MANAGEMENT OF FIBROCYSTIC BREAST DISEASE: A COMPREHENSIVE REVIEW

Abstract

Fibrocystic breast disease (FBD) is the most commonly encountered entity among benign breast disorders (BBD) with features like mastalgia and nodularity or lumpiness. The objective of this article is to present a comprehensive review of FBD and mastalgia to highlight the essential points regarding the etiopathology and to give a brief account of the recent advances and evidences regarding the management. A comprehensive literature review was performed searching through the electronic databases as well as the standard textbooks of surgery and gynecology. It is revealed that FBD is histologically characterized by varying degrees of cyst formations, fibrosis, metaplasia and hyperplasia of epithelium, chronic inflammation and calcification which occurs as a result of aberration of normal process of development and involution in breast tissue in females of reproductive age-group under the influence of cyclical hormonal changes. Certain dietary and other factors are also linked with this condition. Certain proliferative histological changes, with or without atypia, may increase the relative risk of development of breast carcinoma. Though diagnosis is usually made on clinical grounds, ultrasonography, mammography, aspiration cytology and tissue biopsy may aid in doubtful cases. Management include both endocrine and non-endocrine treatments but usually starts with reassurance and counselling with advice of proper breast support and certain dietary changes like restricted consumption of saturated fats and caffeine. Evening primrose oil and flaxseed oil are recommended as first line of therapy by some authorities. Treatment with tamoxifen or danazol should be reserved for severe or refractory cases due to their serious side-effects.