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Why call it a disease when it's not?

Why call it a disease when it's not? "Breast disease" is a phrase that makes most women apprehensive. Yet, after examining a woman's breasts or reading a mammogram, a doctor may well announce that the patient has "fibrocystic disease" or "benign breast disease." This is a nonspecific diagnosis and a true misnomer. Sometimes a doctor uses it to describe chronically lumpy breasts that may be painful and tender before menstruation. More often, "fibrocystic disease" simply refers to the natural overall lumpiness that usually occurs in breast tissue as a woman ages. It's normal and predictable.

So why call it a disease? According to Dr. Susan Love of the Harvard Medical School, a surgeon specializing in breast problems, these changes are natural and are "no more a disease than gray hair or age lines." In 1985 the Cancer Committee of the College of American Pathologists called "fibrocystic disease" unacceptable terminology and expressed concern that women might be denied medical insurance on this basis. "fibrocystic disease" and "benign breast disease" aren't diseases, but refer to a variety of changes and symptoms that occur in many women. (There are certain precancerous cell changes, known as atypical hyperplasia, that may require a biopsy. These are different from the fibrocystic changes discussed here. Their presence, particularly when combined with a family history, can raise the risk of breast cancer.)

Some women whose breasts are naturally lumpy, or "fibrocystic," experience breast swelling and tenderness before their menstrual periods, as do others without "lumps" or cysts. Unfortunately, there's no effective treatment for this. Over the years many doctors and their patients have come to suspect that coffee drinking is responsible for the condition, and doctors often instruct women to give up caffeine. Other recommend taking vitamin E supplements. There's no harm in either step if it seems to work. However, as we've reported previously, large and conclusive studies have found no relationship between caffeine and breast pain. And vitamin supplements have not been shown to be of any therapeutic worth. Still, some home remedies--such as wearing a supportive bra, reducing salt intake to minimize fluid retention, and using ice packs to ease discomfort--may help alleviate swelling and pain.

Every woman needs to see a doctor for diagnosis of any self-discovered breast lump (though the vast majority of lumps are not cancerous) and for a professional examination on a regular schedule, usually once a year. A woman with very lumpy breasts may have trouble doing a self-exam, since she may not be able to detect new lumps; her doctor may suggest that she forgo self-examination. At age 35, women should have a base-line mammogram and get a mammogram every two years afterward; starting at 50, they should get one annually. (See Wellness Letter, November 1990, for more information on mammography.)

The chief hazard of fibrocystic breasts may be financial. If "fibrocystic disease" has been written into your medical records, and if you lose your present health insurance and have to reapply, or are applying for new life insurance, you may have trouble. If your insurance reimburses you for breast exams and mammograms, notice what diagnosis your doctor or radiologist writes on the forms. If she writes "fibrocystic disease," it may be worth paying for exams and mammograms yourself rather than put your insurance status on the line.
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Title Annotation:fibrocystic breast disease
Publication:The University of California, Berkeley Wellness Letter
Date:May 1, 1991
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