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Fibrocystic change of the breast

Dr Garth Kruger and Dr Mirjan - Misko Nadrljanski et al.

Fibrocystic change of the breast represents a wide spectrum of morphological alteration in the female breast ranging from innocuous to those associated with the risk of carcinoma. The term is a rather misleading description of subjective findings associated with normal or abnormal breast physiology and pathology. The term confuses both patients and health care workers. One person's normal breast physiology is another person's fibrocystic change.

The alterations are often with no clinical implications.

A potentially more useful and accurate term is Aberrations in Normal Development and Involution of the breast (ANDI)⁵. The term encompasses all the changes associated with normal variations in breast parenchyma associated with changes in hormone levels and ageing. In general, younger women have proportionally more gland relative to fat in the breast and the converse is true for post menopausal women.

The confusion persists with terms like "fibrocystic disease" which actually has no place in the medical lexicon. The process implies a disease process where it is actually normal breast physiology. It categorizes healthy women as having a disease and not necessarily are cysts actually involved. The term is best avoided.

The morphologic changes include lesions like :

cysts
fibrous stroma changes and / or overgrowth
stromal and epithelial proliferation
predomination of epithelial proliferation

However, there are practically three dominant patterns of morphologic change:

cyst formation and fibrosis (simple fibrocystic change and / or gross cysts)
epithelial hyperplasia (ductal and / or lobular) which can include cystic hyperplasia
sclerosing adenosis

It is worth mentioning that of all patterns, atypical epithelial hyperplasia is associated with increased risk of carcinoma.

Epidemiology

Fibrocystic change is unusual before adolescence. These are most often diagnosed between the age of 20 and 40 with the peak before or at menopause. Hormonal imbalances are considered to have the crucial role in the development of the changes.