Fibrocystic Breast Condition


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Fibrocystic Breast Condition

DRG Category:601
Mean LOS:3.6 days
Description:MEDICAL: Nonmalignant Breast Disorders Without CC or Major CC

Fibrocystic breast condition (sometimes called fibrocystic complex) is the most common type of benign breast disorder. It was previously referred to as fibrocystic breast disease. Fibrocystic breast condition is a catch-all diagnosis used to describe the presence of multiple, often painful, benign breast nodules. These breast nodules vary in size and blend into surrounding breast tissue. However, the histological changes responsible for the breast nodules could belong to one of several different categories.

The College of American Pathologists has categorized the types of fibrocystic breast condition according to the associated increased risk for subsequent invasive breast cancer and the particular histologic (microscopic) change that is present: no increased risk (nonproliferative changes, including microcysts, adenosis, mild hyperplasia, fibroadenoma, fibrosis, duct, apocrine metaplasia, and gross cysts); slightly increased risk (relative risk, 1.5 to 2; proliferative changes without atypia, including moderate hyperplasia and papilloma); moderately increased risk (relative risk, 4 to 5; proliferative changes with atypia or atypical hyperplasia); and significantly increased risk (relative risk, 8 to 10; ductal and lobular carcinoma in situ).

Causes

The monthly variations in the circulating levels of estrogen and progesterone are thought to account for most fibrocystic breast changes. Although the exact contribution of each hormone is not well understood, it is believed that an excess amount of estrogen over progesterone results in edema of the breast tissue. At the onset of menses, hormone levels decrease and the fluid responsible for the breast edema is removed by the lymphatic system. All the fluid in the breast may not be removed; eventually, the fluid accumulates in the small glands and ducts of the breast, allowing cyst formation.

Genetic considerations

Having a family history of cyst formation is common among women with fibrocystic breast disease.

Gender, ethnic/racial, and life span considerations

Fibrocystic changes that cause premenstrual pain, tenderness, and increased tissue density usually begin when a woman reaches her mid 20s to early 30s. Cysts occur most frequently in women in their 30s, 40s, and early 50s. Advanced stages can occur during the mid to late 40s. Symptoms should resolve and cysts should disappear once menopause is complete. However, symptoms may persist in women who are taking hormone replacement therapy for menopausal discomfort. Breast cysts are uncommon in women who are 5 years postmenopause and are not undergoing hormone replacement therapy. Therefore, the possibility of a more serious breast problem in any woman who is more than 5 years postmenopause and who presents with a breast mass should be carefully investigated. Ethnicity and race have no known effects on the risk for fibrocystic breast.

Global health considerations

Limited data are available internationally. Some evidence exists that rates among Japanese women are lower than other groups of women because they consume a diet high in iodine from seafood intake.

Assessment

History

Elicit a reproductive history. Women with a fibrocystic breast condition often have a history of spontaneous abortion, shortened menstrual cycles, early menarche, and late menopause. Patients are frequently nulliparous and have not taken oral contraceptives. Cyclic, premenstrual breast pain and tenderness that last about a week are the most common symptoms. With time, the severity of the breast pain increases, and onset occurs 2 to 3 weeks before menstruation. In advanced cases, the breast pain can be constant rather than cyclic.

Fibrocystic breast changes usually occur bilaterally and in the upper outer quadrant of the breast. A woman may appear with gross nodularity or with one or more defined lumps in the breast. The abnormality may be described as a hardness or a thickening in the breast. The areas are usually tender and change in size relative to the menstrual cycle (becoming more pronounced before menstruation and decreasing or disappearing by day 4 or 5 of the cycle). Approximately 50% of patients have repeated episodes of breast cysts.

Physical examination

The most common symptoms include premenstrual breast pain and tenderness. The breasts should be inspected in three positions: with the patient’s arms at her side, raised over her head, and on her hips. Instruct the patient to “press in” with her hands on the hips to contract the chest muscles. Compare her breasts for symmetry of color, shape, size, surface characteristics, and direction of nipple. Women with deep or superficial cysts or masses may have some distention of breast tissue in the affected area, but often, no changes are noted on examination. Dimpling, retraction, scaling, and erosion of breast tissue indicate more serious breast conditions, and none of these disfigurations are usually found in fibrocystic breast condition.

Palpate the breasts in both the sitting and the supine positions. Use the pads of the three middle fingers to palpate all breast tissue, including the tail of Spence, in a systematic fashion. Breast cysts are filled with fluid and feel smooth, mobile, firm, and regular in shape. Superficial cysts are often resilient, whereas deep cysts often feel like a hard lump. Cystic lesions vary from 1 to 4 cm in size, can appear quickly, are often bilateral, and occur in mirror-image locations.

To conclude palpation of the breasts, gently squeeze the nipple. About one-third of women with advanced fibrocystic change experience nipple discharge. Nipple discharge in benign conditions is characteristically straw-yellowish, greenish, or bluish in color. A bloody nipple discharge often signals the presence of ductal ectasia or intraductal papillomatosis and should be further evaluated.

Psychosocial

Finding a lump or irregularity in the breast is distressing. The almost “overnight” appearance of cysts can make a woman doubt the validity of a recent negative physical examination or mammogram. In addition, the pain associated with advanced fibrocystic changes can be debilitating. Assess the patient’s prior experience with breast problems and her use of coping strategies.

Diagnostic highlights

General Comments: Diagnostic testing is needed to rule out malignancy as well as to confirm the diagnosis. Some 80% of breast lumps are found to be benign.

TestNormal ResultAbnormality With ConditionExplanation
Fine-needle aspiration (FNA)Not applicableGreen, brown, or yellow fluid obtainedConfirms diagnosis; bloody fluid is suspicious and should be sent to pathology
MammogramNo tumor notedWell-rounded mass with a discrete border noted (cyst); vague asymmetrical radiodensity (white)Confirms diagnosis
UltrasoundNo abnormalities seenWill show a fluid-filled mass, which is consistent with a cyst (not a solid mass, which is consistent with a malignant lump)Confirms diagnosis
BiopsyBenignBenignPerformed if a lump remains after an FNA, to diagnose cancer

Primary nursing diagnosis

Diagnosis

Pain (acute, chronic) that is related to edema, nerve irritation, and a pinching sensation in the breast

Outcomes

Comfort level; Pain control; Pain: Disruptive effects

Interventions

Analgesic administration; Pain management

Planning and implementation

Collaborative

The physician will attempt an FNA of a breast mass that appears to be cystic. Once the fluid is removed, the cyst collapses and the pain is relieved. Medical therapies may be used in an effort to decrease breast nodularity and relieve breast pain and tenderness.

Pharmacologic highlights

Medication or Drug ClassDosageDescriptionRationale
Low-estrogen, high-progesterone oral contraceptivesEstrogen and progesterone dosages vary; 1 tab q dayEstrogen-progesterone combinationSuccessful in 60%–70% of young women; relieves pain during the first cycle and improves the condition in 6 mo
Danazol (Danocrine)50–200 mg PO bid or tid, until desired response, then weanSynthetic androgen (gonadotropin inhibitor)Effective with 70%–90% of women with repeat episodes
Tamoxifen (Nolvadex)10 mg PO q dayAntiestrogenPrescribed for perimenopausal women

Controversial Therapy: The efficacy of vitamins E and A in reducing the symptoms of fibrocystic changes has been reported with conflicting results. Likewise, the benefit achieved by decreasing or eliminating the intake of methylxanthine (caffeine) has met with controversy. Injection of omega-3 fatty acids are now being investigated as an anti-inflammatory and antiproliferative compound to reduce nonproliferative breast disease. Iodine intake has also been implicated as a protective mechanism to promote breast health.

Independent

Women who are undergoing evaluation for a breast lump need support and understanding, especially if it is the patient’s first experience with the condition. Encourage the patient to express her feelings. Explain the purpose and procedure of diagnostic studies and surgical techniques (FNA, excisional biopsy). Encourage patients to request information as to the exact nature of a benign breast lump (such as whether it was nonproliferative or proliferative), and explain the actual risk for malignant breast disease that is associated with the various histological changes.

Advise the patient to wear a brassiere that offers good support. Assess the amount of caffeine and salt present in the diet. Help the patient identify foods that are high in these substances and adopt measures to reduce their dietary intake. Other suggested dietary patterns that may decrease fibrocystic breast are supplementing diet with vitamin B6 and primrose, eating organic foods, and avoiding unnecessary chemicals. Some organic topical substances such as soothing oils and poultices may lead to pain relief.

Evidence-Based Practice and Health Policy

Gumus, I.I., Koktener, A., Dogan, D., & Turhan, N.O. (2009). Polycystic ovary syndrome and fibrocystic breast disease: Is there any association? Archives of Gynecology and Obstetrics, 280(2), 249–253.

  • Women with hormonal dysfunction, such as those with polycystic ovarian syndrome (PCOS), may be at greater risk for developing other hormone-related conditions, including fibrocystic breast condition.
  • A case-control study that compared 53 women diagnosed with PCOS to 40 women without PCOS revealed significant differences in the proportion of women with fibrocystic changes in one or more breasts. Eight percent of the women without PCOS had fibrocystic breast disease compared to 39.6% of women diagnosed with PCOS.
  • Women with PCOS were 3.17 times more likely to be diagnosed with fibrocystic breast disease than women without PCOS (95% CI, 1.31 to 7.68; p = 0.004).

Documentation guidelines

  • Description of breast lump or any breast abnormality: Location, size, texture; color and amount of any nipple discharge
  • Characteristics, location, intensity, duration of breast pain

Discharge and home healthcare guidelines

care of the puncture site.
Leave the bandage in place for 24 hours; report any pain, warmth, severe ecchymosis, or drainage. Emphasize to the patient that it is not uncommon for more cysts to form.

care of incision.
Leave the dressing in place until the sutures are removed; clean the site gently with soap and water once sutures are removed; teach the patient how to empty the drains if any are present.

medications.
Explain the purpose, action, dosage, desired effects, and side effects of all medications that have been prescribed by the physician.

follow-up visits.
Women with gross cysts or solid masses in the breast are often seen every 6 months for repeat physical examinations.

early detection procedures.
Assess the patient’s knowledge and performance of breast self-examination (BSE); reinforce and teach the BSE technique as indicated. Explain the importance of adhering to the follow-up visit schedule as recommended by the physician and to the American Cancer Society’s recommendations for screening mammography: first screening by age 40, mammography repeated every 1 to 2 years from age 40 to 49, and mammography repeated every year over age 50.

References in periodicals archive ?
Breast pain, a medical condition known as mastalgia, is typically caused by fibrocystic breast condition (FBC), which can cause soreness ranging from mild tenderness to severe pain that makes it difficult for affected women to even hug a loved one.
In my teens I had fibrocystic breast condition - little fibrous cysts in your breasts which you can control with your diet - and I thought because of the late hours I was keeping, drinking a lot of coffee, and not looking after myself as well as I should have, it was coming back.
Proceeds from the public offering will be used to continue our marketing outreach to promote awareness at various online and storefront retailers for Violet iodine, a daily supplement that helps promote breast health and alleviate symptoms associated with fibrocystic breast condition (FBC), and advance our pre-clinical preparation for IND submission to the FDA for our uniquely formulated topical acne drug.
Both the Violet iodine supplement and BPX03 are uniquely formulated for the treatment of fibrocystic breast condition as well as overall breast health.
About Violet iodine Violet iodine is a daily iodine supplement for the relief of the most common symptoms of cyclic mastalgia and fibrocystic breast condition (FBC), including monthly swelling, tenderness, aches and heaviness.
About Fibrocystic Breast Condition (FBC) Fibrocystic breast condition is thought to be caused by hormonal imbalances, which can cause breast tissue growth to exceed its natural cell turnover.
About Violet(TM) Iodine Violet iodine is a daily iodine supplement for the relief of the most common symptoms of cyclic mastalgia and fibrocystic breast condition (FBC), including monthly swelling, tenderness, aches and heaviness.
Formulated to Help Alleviate Symptoms Associated with Fibrocystic Breast Condition for the Estimated 50 Percent of Women Aged 15 to 49 Who Suffer from Monthly Breast Discomfort
The first-of-its-kind product is based on the latest molecular iodine technology designed to help free women from the burden of breast discomfort by addressing the underlying causes of a condition known as fibrocystic breast condition (FBC), with the added benefit of promoting breast health for women of reproductive age.
Daily use of Violet iodine can help normalize these imbalances and address the underlying causes of fibrocystic breast condition, thereby alleviating symptoms that vary in severity from general soreness to clinically diagnosed FBC.
Beverly Gordon, a Jamaican who immigrated to the United States 10 years ago, cares for disabled, sick and elderly patients in their homes, but must ignore her fibrocystic breast condition that causes recurring and at times painful cystic growths.
While dietary factors may influence benign fibrocystic breast conditions, little is known of their association with fibroadenomas.