RISK FACTORS: Unknown, The effect of consumption of methylxanthine-containing
substances, e.g., coffee, tea, cola, and chocolate is controversial
ADVICE : MAMMOGRAPHY & FNAC TO RULE OUT BREAST CANCER
GENERAL MEASURES
β’ Evaluate to be certain there is no malignancy by means
of imaging and diagnostic procedures
β’ Pain rarely severe or disabling
β’ Frequently resolves spontaneously
β’ Reassure patient there is no malignancy
β’ Cold compresses may be helpful
β’ Well fitting, supportive brassiere (worn night and day)
SURGICAL MEASURES : Possibly excision (under local anesthesia) of benign fi broadenoma or phyllode tumors, and fat necrosis lesions
DIET Abstention from methylxanthines (coffee, tea, caffeine-containing soda and chocolate)
DRUG(S) OF CHOICE
β’ For cyclical pain and swelling unresponsive to general measures - oral contraceptives have been shown to
decrease the risk of fi brocystic breast disease; spironolactone (Aldactone) 10 mg bid premenstrually may
be helpful or vitamin A 150,000 IU daily for 3 months; vitamin E 300-600 IU a day for 3 months
β’ For more severe disease - danazol (Danocrine) 100-200 mg per day or bromocriptine 2.5 mg bid for 3 months may be useful, but side effects and expense limit their usefulness
PATIENT MONITORING :
β’ Patients with fi brocystic change may have an increased risk of malignancy
β’ If there is no atypia on biopsy the risk is only minimally increased
β’ Patients need to be assessed with clinical examination, radiological studies, and, sometimes, biopsy to be
certain a given lump is not malignant
β’ Followup times are variable depending on the clinical situation. A young patient in whom physiological
nodularity is suspected should be observed through one menstrual cycle.
β’ Mammograms should be obtained at age 35, at least every 1-2 years after age 40, and yearly after age 50
β’ Ultrasound is useful to differentiate cysts from solid lesions, but is not used for screening
β’ Aspiration cytology is useful for diagnosis of cysts and solid lesions. The false positive rate ranges from
0-5.8%, and the false negative rate from 1.7-22%.
β’ When physical examination, mammography, and needle aspiration are used in combination, detection rates for breast cancer range from 93-100%
PREVENTION/AVOIDANCE Avoiding caffeine may reduce breast pain
POSSIBLE COMPLICATIONS :
β’ Fibrocystic change can make physical examination and mammograms difficult to interpret
β’ Atypical hyperplasia may lead to cancer
EXPECTED COURSE/PROGNOSIS:
Benign, chronic, recurring, intermittent