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Mammography and ultrasonography should be used to evaluate a mass in a patient with a fibrocystic condition Because a mass due to fibrocystic condition is difficult to distinguish from carcinoma on the basis of clinical findings, suspicious lesions should be biopsied Fine-needle aspiration (FNA) cytology may be used, but if a suspicious mass that is nonmalignant on cytologic examination does not resolve over several months, it should be excised Surgery should be conservative, since the primary objective is to exclude cancer Occasionally, core needle biopsy will suffice Simple mastectomy or extensive removal of breast tissue is rarely, if ever, indicated for fibrocystic condition
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Fibrocystic condition is the most frequent lesion of the breast Although commonly referred to as fibrocystic disease, it does not, in fact, represent a pathologic or anatomic disorder It is common in women 30 50 years of age but rare in postmenopausal women who are not taking hormonal replacement Estrogen is considered a causative factor There may be an increased risk in women who drink alcohol, especially women between 18 and 22 years of age Fibrocystic condition encompasses a wide variety of benign histologic changes in the breast epithelium, some of which are found so commonly in normal breasts that they are probably variants of normal but have nonetheless been termed a condition or disease The microscopic findings of fibrocystic condition include cysts (gross and microscopic), papillomatosis, adenosis, fibrosis, and ductal epithelial hyperplasia Although fibrocystic condition has generally been considered to increase the risk of subsequent breast cancer, only the variants with a component of epithelial proliferation (especially with atypia) represent true risk factors
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Pain, fluctuation in size, and multiplicity of lesions are the features most helpful in differentiating fibrocystic condition from carcinoma If a dominant mass is present, the diagnosis of cancer should be assumed until disproven by biopsy Mammography may be helpful, but the breast tissue in these young women is usually too radiodense to permit a worthwhile study Sonography is useful in differentiating a cystic mass from a solid mass, especially in women with dense breasts Final diagnosis, however, depends on analysis of the excisional biopsy specimen or needle biopsy
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When the diagnosis of fibrocystic condition has been established by previous biopsy or is likely because the history is classic, aspiration of a discrete mass suggestive of a cyst is indicated to alleviate pain and, more importantly, to confirm the cystic nature of the mass The patient is reexamined at intervals thereafter If no fluid is obtained by aspiration, if fluid is bloody, if a mass persists after aspiration, or if at any
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Fibrocystic condition may produce an asymptomatic mass in the breast that is discovered by accident, but pain or tender-
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Breast
time during follow-up a persistent or recurrent mass is noted, biopsy should be performed Breast pain associated with generalized fibrocystic condition is best treated by avoiding trauma and by wearing a good supportive brassiere during the night and day Hormone therapy is not advisable, because it does not cure the condition and has undesirable side effects Danazol (100 200 mg orally twice daily), a synthetic androgen and only treatment approved by the US Food and Drug Administration (FDA), has been used for patients with severe pain This treatment suppresses pituitary gonadotropins, but androgenic effects (acne, edema, hirsutism) usually make this treatment intolerable; in practice, it is rarely used Similarly, tamoxifen reduces some symptoms of fibrocystic condition, but because of its side effects, it is not useful for young women unless it is given to reduce the risk of cancer Postmenopausal women receiving hormone replacement therapy may stop or change doses of hormones to reduce pain Oil of evening primrose (OEP), a natural form of gamolenic acid, has been shown to decrease pain in 44 58% of users The dosage of gamolenic acid is six capsules of 500 mg orally twice daily Studies have also demonstrated a low-fat diet or decreasing dietary fat intake may reduce the painful symptoms associated with fibrocystic condition Further research is being done to determine the effects of topical treatments such as nonsteroidal anti-inflammatory drugs as well as topical hormonal drugs such as tamoxifen The role of caffeine consumption in the development and treatment of fibrocystic condition is controversial Some studies suggest that eliminating caffeine from the diet is associated with improvement while other studies refute the benefit entirely Many patients are aware of these studies and report relief of symptoms after giving up coffee, tea, and chocolate Similarly, many women find vitamin E (400 IU daily) helpful; however, these observations remain anecdotal
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