How is fibrocystic breast condition diagnosed? Will I need a breast biopsy?
The basic problem with fibrocystic breast condition is the threat of breast cancer. Fibrocystic breast condition is itself benign (non-cancerous) and exceedingly common. Additionally, breast cancer is a common malignancy in women. Both conditions, one benign and the other a leading cause of cancer deaths in women, involve the same organ—the breast—and both can involve the presence of breast masses.
Fibrocystic lumps in the breast can closely mimic those found in breast cancer. They can also sometimes make breast cancer difficult to detect. Therefore, fibrocystic breast condition often makes both the patient and her physician quite concerned about the possibility of breast cancer. If a woman’s breasts are fibrocystic, other diagnostic tests in addition to screening mammography may be necessary in order to rule out an underlying breast cancer.
A common indicator of fibrocystic breast condition is breast pain or discomfort, but women with fibrocystic breasts may also not have any symptoms. If discomfort is present, the discomfort may include a dull, heavy pain in the breasts, breast tenderness, nipple itching, and/or a feeling of fullness in the breasts. These symptoms may be persistent or intermittent (coming and going), frequently appearing at the onset of each menstrual period and going away immediately afterwards.
The primary method of diagnosing fibrocystic breast condition is physically touching and feeling (palpation) the lumpy areas in the breast(s). These lumps may be detected by a woman on self-examination or by her physician. This lumpiness is most commonly found in the upper outer quadrant of the breast. (The breast is conventionally divided into quadrants or quarters. The upper outer quadrant is the one closest to the armpit.) The lumps in fibrocystic breast condition are typically mobile (they are not anchored to overlying or underlying tissue). They usually feel rounded, have smooth borders, and may feel rubbery or somewhat changeable in shape. Sometimes, the fibrocystic areas may feel irregular, ridge-like, or like tiny beads. These characteristics all vary from one woman to another.
Extremely fibrocystic breasts in women can be very difficult to examine by palpation (touching and feeling). Even mammograms of such extremely fibrocystic breasts may be difficult to interpret. In these cases, specialized breast ultrasound exams and other tests can be very helpful for cancer screening. It may sometimes be necessary to obtain a sample (biopsy) of breast tissue with a needle or by surgery in order to make an accurate diagnosis and differentiate between fibrocystic breast condition and breast cancer.
One reason to undergo a breast biopsy is to diagnose breast cancer. Another reason is to identify those women with fibrocystic breast condition who may have atypical hyperplasia and are at an increased risk of developing breast cancer in the future. However, it is important to note that the severity of a woman’s symptoms and clinical signs of fibrocystic breast condition (pain and lumpiness) do not necessarily correlate with the severity or the cellular changes seen under the microscope. Therefore, it is difficult to single out every woman with fibrocystic breast condition for whom a breast biopsy would be useful.
Additional reasons why breast biopsies are not done on every woman with fibrocystic breast condition include:
- Invasive nature of the biopsy procedure
- Necessity of anesthesia
- Cost-benefit considerations
Instead, most women with fibrocystic breast condition are followed over time as if they all are at an increased risk for developing breast cancer. The woman herself must ensure that her clinician is appropriately monitoring her on a regular basis.