Q: When is a disease not actually a disease?

A: When we are talking about "Fibrocystic Breast Disease." Or, more accurately, Fibrocystic Tendencies or Fibrocystic Breast Tissue without the word "disease."

From the dictionary... Disease = a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.

As many women can attest, fibrocystic breast tissue is actually relatively common, but its not a disorder per se: nothing is wrong with the breast tissue. Its not even a risk factor for anything particularly dangerous i.e, fibrocystic breasts are NOT predisposed to developing breast cancer. The only reason fibrocystic change was ever called a disease is that women with fibrocystic tissue of the breast may experience pain (a symptom) or characteristic lumpiness (a sign). But, the word "disease," as a term, has a lot of baggage: it implies that there is something wrong. I am here to tell you, there is nothing wrong with otherwise normal breasts that are considered to be fibrocystic.

With that being said, what exactly are we talking about here? What does fibrocystic change even mean? To really understand this, you have to have a basic idea of what comprises normal breast tissue: fat, lobules (the milk producing glands), ducts (the tubes carrying the milk), and stroma (the scaffolding that is supporting this all.) (a.k.a. Science!)

Fibrocystic change is the catch-all term for microscopic non-cancerous changes of the ducts, lobules, and stroma. To the woman, these changes may end up causing pain, especially cyclical pain and lumpiness. Usually the lumpiness is diffuse, meaning both breasts have a lumpy feel, but sometimes, a dominant cyst can occur and this will feel like a single large lump. Most women report that they will experience more tenderness and pain correlating to their menstrual cycle, suggesting that there is a hormonal influence to fibrocystic change. But, the important point is that fibrocystic changes are not diseases, they are really part of the spectrum of normal findings, and they are not considered risk factors for development of breast cancer.

How do we treat fibrocystic breasts? We treat them nicely! Supportive bras help a lot to decrease pain and tenderness. Avoiding caffeine is another classic recommendation, as well as careful use of over-the-counter pain relievers, like acetaminophen. Some women will use oral contraceptive pills to help regulate their hormonal cycles to improve symptoms.

But, here is the take-home message: If you feel a lump that has you concerned AT ALL, please, please, (Please!) have your doctor look at it. I see patients all the time for lumps that they're just not sure about. It's not a bother...you're not wasting anyone's time. Always better to have an informed answer than a lingering question.