by Elaine Gottlieb
Do your breasts feel lumpy? In most cases, you're probably experiencing fibrocystic breast changes—a benign condition that occurs in at least 60 percent of all women of child-bearing age.
It sounds very unglamorous, but the human breast is no more than a lumpy gland made up of milk glands and ducts and the tissues that separate and support them. Most breasts have at least a lump or two; however, if your breast feels especially lumpy and uncomfortable, you're probably experiencing fibrocystic breast changes.
"The vast majority of women have [fibrocystic changes]...and are no worse for it," reports Dr. Carolyn Kaelin, a gynecologist and director of the breast clinic at Brigham & Women's Hospital in Boston.
What are fibrocystic changes?
Fibrocystic changes are benign breast changes. The medical literature used to refer to them as "fibrocystic disease," but that was before fibrocystic changes were found to be no more a disease than menstruation or menopause. The breast tissue may feel dense with an irregular area of thicker tissue with a lumpy or ridge-like surface. You might also feel tiny bead-like masses scattered throughout the breasts.
Your breasts may feel tender, swollen and full with a dull, heavy pain. They may be sensitive to touch with a burning sensation. This discomfort is normal and does not indicate the presence of disease. For some women the pain is so severe that they cannot exercise or lie on their stomachs. Fibrocystic changes usually occur in both breasts, most often in the upper outer quadrant and the underside of the breast where most of the milk-producing glands are located.
Why does this happen?
Fibrocystic changes are associated with hormonal shifts in estrogen and progesterone, which affect the breast tissue. During the menstrual cycle, the breasts swell as the milk glands and ducts enlarge and the breasts retain water. After menstruation the breast swelling goes down and the breasts return to normal.
Fibrocystic changes generally begin when women are in their twenties or thirties and usually last until menopause. For a small number of women, the condition worsens over the years, causing constant pain and lumpiness. In general, some of the lumps become permanent and may or may not shrink after menopause.
Some women with fibrocystic changes develop cysts in their breasts. A cyst is a fluid-filled sac that is usually smooth, firm, movable and sometimes tender—like a water balloon without the water. The cyst will generally increase in size before the menstrual period and decrease afterwards. A large cyst may be round and feel a bit like an eyeball when pressed with the eyelid closed.
If you are concerned about a lump, your health care provider can determine whether or not it warrants further attention. Determining whether a lump is a cyst or something more serious can be determined by a simple office procedure known as fine needle aspiration. A fine-gauge needle is inserted into the lump and fluid is withdrawn.
If the lump is a cyst, as is the case 95% of the time, it will collapse once the fluid is removed. If it's a complex cyst, the next step is an ultrasound-guided fine needle aspiration that would likely cause the cyst wall to collapse. "If we were concerned that there was something in the cyst wall, we would proceed with a biopsy," says Kaelin.
While there is no definitive, medically proven treatment for breast pain caused by fibrocystic changes, there are various remedies that can be helpful.Foods and supplements
- Avoiding foods and beverages containing caffeine, such as coffee, tea, chocolate and soft drinks, can decrease water retention and may help to alleviate the discomfort. Reducing fat in the diet may also be helpful. Various herbs, vitamins and natural preparations, such as evening primrose oil and vitamins B6 and E, are sometimes effective. Women who stop smoking sometimes notice that their lumps decrease.
- Aspirin and other pain relievers, as well as the application of heat can relieve uncomfortable symptoms, as does wearing a bra that provides firm support. In worse case scenarios, oral contraceptives—which change the hormonal balance—can lessen fibrocystic changes. For severe cases, Danazol, a synthetic form of the hormone androgen, may be prescribed. However, many women find that the side effects of Danazol, including weight gain, hair growth and voice changes, are more distressing than the fibrocystic discomfort.
"Finding out what works for individual women is a trial and error process. If there was one good way to treat the discomfort, everyone would be treated that way. Not every remedy works for everyone but hopefully, at least something works for everyone," Kaelin observes.
Fibrocystic changes and breast cancer
There is no correlation between fibrocystic changes and breast cancer. There are some variations in breast tissue that create a predisposition to breast cancer, but this is rare. The best way to alleviate concerns about these cyclic changes is to examine your breasts every month seven days after your period when hormone levels are lowest and there is less texture. That way you'll know what degree of texture and lumpiness is normal for your breasts and be able to detect changes. It's also a good idea to keep a diagram of the textured areas, says Kaelin.
Kaelin strongly advises women to have a clinician examine their breasts once a year; this should be done in addition to mammograms since 10%-15% of lumps elude detection by mammogram. Any woman who is concerned about the texture of her breasts need only talk with other women, says Kaelin, to find out just how common lumpiness and texture are.How to examine your breasts
In the shower
- It is normal to have some lumpiness or thickening in the breasts. By examining your breasts once each month, you will learn what is normal for you and notice when any changes do occur. Some women find that doing a weekly self-exam works better for them. They learn how their breasts feel at all phases of their menstrual cycles. The more you can examine your breasts, the better you can learn what is normal for you. Your job isn't just to find lumps, but to notice if there are any changes.
In front of a mirror
- With your fingers flat, move gently over every part of each breast. Use your right hand to examine the left breast and your left hand to examine the right breast. Check for any thickening, hard lump or knot.
- Check your breasts with your arms at your sides. Then raise your arms overhead. Look for any changes in the shape of each breast, swelling, dimpling or changes in the nipples.
- To examine your right breast, put a pillow under your right shoulder. Place your right hand behind your head. Then with the flat fingers of your left hand, press gently in small circular motions around an imaginary clock face. Begin at the outermost top of your right breast for 12 o'clock, then move to 10 o'clock, etc. until you get back to 12 o'clock. Each breast will have a normal ridge of firm tissue. Then move in one inch toward the nipple, including the nipple. Keep circling to examine every part of your breast including the nipple.
- Repeat the procedure on the left breast with a pillow under the left shoulder and your left hand behind your head. Finally, squeeze the nipple of each breast gently between the thumb and index finger. Any clear or bloody discharge should be reported to your physician immediately.