Fibrocystic breasts

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 6 Aug 2025

Last updated: 17 Nov 2023

Fibrocystic breasts are characterized by "lumpy" breasts associated with pain and tenderness that fluctuate with the menstrual cycle.

Diagnosis often involves exclusion of other significant breast diseases.

Assessment of risk for the development of breast cancer is important and is useful in patient reassurance or to design risk reduction strategies.

Cyclic mastalgia is treated symptomatically with lifestyle modification, analgesics, and hormonal therapy.

Mastalgia and breast cysts run a chronic relapsing course throughout life with improvement at menopause.

Definition

Fibrocystic change of the breast is a nonspecific term, commonly understood as a continuum of physiologic changes that expand to the pathologic spectrum. It is a condition characterized by "lumpy" breasts, associated with pain and tenderness that fluctuate with the menstrual cycle. These changes do not correlate with an increased risk of breast cancer; fibrocystic changes of the breast reflect a broad spectrum of conditions that carry different risks for future development of breast cancer.[1][2]

History and exam

Key diagnostic factors

mastalgia
diffuse symmetric lumpiness through both breasts

Full details

Other diagnostic factors

age 30 to 50 years
nipple discharge
palpable breast mass

Full details

Risk factors

late-onset menopause
later age at first childbirth
nulliparity
obesity
estrogen replacement therapy

Full details

Diagnostic tests

1st tests to order

mammography
breast ultrasound

Full details

Tests to consider

cyst aspiration
breast biopsy

Full details

Treatment algorithm

ONGOING

mastalgia

nipple discharge

Contributors

Authors

Sonia Sugg, MD

Professor of Surgery

Division of Surgical Oncology and Endocrine Surgery

University of Iowa Hospitals and Clinics

Iowa City

Disclosures

SS declares that she has no competing interests.

Ingrid Lizarraga, MBBS, FACS

Clinical Associate Professor

Division of Surgical Oncology and Endocrine Surgery

University of Iowa Hospitals and Clinics

Iowa City

Disclosures

IL declares that she has no competing interests.

Acknowledgements

Dr Sonia Sugg and Dr Ingrid Lizarraga would like to gratefully acknowledge Dr Sophia Fu, Dr Sarah E. Colwick, Dr Hernan I. Vargas, Dr Carol Scott-Connor, Dr Anjali Thawani, and Dr Jesse Dirksen, the previous contributors to this topic. SEC, HIV, CSC, AT and JD declare that they have no competing interests.

Disclosures

SF, SEC, HIV, CSC, AT, and JD declared that they had no competing interests.

Peer reviewers

Fred Dirbas, MD

Assistant Professor of Surgical Oncology

Stanford University

Stanford

Disclosures

FD declares that he has no competing interests.

Justin Stebbing, MA, MRCP, MRCPath, PhD

Consultant Medical Oncologist/Senior Lecturer

Imperial College Healthcare NHS Trust

Charing Cross Hospital

London

Disclosures

JS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Marchant DJ. Benign breast disease. Obstet Gynecol Clin North Am. 2002 Mar;29(1):1-20. Abstract

Santen RJ, Mansel R. Benign breast disorders. N Engl J Med. 2005 Jul 21;353(3):275-85. Abstract

Love SM, Gelman RS, Silen W. Sounding board. Fibrocystic "disease" of the breast--a nondisease? N Eng J Med.1982 Oct 14;307(16):1010-4. Abstract

Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985 Jan 17;312(3):146-51. Abstract

Fisher B, Constantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998 Sep 16;90(18):1371-88.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Chest wall pain
- Costochondritis
- Fibroadenoma
More Differentials
Guidelines
- Screening for breast cancer: recommendation statement
- ACR appropriateness criteria: palpable breast masses
More Guidelines
Patient information
Breast cancer: DCIS (very early breast cancer) in women
Breast cancer, locally advanced: what is it?
More Patient information
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Fibrocystic breasts

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

mastalgia

nipple discharge

Contributors

Authors

Sonia Sugg, MD

Disclosures

Ingrid Lizarraga, MBBS, FACS

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Fred Dirbas, MD

Disclosures

Justin Stebbing, MA, MRCP, MRCPath, PhD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice