Fibrocystic change is not associated with an increased risk of breast cancer unless there is histologic evidence of epithelial proliferative changes, with or without atypia (92–97). The common coincidence of fibrocystic disease and malignancy in the same breast reﬂects the fact that both processes are common events. Approximately 80% of biopsies show fibrocystic changes. In an evaluation of the relationship between fibrocystic change and breast cancer in 10,366 women who underwent biopsy between 1950 and 1968 and were followed for a median of 17 years, approximately 70% of the biopsies showed nonproliferative breast disease, whereas 30% showed proliferative breast disease (95). Cytologic atypia were present in 3.6% of cases. Women with nonproliferative disease had no increased risk of breast cancer, whereas women with proliferative breast disease and no atypical hyperplasia had a twofold higher risk of breast cancer. Patients whose biopsy results showed atypical ductal or lobular hyperplasia had an approximately fivefold higher risk than women with nonproliferative disease to develop invasive breast cancer in either breast. Patients with carcinoma in situ have an eight-to tenfold risk of developing breast cancer. This risk is bilateral for lobular lesions and ipsilateral for ductal lesions. A family history of breast cancer added little risk for women with nonproliferative disease, but family history plus atypia increased breast cancer risk 11-fold. The presence of cysts alone did not increase the risk of breast cancer, but cysts combined with a family history of breast cancer increased the risk about threefold (76,92–97). Women with these risk factors (family history of breast cancer and proliferative breast disease) should be followed carefully with physical examination and mammography. For such women, age-specific probability of developing invasive breast carcinoma in the next 10 years is 1 in 2,000 (age 20), 1 in 256 (age 30), 1 in 67 (age 40), 1 in 39 (age 50), and 1 in 29 (age 60) (93). The relative risk for developing breast cancer depends on the type of proliferative lesion diagnosed.
Management of Fibrocystic Change
Fibrocystic change is a normal evolutionary change in breast development and involution and does not require a specific treatment other than a good clinical breast examination and age-appropriate mammographic screening or imaging studies directed to signs and symptoms. A number of nutritional and dietary supplements were investigated to relieve symptoms. The role of caffeine consumption in the aggravation of fibrocystic change is controversial (98– 101). Results of some studies suggest that eliminating caffeine from the diet is associated with improvement of symptoms (100,101). Many patients are aware of these studies and report relief of symptoms after discontinuing intake of coffee, tea, and chocolate. Similarly, many women find vitamin E (150 to 600 IU daily) or B6 (200 to 800 mg per day) helpful (102,103). Observations about these effects are difficult to confirm and are anecdotal (104–106). A recent review of nutritional interventions for fibrocystic breast conditions that evaluated evening primrose oil, vitamin E, or pyridoxine suggested that there are insufficient data to draw clear conclusions about their effectiveness (107). Exacerbations of pain, tenderness, and cyst formation may occur at any time until menopause, when symptoms usually subside unless patients are taking estrogen. A patient with fibrocystic changes should be advised to examine her own breasts each month just after menstruation and to inform her physician if a mass appears.