![]() Large cysts are more common in women aged 25 to 50-an age group when cancer just begins to apear. In women under age 25, it can be observed over time. A fibroadenoma is a rubbery, smooth, benign, fibrous tumor common in younger women. Most commonly they are either fibroadenomas or “gross” (obvious) cysts. They persist over time, and except in the very young demand some kind of assessment. These outright noncyclical unilateral lesions are clearly distinct on all sides from the surrounding breast tissue. Only a fraction, roughly the 5 percent that show atypical hyperplasia, carry a significantly increased risk of breast cancer, especially when coupled with a positive family history. None of these conditions places one at increased risk for cancer, and all are self-limited. When these lesions are biopsied or, preferably, a sample of cells is taken in the office through a needle to be looked at microscopically (fine-needle aspirate), some 70 percent will show “non-proliferative changes (adenosis, fibrosis, microcysts, mild hyperplasia, and more) some 20 percent will show “proliferative changes without atypia”- mostly epithelial hyperplasia. When palpation of the lump reveals that the density merges in one or more places with the surrounding breast tissue, it is considered non-dominant and may be comfortably observed for change over time. Non-Dominant MassesĮven densities that are not symmetrical are largely due to benign non-progressive causes but do require careful distinction from dominant masses. Symmetry is important finding a mirror-image thickening in the opposite breast indicates a normal condition. Glands can be more or less prominent and more or less obscured by fat or fluid, so all breasts feel different. It is a mix of glands, fat, and connective tissue. Normal breasts are always irregularly textured because the tissue they are made of is not homogeneous. The distinction between these and normal breasts is often simply a matter of degree. ![]() Breast nodularity or diffuse lumpinessīreast lumpiness- the most worrisome category in most’ women’s minds- may be either cyclic or non-cyclic, and might or might not include pain. Painful swellings that flux with the cycle unchanging over time are not worrisome as cancers signals. In contrast, breast cancer presents as a unilateral painful firm lump about 5 percent of the time. Pain may be due to old trauma, acute infection, or sometimes something related to the chest wall. Women who suffer from noncyclical pain are rarer, and the pain is less likely to be hormonal in cause. Physiologic cyclical mastalgia is this severe about 15 percent of the time, and comprises the bulk of this group. Mastalgia refers to any breast pain severe enough to interfere with the quality of a woman’s life, causing her to seek treatment. Women who take exogenous estrogen, such as oral contraceptives or estrogen replacement therapy during menopause, may be similarly affected. Most women tolerate this well enough once reassured it is normal, and the symptoms always resolve with menses. Other women may have average amounts of progesterone but increased tissue sensitivity to estrogen with related fluid retention. Sometimes less progesterone is made late in the cycle, as in irregular ovulation. This has been attributed to a more prominent estrogen than progesterone effect on breast tissue at this time. Many women notice painful or sensitive breasts just prior to menstruation. Tender or lumpy breasts are one of the most common reasons why women consult their women’s health practitioner for both assessment, examination and treatment. Physiological, Cyclical Pain and Swelling ![]() ![]() This reinforces misinformation and fear and obscures the safe and simple means that exist for obtaining relief and reassurance. Unfortunately, our health care system requires a diagnostic code to reimburse services, and fibrocystic breast disease has one, even though the medical literature is replete with reasons why it shouldn’t. Moreover, the widespread misconception that women with painful or lumpy breasts are at increased risk of breast cancer borders on the tragic. First of all, the benign breast conditions that are present in almost all of us to some degree should never have been given the “disease” label in the first place. ![]() Virtually all knowledgeable health care providers agree that the term fibrocystic breast “disease” or “condition” should be abandoned in favor of a more accurate physiologically based description. Since painful breasts are not always lumpy, and lumpy breasts are not always painful (and neither is usually abnormal), it is useful to create descriptive categories of symptoms and conditions to replace the generic term “fibrocystic”. Tender or lumpy breasts are one of the most common reasons why women consult their gynecologists for assessment and treatment. ![]()
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