyroid gland
- Gynecological diseases: ovarian diseases of different nature
- Family history
- Injuries of the breast
- Lack of breastfeeding
- Sexual dissatisfaction
- Psycho-emotional stress
- Liver disorders
- Unhealthy diet: excess of fat, sugar and coffee; excess caffeine in tea, chocolate, caffeinated soft drinks
- Infectious diseases
- Tobacco and alcohol abuse
- Breasts insolation
Fibrocystic breast disease is usually symmetrical (bilateral) and affects both breasts. Fibrocystic damage may be higher in one breast as compared to the other. However, in time, the less affected breast soon reaches the state of the more affected one and, in the end, both are about as fibrocystic.
Symptoms in mammary dysplasia can range from mild to severe. They usually reach a peak before each menstrual period and improve after menstruation.
Below are the main symptoms described for FBD:
- palpation in the breast of a consistent and irregular formation, similar to a “cobblestone”, usually in the upper outer quadrants of the breast;
- persistent or intermittent sensation of discomfort and tenderness in the breast;
- feeling of fullness in the breasts;
- breast pain;
- premenstrual pain and swelling in the breasts, followed by pain relief after menstruation;
- itchiness of nipples;
- green nipple secretion.
Symptoms of diffuse fibrocystic breast disease
The symptoms of diffuse fibrocystic breast disease most often appear in the initial stages. Progression of the disease starts with a subtle feeling of fullness and discomfort in the breast before menstrual bleeding; these feelings pass in the first phase of the cycle. The pain then gets stronger, sometimes reaching the armpit, shoulder, or shoulder blade. In such cases, patients have disrupted sleep. This form is more common in women under the age of 35. In the following stages the soreness disappears, but may cause discharge of different nature from mammary glands: clear, yellowish, greenish, colostrum-type and other. The painful feeling of compression, along with the discharge from nipples worsen in the premenstrual period, after which their intensity decreases. Even so, complete softening of the nodule does not occur.
Symptoms of nodal fibrocystic breast disease
The symptoms of nodal fibrocystic breast disease are more common in women aged from 30 to 50 years. Nodes in the breast are more pronounced, with distinct borders, unlike nodes in diffuse form. The easiest way to test the node is by maintaining a standing position; when lying down, nodes lose their sharpness at the borders, disappearing into the gland tissue. Nodules may appear in one or both glands, and can be single or multiple. They occur on a background of diffuse changes and may be accompanied by a discharge from the nipple.
Nodal diseases of the breast should be more carefully examined for malignancy, as the symptoms of cancer and nodal mammary dysplasia are very similar.
Clinical examination shows the presence of one or more mobile masses in the breast. These masses are usually round, with smooth edges, of irregular or variable form.
Mammography, or the X-ray picture of mammary glands, is the leading method for diagnosis of breast diseases and is widely used as screening for breast cancer. The method’s sensitivity is of 96-98%. Mammography is performed in the first phase of the menstrual cycle (i.e. the first 12 days). If breast cancer is suspected, the examination is performed regardless of the day of the cycle. All women aged 35 to 40 years are advised to undergo this survey.
Depending on the known risk factors, women aged 40-50 years must actively request a mammogram every year or every two years, while women over 50 should have one every year. Annual inspection is also recommended to women belonging to risk groups.
Ductography — a method of X-ray with the introduction of contrast into milk ducts. The indication for the study is serous or bloody discharge from the nipple.
Breast ultrasound is also performed in the first phase of the menstrual cycle (up to 12 days, excepting cases of suspected breast cancer, where ultrasound is carried out regardless of the day of the cycle). It is a more sensitive method for young women in whose mammary glands prevail denser connective tissues.
Pneumocystography shows the presence of breast cysts. The cyst is punctured and aspirated, after which it is filled with gas and pictures in the anterior and lateral projections are taken. Injected gas dissolves itself in 7 to 10 days. Often, after aspiration of its contents, the cyst is cured.
Cytological examination — the material for cytological examination is obtained by swabbing the emitted stain from the nipple of the breast during the puncture-aspiration biopsy.
Puncture is used to establish a definitive diagnosis of breast lumps of unclear origin, to confirm the diagnosis and determine the structure of the tumor in a diagnosis of cancer, to determine the degree of morphological changes in tumors after radiation or chemotherapy.
Sectoral resection is used to establish a definitive diagnosis in doubtful cases, and as a treatment for benign nodules of the breast.
Additional research methods of the FBD diagnosis include:
Thermography — skin temperature recorded on a film in benign and malignant tumors, which is higher than in normal tissue.
CT and MRI are more expensive methods of widespread use in clinical practice for the diagnosis of fibrocystic breast disease.
Along with targeted screening carried out by medical staff, breast self-examination plays an important role in the early diagnosis of fibrocystic breast disease.
In patients who do not complain of discomfort in the breast and in whom the disease was accidentally detected, treatment is generally not required. Upon first suspicion of the disease, they are prescribed a comprehensive examination (mammography, ultrasound, diagnostic puncture) with a follow-up visit to the gynecologist or mammologist once a year.
Patients with moderate cyclical or permanent form of engorgement combined with breast tenderness and diffuse cystic fibrosis in the glands tissue are prescribed a treatment that starts with a special healthy diet and a correction of hormonal imbalance. Most often, the disease is peculiar to young women who have no other health problems.
If a woman complains of severe permanent or cyclical pain in the breast, and palpation reveals changes in the structure of the breast, combined with induced or spontaneous secretions from the mammary glands, such a condition should be corrected with the help of modern treatment methods.
There is no particular method of treatment for fibrocystic breasts, because in each case there are different causal factors that require correction beforehand:
- Psychosomatic disorders;
- Hormonal disorders;
- Metabolic disorders, etc.
The selection of existing treatments should be made by a qualified specialist.
Doctors should prescribe hormonal treatment only after receiving the results of hormonal blood tests. All hormonal drugs included in the FBD treatment program are comprised of:
- antiestrogen drugs that suppress estrogens in the first half of the menstrual cycle and consequently decrease the proliferation of breast tissue;
- androgen drugs that inhibit the synthesis of pituitary gonadotropins;
- progestin drugs containing progesterone; sometimes hormonal contraceptives are used, containing high doses of progesterone and small doses of estrogen;
- drugs that suppress the synthesis of prolactin;
- GnRH from the hypothalamus, which controls the synthesis by the pituitary gland of luteinizing hormones, responsible for the maturation of corpus luteum, which produces progesterone;
Typically expressed nodal fibrocystic breast disease, when nodules are clearly defined, requires surgical treatment, which includes nodule excision followed by histological examination. Conservatory treatment of nodal FBD can only be made in the early stages, when there is no pronounced discomfort and pain. Surgical correction is performed rarely and in very severe cases.
Prevention of fibrocystic breast disease includes a healthy lifestyle, breastfeeding, observance of hygienic rules and periodic checkups.
Women should take care of their health in time, avoid missing the first signs of the disease and, if necessary, seek for medical advice. Once the diagnosis of fibrocystic breast disease is established, the patient’s further attitude towards her usual habits must change, in order to prevent negative development. Untreated, this disease threatens the woman’s quality of life with severe complications that may require surgical intervention.