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发表于 2007-12-13 11:29:27
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fibrocystic breast
Definition Return to top
Fibrocystic breast disease is described as common, benign (non-cancerous) changes in the tissues of the breast. The term "disease" in this case is misleading, and many providers prefer the term "change."
The condition is so commonly found in breasts, it is believed to be a variation of normal. Other related terms include "mammary dysplasia," "benign breast disease," and "diffuse cystic mastopathy."
Causes Return to top
The cause is not completely understood, but the changes are believed to be associated with ovarian hormones since the condition usually subsides with menopause, and may vary in consistency during the menstrual cycle.
The incidence of it is estimated to be over 60% of all women. It is common in women between the ages of 30 and 50, and rare in postmenopausal women. The incidence is lower in women taking birth control pills. The risk factors may include family history and diet (such as excessive dietary fat, and caffeine intake), although these are controversial.
Symptoms Return to top
- A dense, irregular and bumpy "cobblestone" consistency in the breast tissue
- Usually more marked in the outer upper quadrants
- Breast discomfort that is persistent, or that occurs off and on (intermittent)
- Breast(s) feel full
- Dull, heavy pain and tenderness
- Premenstrual tenderness and swelling
- Breast discomfort improves after each menstrual period
- Nipple sensation changes, itching
Note: Symptoms may range from mild to severe. Symptoms typically peak just before each menstrual period, and improve immediately after the menstrual period.
Exams and Tests Return to top
Physical examination reveals the presence of mobile (non-anchored) breast "masses." These masses are usually rounded, with smooth borders, and either rubbery or slightly changeable in shape. Dense tissue may make the breast examination more difficult to interpret.
Treatment Return to top
Self care may include restricting dietary fat to approximately 25% of the total daily calorie intake, and eliminating caffeine.
Performing a breast self-examination monthly, and wearing a well-fitting bra to provide good breast support are important.
The effectiveness of Vitamin E, Vitamin B-6, and herbal preparations, such as evening primrose oil are somewhat controversial. Discuss their use with your health care provider.
Oral contraceptives may be prescribed because they often decrease the symptoms. A synthetic androgen may be prescribed by a doctor in severe cases, when the potential benefit is thought to outweigh the potential adverse effects.
Outlook (Prognosis) Return to top
If dietary changes decrease the symptoms, and are maintained, the benefit most likely will persist. A combination of treatment and use of medications may be necessary to obtain relief for severe cases.
Possible Complications Return to top
Because fibrocystic changes may make breast examination and mammography more difficult to interpret, early cancerous lesions may occasionally be overlooked.
When to Contact a Medical Professional Return to top
Call your health care provider if you feel a new, unusual, or "dominant" lump during a breast self-examination.
Call for an appointment with your health care provider if you are a woman, aged 20 or older, who has never been taught, or does not currently know how, to perform breast self-examination. Also call if you are a woman, aged 40 or older, who has not had a screening mammogram.
Prevention Return to top
Reduction of dietary fat and caffeine if you have fibrocystic breast changes has been suggested, although recent studies have questioned the role of caffeine and fat in fibrocystic disease.
What are fibrocystic breasts?
Fibrocystic breasts are characterized by lumpiness and usually discomfort in one or both breasts. The condition is very common and benign, meaning that fibrocystic breasts are not malignant (cancerous). Fibrocystic breast disease (FBD), now referred to as fibrocystic changes or fibrocystic breast condition, is the most common cause of "lumpy breasts" in women and affects more than 60% of women. The condition primarily affects women between the ages of 30 and 50 and tends to become less of a problem after menopause.
The diagnosis of fibrocystic breasts is complicated by the fact that the condition can vary widely in its severity. In some women, the symptoms of fibrocystic breast condition can be very mild with minimal breast tenderness or pain. The symptoms can also be limited in time, usually occurring only premenstrually. It may not even be possible to feel any lumps when the breasts are examined by the woman herself or by her doctor. In other women with fibrocystic breasts, the pain and tenderness are constant, and many lumpy or nodular areas can be felt throughout both breasts.
Is there a difference between fibrocystic breast condition and fibrocystic breast disease?
No. In the past, fibrocystic breast condition was often called fibrocystic breast disease. However, it is not a disease, but a condition. Most women tend to have some lumpiness in their breasts. Therefore, it is now being more appropriately termed fibrocystic breast condition. The abbreviation is FCC (an acronym derived from FibroCystic breast Condition).
Other names that have been applied to fibrocystic breast condition include mammary dysplasia, chronic cystic mastitis, diffuse cystic mastopathy, and benign breast disease (a term that includes other benign breast disorders, including infections).
What causes fibrocystic breasts?
Fibrocystic breast condition involves the glandular breast tissue. The sole known biologic function of these glands is the production, or secretion, of milk. Occupying a major portion of the breast, the glandular tissue is surrounded by fatty tissue and support elements. The glandular tissue is composed of different types of cells: (1) clusters of secretory cells (cells that produce milk) that are connected to the milk ducts (tiny tubes); and (2) the cells that line the surfaces of the secretory cells, called the epithelial cells.
The most significant contributing factor to fibrocystic breast condition is a woman's normal hormonal variation during her monthly cycle. Many hormonal changes occur as a woman's body prepares each month for a possible pregnancy. The most important of these hormones are estrogen and progesterone. These two hormones directly affect the breast tissues by causing cells to grow and multiply.
Many hormones aside from estrogen and progesterone also play an important role in causing fibrocystic breasts. Prolactin, growth factor, insulin, and thyroid hormone are some of the other major hormones that are produced outside of the breast tissue, yet act in important ways on the breast. In addition, the breast itself produces hormonal products from its glandular and fat cells. Signals that are released from these hormonal products are sent to neighboring breast cells. The signals from these hormone–like factors may, in fact, be the key contributors to the symptoms of fibrocystic breast condition. These substances may also enhance the effects of estrogen and progesterone and vice versa.
The same cyclical hormones that prepare the glandular tissue in the breast for the possibility of milk production (lactation) are also responsible for a woman's menstrual period. However, there is a major difference between what happens in the breast and uterus.
In the uterus (the womb), these hormones promote the growth and multiplication of the cells lining the uterus. If pregnancy does not occur, this uterine lining is sloughed off and discharged from a woman's body during menstruation.
In the breast, these same hormones stimulate the growth of breast glandular tissue and increase the activity of blood vessels, cell metabolism, and supporting tissue. All this activity may contribute to the feeling of breast fullness and fluid retention that women commonly experience before their menstrual period.
When the monthly cycle is over, however, these stimulated breast cells cannot simply slough away and pass out of the body like the lining of the uterus. Instead, many of these breast cells undergo a process of programmed cell death, called apoptosis. During apoptosis, enzymes are activated that start digesting cells from within. These cells break down and the resulting cellular fragments are then further broken down by scavenger cells (inflammatory cells) and nearby glandular cells.
During this process, the fragments of broken cells and the inflammation may lead to scarring (fibrosis) that damages the ducts and the clusters (lobules) of glandular tissue within the breast. The inflammatory cells and some of the breakdown fragments may release hormone–like substances that in turn act on the nearby glandular, ductal, and structural support cells.
The amount of cellular breakdown products, the degree of inflammation, and the efficiency of the cellular cleanup process in the breast vary from woman to woman. These factors may also fluctuate from month to month in an individual woman. They may even vary in different areas of the same breast in a woman.
Cysts and fibrosis: Usually, even when the breast is not stimulated to produce milk, some secretions are produced by the secretory glandular cells. These secretions are normally reabsorbed "downstream" in the ducts. However, when there has been tissue damage and scarring (fibrosis) in the breast, these secretions may be trapped in the glandular portions of the breasts, thereby leading to the formation of fluid–filled sacs called cysts. In some areas of the breasts, there may be excessive fluid secretions due to stimulation by hormone–like substances. The resulting cysts may remain microscopic or enlarge until they contain several teaspoons or even tablespoons of fluid. These larger cysts may be felt as palpable (capable of being detected by touching) breast lumps. Even microscopic cysts may sometimes be felt as palpable lumps if many cysts are clustered together and there is a buildup of fibrous (scar) tissue around the cysts.
Hyperplasia and atypical hyperplasia of breast cells: With repeated stimulation from normal hormones, and possibly the effects of many of the hormone–like substances produced in the breast, a few of the epithelial cells (cells that line the ducts in the breast) may eventually lose some of their genetic controls, which normally limit their multiplication (cell division). When this happens, cells may proliferate, leading to an abnormal architectural pattern of the epithelial cells. This over–proliferation of cells is termed hyperplasia. Sometimes these proliferating cells begin to appear abnormal and to look different from one another. They are now described as "atypical." As other more normal cells continue to cycle, die and break down, these atypical cells can move in, spread out, and accumulate. This extensive overgrowth and accumulation of atypical cells is called atypical hyperplasia.
[ 本帖最后由 zhangheng1020 于 2007-12-13 00:01 编辑 ] |
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