Benign Breast Conditions

Lobular Carcinoma in Situ (LCIS)

Though technically a Stage 0 cancer, lobular carcinoma in situ (LCIS, also called lobular neoplasia) is not usually classified as a cancer. Instead, LCIS is considered a pre-cancerous condition. It signals a significantly increased risk of cancer anywhere in the breast. LCIS begins in the lobules (the milk-producing glands of the breast) but does not penetrate the lobular walls. Many times, physicians encounter LCIS serendipitously (by chance) on breast biopsy while investigating an area of concern.

While the microscopic features of LCIS are abnormal and are similar to malignancy, LCIS does not behave as a cancer (and therefore is not treated as a cancer). However, a mastectomy (breast removal) may be occasionally performed if LCIS patients have a strong family history of breast cancer. More likely, LCIS patients are closely monitored with physician performed clinical breast examinations and mammograms.

Some LCIS patients are eligible to take the drug tamoxifen to help prevent breast cancer. In 1998, the Food and Drug Administration approved the drug tamoxifen to prevent breast cancer in high risk patients. Tamoxifen is an "anti-estrogen" and works by binding to estrogen receptors. Research has shown that tamoxifen can reduce breast cancer risk in some women.

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Fibrocystic Breast Condition

Fibrocystic breast condition (sometimes referred to as fibrocystic disease, fibrocystic change, cystic disease, chronic cystic mastitis or mammary dysphasia) is not a disease, but rather, it describes a variety of changes in the glandular and stromal tissues of the breast. Symptoms of fibrocystic breasts in the breast include cysts (accumulated packets of fluid), fibrosis (formation of scar-like connective tissue), lumpiness, areas of thickening, tenderness, or breast pain. Though sometimes painful, fibrocystic breast condition is not cancer. However, fibrocystic breasts can sometimes make breast cancer more difficult to detect with mammography. Therefore, ultrasound may be necessary in some cases if a breast abnormality is detected in a woman with fibrocystic breasts. According to the American Cancer Society, fibrocystic breasts affect at least half of all women at some point in their lives. Fibrocystic changes are the most common cause of breast lumps in women between 30 and 50 years old.

Symptoms of fibrocystic changes in the breast include:

• cysts (packets of fluid)
• fibrosis (formation of scar-like connective tissue)
• lumpiness
• areas of thickening
• tenderness
• pain

Women who suffer from fibrocystic changes typically have cyclic breast pain since the cause of the condition is related to the way breast tissue responds to monthly changes in the body’s levels of the hormones estrogen and progesterone. During each menstrual cycle, breast tissue sometimes swells because hormonal stimulation causes the breast’s milk glands and ducts to enlarge, and in turn, the breasts retain water. During menstruation, breasts may feel swollen, painful, tender, or lumpy. Breast swelling usually ends when menstruation is over. Symptoms of fibrocystic change usually stop after menopause but may be prolonged if a woman undergoes hormone replacement therapy.

Fibrocystic breast condition is often first noticed by the woman and further investigated with clinical breast exam, mammogram, or in some instances, biopsy. Fibrocystic changes are typically discovered in both breasts in the upper outer quadrant and the underside of the breast where a ridge may sometimes be felt.

Often, physicians may recommend that the symptoms of fibrocystic breasts be treated with self-care. Depending on the individual situation, several measures may be recommended to relieve the symptoms of fibrocystic breasts. The following chart summarizes treatment options for fibrocystic breasts:

Occasionally, doctors may surgically remove non-cancerous breast lumps. For women with painful cysts, draining the fluid by fine needle aspiration biopsy may help relieve symptoms of fibrocystic breasts.

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Simple Cysts

Simple breast cysts are accumulations of fluid in the breast. Simple cysts are non-cancerous and typically present themselves in the form of smooth, rounded lumps. They are often moveable within the breast, although they can also appear deep within the breast tissue. While the cause of simple cysts is unknown, experts do know that such cysts respond to the body's hormone levels. For instance, simple cysts may appear a week or two before a woman's menstrual period and disappear afterwards. These cysts are most common in pre-menopausal women, especially when they are approaching menopause. However, simple cysts can occur in women after menopause as well, especially if they are taking hormone replacement therapy (HRT). Existing simple cysts may also persist or enlarge in women on HRT. Some research has suggested that caffeine can cause simple breast cysts, although this is controversial among members of the medical community. Nevertheless, some women find that reducing caffeine consumption decreases breast discomfort.

Most women only develop one or two simple cysts at a time, but in some cases, multiple simple cysts may appear throughout the breast. These cysts are usually confirmed with mammography and ultrasound (sonogram). In particular, ultrasound is excellent at quickly identifying whether a breast abnormality is in fact a simple cyst or a solid mass. After the abnormality is found to be a simple cyst with ultrasound, it is usually left alone unless:

• The diagnosis is uncertain. Most simple cysts are well-defined, have distinct borders, and ultrasound signals are able to easily pass through them. If radiologists detect an area with fluid that does not meet the criteria of a simple cyst, they may term the area "a complex cyst." Complex cysts can be cancerous because they are actually not cysts but tumors that have necrosed, or bled into themselves.
• The simple cyst is causing discomfort. In some instances, simple cysts can be painful. Draining the cysts with a thin needle (fine needle aspiration) collapses them and reduces discomfort. Some radiologists inject air into the area after drainage to help minimize the chances that the cyst will return.

When cysts are drained, the fluid is usually discarded unless it is bloody or looks suspicious. In these cases, it is sent to a pathology laboratory for analysis under a microscope. Normal cystic fluid can be a number of colors including yellow, brown, green, black, amber, or milky.

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