History and exam
Key diagnostic factors
common
mastalgia
Pain may be cyclic or noncyclic.
Cyclic pain often precedes the onset of menses by a few days and ceases shortly thereafter. Described as constant and dull in nature in most patients, though it can throb and cause a burning sensation.[1][2][13]
Generally diffuse and bilateral but may be localized to an area of the breast often associated with a ruptured cyst.
Rarely, pain may be constant in nature and unrelated to the menstrual cycle. In these cases it is important to differentiate other causes of pain, such as pain arising from chest wall structures.[13]
diffuse symmetric lumpiness through both breasts
A common finding that should not be regarded as a disease.
Other diagnostic factors
common
age 30 to 50 years
Symptoms typically arise between the third and fifth decades of life.[4]
nipple discharge
Approximately 80% of women will experience at least one episode of nipple discharge during their reproductive years. Approximately 5% to 10% of women presenting for routine evaluation will report spontaneous nipple discharge.[19]
Nonsuspicious nipple discharge is scant, milky, green, gray, or black, is either unilateral or bilateral, and may be expressed from several ducts.
Suspicious nipple discharge is bloody or watery, profuse, and emanates from a single nipple duct. This clinical scenario is most often caused by an intraductal papilloma (70%), ductal ectasia (25%), which is part of the fibrocystic disease spectrum, or breast cancer (5%).
uncommon
palpable breast mass
Patients may also have a focal area of asymmetry or a dominant mass on palpation.
Often discovered incidentally by the patient or during routine physical examination.
Less frequently, the patient may notice a tender mass, which often correlates with an enlarged or ruptured cyst.[13]
Other breast diseases (e.g., breast cancer, intraductal papilloma) must be excluded in these patients.
Risk factors
weak
late-onset menopause
later age at first childbirth
Younger age at the time of first childbirth may positively affect the risk of developing fibrocystic breasts. Findings are inconsistent across studies.[3]
nulliparity
Nulliparity may increase the risk. High parity may decrease the risk.[6]
obesity
Higher BMI is associated with a higher risk of fibrocystic breasts.[3]
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