Intervertebral discs

Figure. The adult vertebral column and typical vertebrae in each region, lateral views.

There are at least 24 intervertebral discs interposed between the vertebral bodies: six in the cervical, twelve in the thoracic and five in the lumbar region, with one between the sacrum and coccyx. (Additional discs may be present between fused sacral segments.) The discs account for approximately one-quarter of the total length of the vertebral column, and are primarily responsible for the presence of the various curvatures. On descending the vertebral column, the discs increase in thickness, being thinnest in the upper cervical region and thickest in the lower lumbar. In the upper thoracic region, however, the discs appear to narrow slightly. In the cervical region the disc is about two-fifths the height of the vertebrae, being approx-imately 5 mm thick. In the thoracic region the discs average 7 mm in thickness, so that they are one-quarter of the height of the vertebral bodies. The discs in the lumbar regions are at least 10 mm thick, equivalent to one-third of the height of the lumbar vertebral bodies. The relative height of the disc to the vertebral bodies is an important factor in determining the mobility of the vertebral column in each of the regions. Individual discs are not of uniform thickness; they are slightly wedge-shaped in conformity with the curvature of the vertebral column in the region of the disc. The curvatures in the cervical and lumbar regions are primarily due to the greater anterior thickness of the discs in these regions.

The overall shape of the discs also varies from one region to another, being similar to the shapes of the adjacent vertebral bodies. Consequently, in the cervical region they tend to be oval, in the thoracic region almost heart-shaped and in the lumbar region kidney-shaped.

It is of considerable practical importance to remember that the intervertebral disc forms one of the anterior boundaries of the intervertebral foramen, and as the spinal nerves pass through the foramina they lie directly behind the corresponding discs. In addition the discs also form part of the anterior wall of the vertebral canal. Consequently, any posterior bulging of the disc may compress the spinal cord as well as the individual spinal nerves.

Structure

Figure. (A) Components of the intervertebral disc, (B) Fluid content of the nucleus pulposus and changes with trauma. (Adapted from Hendry N (1958) The hydration of the nucleus pulposus and its relation to the intervertebral disc derangement Journal of Bone and Joint Surgery, 40B, 132-144.)

Each disc is structurally characterized by three integrated tissues: the central nucleus pulposus, the surrounding annulus filvvsus and the limiting cartilage end plates (Fig. A). It is anchored to the vertebral body by the annulus fibrosus fibres and the cartilage end plate.

Nucleus pulposus

The soft, highly hydrophilic substance contained within the centre of the disc. There appears to be no clear division between the nucleus pulposus and the surrounding annulus fibrosus, the main difference being in tlie density of the fibres contained, with the nucleus having large extrafibrillar spaces containing glycos-aminoglycans enabling it to retain fluid. The classical idea, therefore, of a distinct division between the two regions is not true. Furthermore, the concept of the nucleus being round or oval has not been supported by discography, which has shown it to be more rectangular in infants and young children, and anything from oval to multilobed in adults. (Discography is a radiographic technique which allows visualization of the disc in the living subject; clinically it enables the health of the disc to be assessed.) The region between the nucleus and the annulus fibrosus is an area of maximum metabolic activity. It is also sensitive to physical forces as well as to chemical and hormonal regulation of growth processes. Consequently, it may be considered to represent the growth plate of the nucleus pulposus, similar to epiphyseal growth plates, since the nucleus can only increase in size and remodel itself at the expense of the inner part of the annulus fibrosus. The annulus on the other hand increases in horizontal diameter by the addition of new lamellae at the periphery.

Figure. The relative position of the nucleus pulposus within the intervertebral disc, and its relation to the axis about which movements occur.

The position of the nucleus pulposus within the disc varies regionally, being more centrally located in cervical and thoracic discs and posteriorly located in lumbar discs. Nucleus position is related to certain aspects of function.

The nucleus pulposus consists of a three-dimensional lattice of collagen fibres in which is enmeshed a proteoglycan gel, which is responsible for the hydrophilic nature of the nucleus. Patchy loss and disappearance of this gel occurs with ageing, which lowers the water content until in advanced degeneration the collagen may be devoid of proteoglycan material (Fig. 4.29B). This is the major change underlying dehydration of the nucleus in later life. In early life, a water content of 80-88% is usual. However, from about the fourth decade onwards this decreases to 70%. These changes in the proteoglycans of the nucleus, both in terms of their loss and composition, change the mechanical behaviour of the disc.

Studies suggest that the nucleus pulposus represents the functional centre of the disc, and that systemic changes within it may be important as a primary cause of pathological change within the disc, and consequently of all pathological change within the intervertebral space. There is, however, the view that in disc degeneration the first morphological change to be observed is the separation of part of the cartilage end plate from the adjacent vertebral body.

Annulus fibrosus

A series of annular bands whose geometry varies as a function of vertebral level and intradiscal region. Each annular band has a roughly parallel course, with the directional arrangement of fibres alternating in adjacent bands (Fig. A), with the obliquity of these bands being greatest in the innermost layer of any given disc. The number of lamellae, as well as their size, thickness and obliquity of arrangement, shows large variations for any given band within different parts of the same disc, for any particular ver-tebral level, and from individual to individual. Nevertheless, the average number of lamellae is 20 and in general their thickness varies from 200 to 400 |im, increasing from the inside out. Within each lamella the fibrils (0.1-0.2 mm) are uniformly arranged, but their orientation varies considerably from one lamella to another.

Each lamella is composed of obliquely arranged bundles of fibrils, varying in size between 10 and 50 mm. Except for thin fibrils, there is little interconnection between adjacent lamellar sheets; consequently there will be only limited restriction to movement during compression and tension. The question arises as to whether orientation of the collagen bundles is predetermined or mechanically induced when movement occurs. There are considerable differences in fibril thickness and lamellar organization in the fetus. It is therefore likely that mechanical phenomena, particularly torsion, are responsible for the arrangement seen in adults.

The density of the fibrocartilaginous lamellae is a function of the annular region, being more closely packed anteriorly and posteriorly than laterally. The lamellar bands do not form complete rings but split intricately or merge to interlock with other bands. The posterolateral regions of the annulus appear to have marked irregularities and are much less orderly. With ageing, the annulus becomes weakest in these posterolateral regions, thereby predisposing to nucleus herniations.

Elastic fibres are present within both the annulus fibrosus and nucleus pulposus. In the annulus they are circularly, obliquely and vertically arranged, although they are not distributed throughout, but are restricted to the lamellae at the vertebral epiphysis and disc interface. Interlamel- lar elastic fibres branch and join, freely imparting a dynamic flexibility to the tissue, with obvious implications for function. The intralamellar elastic fibres penetrate the bony vertebrae as perforating fibres.

Figure. Type and ratio of collagen found within the intervertebral disc. (Adapted from Taylor TKF, Ghosh Pand Bushel GR (1981) The contribution of the intervertebral disc to scoliotic deformity. Clinical Orthopaedics and Related Research, 156, 79-90.)

Within the annulus the total collagen content is not constant, decreasing from the outer layers towards the nucleus. However, the proportion of type I to type II collagen (the principal collagen types within the disc) decreases from the outer layer of the annulus to the nucleus, and also varies from region to region. In other words, type I collagen predominates in the outermost regions of the annulus and type II the innermost; the nucleus pulposus contains type II only. Since type I collagen is typical of tendons and type II of articular cartilage, where large transient compressive forces are generated, the tensile strength of the annulus is probably provided by type I collagen, while the compressive component involves type II. With increasing age, the collagen content of the annulus increases from the inside outwards in the disc, and also downwards from cervical to lumbar regions. However, the proportion of type II collagen does not appear to change with age.

The attachment of the annulus fibrosus to the vertebrae is fairly complicated. The annulus fibres pass over the edges of the cartilage end plate and anchor themselves to and beyond the compact bony zone that forms the outside of the vertebral rim, as well as to the margins of the adjacent vertebral body and its periosteum, thereby forming stable connections between adjacent vertebral bodies. These perforating fibres become interwoven with fibrillar lamellae of the bony trabeculae. This fibrillar anchorage is already present at birth even though the vertebral rim is not ossified.

Cartilage end plate

Found on each surface of the vertebral body it represents the anatomical limit of the disc (Fig. A). It is approximately 1 mm thick at the periphery and decreases towards the centre. It can be considered to have three main functions: (i) it appears to protect the vertebral body from pressure atrophy; (ii) it confines the annulus fibrosus and nucleus pulposus within their anatomical boundaries, and (iii) it acts as a semipermeable membrane to facilitate fluid exchanges between the annulus, the nucleus and the vertebral body via osmotic action. Regarding this third function, however, studies suggest that only the central part of the end plate is permeable.

In the first few years of life, the end plates are loosely attached by a thin layer of calcified material to irregular, radiating, fanshaped ridges and furrows on the vertebral bodies. Later, a thin layer of calcified material on the end plate firmly adheres to the trabeculae of the porous surface of the vertebral body. It is thought that the end plate is in contact with the bone marrow, through which it receives its nutrients.

In the early part of life, numerous minute vascular channels (cartilage canals) penetrate deeply into the end plate from tlie vertebral side. However, these channels disappear with increasing age so that by the third decade they are largely obliterated. Following the third decade, retrogressive changes occur in the end plate: it begins to show signs of ossification and there is an increase in calcification. It becomes more brittle, with fimbriation becoming more evident, ranging from thinning to complete destruction of the central end plate zone.

Development of the intervertebral disc

Figure. Development of the intervertebral disc, frontal section: (A) at 4 weeks showing sclerotome cells around the notochord and (B) in the adult.

The vertebral column begins to develop in the embryonic mesoderm at about 4 weeks, with individual vertebrae developing under the combined inductive influence of the notochord and neural tube. Ablation of either the notochord or neural tube at an early stage results in failure of sclerotomal and myotomal segmentation. The segmental vessels of aortic origin pass between two sclerotomal zones, which then fuse to form the mesenchymal body of the vertebra.

The intervertebral disc therefore develops initially in an environment which contains few blood vessels and is surrounded by a perichondral layer, whose continuity foreshadows the longitudinal vertebral ligaments. The nerves come to lie close to the discs while the intersegmental arteries come to lie either side of the vertebral bodies.

In those regions where the notochord is surrounded by the developing vertebral body it degenerates and disappears. Between the vertebrae, however, the notochord expands as local aggregations of cells within a proteoglycan matrix, forming the gelatinous centre of the disc, the nucleus pulposus. The nucleus is later surrounded by the circularly arranged fibres of the annulus fibrosus, which are derived from the perichordal mesenchyme. The nucleus pulposus and annulus fibrosus constitute the embryonic intervertebral disc. Remnants of notochord may persist in any part of the axial skeleton and give rise to a chordoma. This slow-growing neoplasm occurs most frequently at the base of the skull and in the lumbosacral region.

Following the proliferation and later degeneration of the notochordal cells, there is a fibrocartilaginous invasion of the nucleus pulposus by the orginal mesenchymal intervertebral cells. This invasion occurs at about 6 months in utero.

Intervertebral discs lose their embryonic integrity with time, with structural changes occurring in the nucleus throughout adulthood. These normal processes are often considered to be signs of degeneration; they are merely stages in the natural evolution of connective tissue which is subjected to mechanical stress in the form of combined shear and compression forces. The growth of the intervertebral disc, together with the microscopic changes within it, has been correlated with changes associated with weight-bearing in the erect posture. This may be a similar mechanism to that associated with the formation of subcutaneous connective tissue bursae, e.g. housemaid’s knee, in which the alternate action of compression forces at right angles to the skin surface and tangential shear stresses induce thickening and delamination of the connective tissue.

Intervertebral discs are subjected to compression, torsion and shear. However, the shear stresses are constantly changing, being dependent on the instantaneous centre of rotation between adjacent vertebrae. This could explain the mechanical delamination of the central region of the disc at different vertebral levels. In other words, the appearance of an irregular cavity in the central region is mechanically induced.

The cartilage end plate also appears to follow this mechanical induction. It is thought to be derived not from the vertebra but from the undifferentiated cells which accumulate in early embryonic life, and develops as an organized structure under mechanical influences. The annular epiphysis of the vertebral body develops in the marginal part of this thin plate of hyaline cartilage, and could therefore be considered to be either part of the disc, or part of the vertebral body.

Understanding Spinal Anatomy: Intervertebral Discs

Between each vertebral body is a cushion called an intervertebral disc. Each disc absorbs the stress and shock the body incurs during movement and prevents the vertebrae from grinding against one another. The intervertebral discs are the largest structures in the body without a vascular supply. By means of osmosis, each disc absorbs needed nutrients.

Each disc is made up of two parts: the annulus fibrosus and the nucleus pulposus.

Annulus Fibrosis

The annulus is a sturdy tire-like structure that encases a gel-like center, the nucleus pulposus. The annulus enhances the spine’s rotational stability and helps to resist compressive stress.

The annulus is a layered structure consisting of water and sturdy elastic collagen fibers. The fibers are oriented at different angles horizontally similar to the construction of a radial tire. Collagen consists of fibrous bundles made of protein bound together by proteoglycan gel.

The intervertebral discs are the largest structures in the body without a vascular supply. Through osmosis, each disc absorbs needed nutrients.

Nucleus Pulposus

The center portion of each intervertebral disc is a filled with a gel-like elastic substance. Together with the annulus fibrosis, the nucleus pulposus transmits stress and weight from vertebra to vertebra.

The structural components of the nucleus pulposus is similar to the annulus fibrosus; water, collagen and proteoglycans. The difference is the concentration of these substances. The nucleus contains more water than the annulus.

Endplates

The top (superior) and bottom (inferior) of each vertebral body is coated with an endplate. Endplates are complex structures that blend into the intervertebral disc and help hold the disc in place.

Fibrocystic breasts

ICD-9: 610.1

Description

Fibrocystic breasts are breasts with palpable lumps or cysts that fluctuate in size with the menstrual cycle. The condition is seen more frequently in women ages 30 to 55 and rarely after menopause. Fibrocystic breast tissue exhibits fluid-filled round or oval cysts, fibrosis, and hyperplasia of the cells lining the milk ducts or lobules of the breast. Fibrocystic breasts are fairly common; more than half of women experience fibrocystic breast changes at some point in their lives. Medical professionals stopped using the term fibrocystic breast disease because fibrocystic breasts are not considered a disease.

FIGURE. Fibrocystic breast illustrating fibroadenoma.

Etiology

The causes of fibrocystic breasts are not well understood, but they are linked to the hormonal changes associated with ovarian activity. There is a tendency for fibrocystic breasts to run in families.

Signs and Symptoms

There may be widespread lumpiness or a localized mass, usually in the upper, outer quadrant of the breast. Pain, tenderness, and feeling of fullness are likely before menstruation. There can be fluctuating size of breast lumps, nonbloody nipple discharge (rare), and changes in both breasts.

Diagnostic Procedures

Monthly breast self-examinations cannot be overemphasized. Palpation is essential. A mammogram is especially useful if there is any suspicious change in the breast. Ultrasound is particularly helpful in distinguishing between fluid-filled breast cysts and any solid masses. When a suspicious area is discovered through these tests, a biopsy is essential to confirm the diagnosis. The clinical picture of pain, fluctuation in size, and lumpiness helps to differentiate fibrocystic breasts from breast cancer.

Treatment

No treatment is usually warranted; however, severe pain or large cysts may need treatment. Treatment is usually fine-needle aspiration to draw the fluid from the cyst or, on rare occasions, surgical excision. Acetaminophen or ibuprofen can reduce pain; oral contraceptives to lower the hormone levels linked to fibrocystic breasts may be prescribed. Breast pain also may be lessened with a good supportive bra. Caffeine intake may be restricted, salt intake reduced, and a low-fat diet advised because some studies indicate that these steps may reduce symptoms.

Complementary Therapy

Many women take one capsule of evening primrose oil up to three times a day to manage symptoms of fibrocystic breasts. It is believed that evening primrose oil may replace linoleic acid in women who are deficient in this essential fatty acid that can help to make breast tissue less sensitive to hormonal influences. Removing all forms of caffeine from the diet is suggested.

Client communication

Teach clients how to perform breast self-examinations. Fibrocystic breasts often feel lumpy, and clients can best assess whether the lumps they feel are normal or abnormal.

Prognosis

The prognosis is good, although exacerbations may continue until menopause, after which they subside. Fibrocystic breasts can make breast examination and mammography more difficult to interpret, possibly causing a few early cancerous lesions to be overlooked.

Prevention

There is no known prevention. Monthly selfexamination of the breasts and regular mammography are advised. Reducing caffeine and fat in the diet are other helpful measures.

Fibrocystic Breast Disease: Signs, Symptoms, and Treatment

Understanding Fibrocystic Breast Disease

Fibrocystic breast disease, like fibroids, PMS, and menstrual irregularities are all parts of the continuum of estrogen excess in your body. Fibrocystic breast disease tends to be one of the first symptoms of estrogen dominance. It can affect women of 20 to 50 years and even teenagers.

Let’s take a step back so that we can understand the concept of fibrocystic breast disease. When you are growing, estrogen is very necessary. It is most of the time balanced with progesterone. When your body produces estrogen in excess, it flows into different tissues of your body, including the breast, and then the fibrocystic breast disease can become an issue. Fibrocystic breast disease is a type of condition that causes breast pain, non-cancerous breast lumps, and cysts.

Most young girls begin their menstruation at the age of 10 nowadays even though historically, the menstruation period began between ages 14 and 16 as recently as one generation ago. Menopause occurs around age 50. This unprecedented extension of the menstrual lifetime can have a devastating effect on women. This is especially especially true for areas sensitive to high estrogen such as the breast and ovaries. The fluctuating estrogen level accounts for inflammatory tendencies with cysts and swelling common in women suffering from PMS.

Cysts are fluid-filled sacs found in the breast. The often feel soft and oval shaped, but a cyst which is deep within the breast may feel hard. A woman who has a cyst in her breast may experience pain, particularly if the cyst increases in size ahead of the menstrual cycle.

What Are the Signs and Symptoms of Fibrocystic Breast Disease?

If you are experiencing fibrocystic breast disease, you may experience the following:

Pain
Swelling
Tenderness
Lumps in one or both breasts
Thickening of tissue
Increased swelling or lumps in one of your breasts compared to the other
Pain under your arms
A dark brown or green discharge from the nipple
Aching or sharp pain
Itching
Burning

Other symptoms may include:

Wandering tension
Irritability
Brain fog
Period pain and heavy bleeding

The symptoms are not static and can vary during your menstrual cycle as fluid changes in the breast are driven by hormone fluctuations. Changes in the breast as a result of hormone fluctuations also may appear during pregnancy

Types of Fibrocystic Breast Disease

Most fibrocystic breast diseases are the outcome of monthly hormonal changes. There are two types of fibrocystic breast changes:

Fibrosis: Fibrosis is fibrous tissue that is similar to a scar tissue. It may be hard to the touch and feel rubbery or firm.

Cysts: These are fluid-filled sacs. They may enlarge to the point that you can feel them. The cyst may enlarge and become tender before your period. It may be difficult to differentiate between a solid mass and a cyst because they tend to be movable and round.

Getting to the Root of Fibrocystic Breast Disease

When you are suffering from fibrocystic breast disease your breast feels enlarged and it can often become lumpy. Ultrasound can show multiple cysts, and this can be very uncomfortable. These cysts are often made worse during the menstrual cycle.

Fibrocystic breast disease is one of the signs of a body in hormonal imbalance. Most health professional, conventional doctors especially, will attempt to resolve this with the use of birth control pills. There are benefits to this, but at the same time it really just suppresses the symptoms and does not address the real, underlying cause of the fibrocystic breast disease.

If you have the symptoms mentioned above, check with your doctor to make sure that everything is fine. However, if you also have other symptoms, including possibly wandering tension, irritability, brain fog, as well as period pain and heavy bleeding, you need to think about what is really going on in your body that is causing these symptoms. These are not normal signs from your body. These are behaviors that your body is trying to send you a message, and the message is do not put more estrogen in the system.

Estrogen Dominance and Adrenal Fatigue

As mentioned earlier, fibrocystic breast disease is part of the estrogen dominance continuum. Estrogen dominance is the result of excessive estrogen over time. Symptoms of estrogen dominance also include PMS, fibroids, endometriosis, and cancer. Estrogen dominance is very serious in that it can start at an early age, even as a teenager, but often goes unnoticed. One possible cause of estrogen dominance is the intake of estrogenic compounds which are structurally similar to estrogen. Estrogen is very prevalent in the modern world. It exists in our food, from hormones in meat; it can even come from our garden. Xenoestrogens, compounds that act like estrogen, are present in chemicals that exist in many products including shampoo and plastic containers. So there is a host of places where we get estrogen.

Not only can estrogen dominance encourage fibrocystic breast disease, but it can also stimulate the tissue of the breast and can lead to breast cancer. Estrogen is largely secreted from the ovaries, adipose tissue(fat cells), and the adrenal glands.

Adrenal Fatigue and Fibrocystic Breast Disease

When the body is stressed and low on energy, the adrenal glands can shunt production of progesterone towards cortisol, the anti-stress hormone. When this occurs, progesterone levels drop as its building blocks are instead converted into cortisol. One of progesterone’s function in the body is to help balance estrogen function. Accordingly, a drop in progesterone leads to a rise in estrogen on a relative basis. This does not result in an absolute increase in the estrogen levels in your blood, but estrogen dominance is still present as the ratio of estrogen to progesterone is skewed, leading to estrogen dominance. If you have are overweight, then the increase in fat tissue also boosts estrogen levels. This increased estrogen can lead to fibrocystic breast disease, so look at fibrocystic breast disease as a symptom.

Remedies for the Fibrocystic Breast Disease

In many cases of fibrocystic breast disease, you need a breast examination to be able to ascertain the proper remedy. Your doctor may be able to help you remove the fluid to relieve the pain, but the fluid will likely return later. You can also try the following to assist you with mild discomfort:

Reduce the amount of stimulants and caffeine you are consuming, such as coffee, which stimulates adrenal gland function.
Reduce stress and physical overexertion.
Use a supportive bra to avoid physical trauma to the cysts that can increase inflammation.
Stop or reduce taking synthetic hormone therapy. Bioidentical hormone replacement needs to be carefully considered to weigh the risk and benefits.
Use warm water or heating pad for any pain or discomfort.
Wear a sport bra while sleeping or during exercise for extra support.

Supplement Consideration:

Iodine supplementation (12-50 mg daily): fibrocystic breast disease and iodine deficiency are strongly associated. Iodine supplementation has been shown to improve fibrocystic breast disease.
Natural progesterone cream (20 mg topically): natural progesterone can help offset estrogen dominance and relieve fibrocystic breast pain.
Calcium D glucurate (200-800 mg daily): Calcium D glucarate helps eliminate excess estrogen in the body, thereby decreasing estrogen dominance and improving fibrocystic breasts.

Fibrosis and Simple Cysts in the Breast

Many breast lumps turn out to be caused by fibrosis and/or cysts, which are non-cancerous (benign) changes in breast tissue that happen in many women at some time in their lives. These changes are sometimes called fibrocystic changes, and used to be called fibrocystic disease.

Fibrosis and/or cysts are most common in women of child-bearing age, but they can affect women of any age. They may be found in different parts of the breast and in both breasts at the same time.

Fibrosis

Fibrosis refers to a large amount of fibrous tissue, the same tissue that ligaments and scar tissue are made of. Areas of fibrosis feel rubbery, firm, or hard to the touch.

Cysts

A round, movable lump, which might also be tender to the touch, suggests a cyst. Cysts are fluid-filled, round or oval sacs within the breasts. They are most often found in women in their 40s, but they can occur in women of any age. Monthly hormone changes often cause cysts to get bigger and become painful and sometimes more noticeable just before the menstrual period.

Cysts begin when fluid starts to build up inside the breast glands. Microcysts (tiny, microscopic cysts) are too small to feel and are found only when tissue is looked at under a microscope. If fluid continues to build up, macrocysts (large cysts) can form. These can be felt easily and can be as large as 1 or 2 inches across.

Diagnosis

Most often, fibrocystic changes are diagnosed based on symptoms, such as breast lumps, swelling, and/or tenderness or pain. These symptoms tend to be worse just before your menstrual period begins, and may change as you move through different stages of your menstrual cycle. Your breasts may feel lumpy and, sometimes, you may notice a clear or slightly cloudy nipple discharge.

Sometimes, one of the lumps might feel firmer or have other features that lead to a concern about cancer. When this happens, an ultrasound may be done to see if the lump is solid or is just filled with fluid (called a simple cyst). If the ultrasound shows the lump is solid or if the cyst has both fluid and solid components (a complex cyst), a biopsy may be needed to make sure that it’s not cancer.

How do fibrosis and simple cysts affect your risk for breast cancer?

Neither fibrosis nor simple cysts increase your risk of later developing breast cancer. Complex cysts are more of a concern, as there is a small chance they might contain cancer or put you at risk of cancer later on, depending on what is found at the time of biopsy.

Treatment

Cyst fluid doesn’t need to be removed unless it’s causing discomfort. But it can be drained by putting a thin, hollow needle into the cyst, which might be done to confirm the diagnosis. Removing the fluid may reduce pressure and pain for some time. If removed, the fluid might come back later, but cysts may also go away over time. For cysts that continue to come back and cause symptoms, surgery to remove them might be an option.

Most women with fibrocystic changes and without bothersome symptoms do not need treatment, but they might be watched closely. If you have mild discomfort from fibrosis, you may get relief from well-fitted, supportive bras, applying heat, or using over-the-counter pain relievers.

Some women report that their breast symptoms improve if they avoid caffeine and other stimulants found in coffee, tea, chocolate, and many soft drinks. Studies have not found that these stimulants cause these symptoms, but many women feel that avoiding these foods and drinks for a couple of months is worth trying.

Because breast swelling toward the end of the menstrual cycle is painful for some women, some doctors recommend pain relievers such as acetaminophen or ibuprofen, or other medicines. It’s been suggested that some types of vitamin or herbal supplements might relieve symptoms, but so far none have been proven to be helpful, and some may have side effects if taken in large doses. Some doctors prescribe hormones, such as oral contraceptives (birth control pills), tamoxifen, or androgens. But these are usually given only to women with severe symptoms because they also can have serious side effects.

Fibrocystic breasts: Symptoms and causes

Overview

Fibrocystic breast changes. Fibrocystic breast changes lead to the development of fluid-filled round or oval sacs (cysts) and more prominent scar-like (fibrous) tissue, which can make breasts feel tender, lumpy or ropy.

Fibrocystic breasts are composed of tissue that feels lumpy or rope-like in texture. Doctors call this nodular or glandular breast tissue.

It’s not at all uncommon to have fibrocystic breasts. More than half of women experience fibrocystic breast changes at some point in their lives. In fact, medical professionals have stopped using the term “fibrocystic breast disease” and now simply refer to “fibrocystic breasts” or “fibrocystic breast changes” because having fibrocystic breasts isn’t really a disease. Breast changes categorized as fibrocystic are considered normal.

Although many women with fibrocystic breasts don’t have symptoms, some women experience breast pain, tenderness and lumpiness — especially in the upper, outer area of the breasts. Breast symptoms tend to be most bothersome just before menstruation. Simple self-care measures can usually relieve discomfort associated with fibrocystic breasts.

Symptoms

Signs and symptoms of fibrocystic breasts may include:

Breast lumps or areas of thickening that tend to blend into the surrounding breast tissue
Generalized breast pain or tenderness
Breast lumps that fluctuate in size with the menstrual cycle
Green or dark brown nonbloody nipple discharge that tends to leak without pressure or squeezing
Breast changes that are similar in both breasts
Monthly increase in breast pain or lumpiness from midcycle (ovulation) to just before your period

Fibrocystic breast changes occur most often in women in their 20s to 50s. Rarely do postmenopausal women experience fibrocystic breast changes, unless they’re on hormone therapy.

When to see a doctor

Most fibrocystic breast changes are normal. However, make an appointment with your doctor if:

You find a new breast lump or area of prominent thickening
You have specific areas of continuous or worsening breast pain
Breast changes persist after your period
Your doctor evaluated a breast lump but now it seems to be bigger or otherwise changed

Causes

Breast anatomy. Each breast contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk for breast-feeding. Small tubes (ducts) conduct the milk to a reservoir that lies just beneath your nipple.

The exact cause of fibrocystic breast changes isn’t known, but experts suspect that reproductive hormones — especially estrogen — play a role.

Fluctuating hormone levels during your menstrual cycle can cause breast discomfort and areas of lumpy breast tissue that feel tender, sore and swollen. Fibrocystic breast changes tend to be more bothersome before your menstrual period, and the pain and lumpiness tends to clear up or lessen once your menstrual period begins.

When examined under a microscope, fibrocystic breast tissue includes distinct components such as:

Fluid-filled round or oval sacs (cysts)
A prominence of scar-like fibrous tissue (fibrosis)
Overgrowth of cells (hyperplasia) lining the milk ducts or milk-producing tissues (lobules) of the breast
Enlarged breast lobules (adenosis)

Risk factors

Having fibrocystic breasts doesn’t increase your risk of breast cancer.

Predisposing Factors

A predisposing factor is a condition or situation that may make a person more at risk or susceptible to disease. Some ⚡ predisposing factors ⚡ include heredity, age, gender, environment, and lifestyle.

Heredity is a ⚡ predisposing factor ⚡ when a trait inherited from a parent puts an individual at risk for certain diseases. Cystic fibrosis (ICD-9: 277.00), sickle cell anemia (ICD-9: 282.60), and Down syndrome (ICD-9: 758.0) are examples of hereditary diseases related to genetic abnormalities. If hereditary risks are known, individuals can be better prepared to prevent, treat, or cope with possible problems.

Age is a risk factor related to the life cycle. For example, adenoid hyperplasia (ICD-9: 474.12), acute tonsillitis (ICD-9: 463), and otitis media (ICD-9: 382.9) are more common among children than adults. Older adults are at greater risk than younger adults for degenerative arthritis (ICD-9: 715.9) and senile dementia (ICD-9: 290.0). Elderly persons have unique problems that arise from the aging process itself. Physiological changes occur in the body systems, and some of these changes can cause functional impairment. Elderly persons experience problems with temperature extremes, have lowered resistance to disease as the result of decreased immunity, and have less physical activity tolerance.

Gender is a predisposing factor when the disease is physiologically based. For example, prostate cancer (ICD-9: 185, 198.82, 233.4) occurs only in men; ovarian cancer (ICD-9: 183, 198.6, 233.39) occurs only in women. Men have gout (ICD-9: 274.0) more frequently than do women, whereas osteoporosis (ICD-9: 733.00) is more common in women. Lung cancer (ICD-9: 162.9, 197.0, 231.2) is as prevalent in women as in men. Also, women experience heart disease as often as do men.

The environment can be a risk factor. Exposure to air, noise, and other environmental pollutants may predispose individuals to disease. For example, living close to a heavily traveled thoroughfare in a city may be a predisposition to respiratory disease.

Some geographical locations have a higher incidence of insect bites and exposure to venom. Living in rural areas where fertilizers and pesticides are ommonly used can predispose individuals to disease. Conditions and diseases once endemic to only one area of the world are crossing borders to invade an unsuspecting and unprepared society. This invasion is due largely to the increased mobility of the world’s inhabitants and population density. Even office employees may be affected by environmental or occupational health problems, as seen in carpal tunnel syndrome (ICD-9: 354.0) and eye problems that can result from heavy computer use.

Lifestyle choice may predispose some diseases. Smoking and exposure to secondhand smoke is known to be a major cause of lung cancer. Substance abuse leads to a number of illnesses. Poor nutritional choices and lack of exercise are often cited as predispositions to diseases and disorders.

Risk factors in health and disease

Introduction

Health and wellbeing are affected by many factors – those linked to poor health, disability, disease or death, are known as risk factors. A risk factor is a characteristic, condition, or behaviour that increases the likelihood of getting a disease or injury. Risk factors are often presented individually, however in practice they do not occur alone. They often coexist and interact with one another. For example, physical inactivity will, over time, cause weight gain, high blood pressure and high cholesterol levels. Together, these significantly increase the chance of developing chronic heart diseases and other health related problems. Ageing populations and longer life expectancy have led to an increase in long-term (chronic), expensive-to-treat diseases and disabilities.

There is a rising demand for healthcare, placing the sector under increasing budget pressure which is not always met. It is important that we, as a society and users of healthcare systems, understand the causes and risk factors behind diseases, so that we can actively take part in available cost effective prevention and treatment programmes.

In general, risk factors can be categorised into the following groups:

Behavioural
Physiological
Demographic
Environmental
Genetic

These are described in more detail below.

Types of risk factors

Behavioural risk factors

Behavioural risk factors usually relate to ‘actions’ that the individual has chosen to take. They can therefore be eliminated or reduced through lifestyle or behavioural choices. Examples include:

smoking tobacco
drinking too much alcohol
nutritional choices
physical inactivity
spending too much time in the sun without proper protection
not having certain vaccinations
unprotected sex.

Psychological risk factors

Physiological risk factors are those relating to an individual’s body or biology. They may be influenced by a combination of genetic, lifestyle and other broad factors. Examples include:

being overweight or obese
high blood pressure
high blood cholesterol
high blood sugar (glucose).

Demographic risk factors

Demographic risk factors are those that relate to the overall population. Examples include:

age
gender
population subgroups, such as occupation, religion, or income.

Environmental risk factors

Environmental risk factors cover a wide range of topics such as social, economic, cultural and political factors as well as physical, chemical and biological factors. Examples include:

access to clean water and sanitation
risks in the workplace
air pollution
social settings.

Genetic risk factors

Genetic risk factors are based on an individual’s genes. Some diseases, such as cystic fibrosis and muscular dystrophy, come entirely from an individual’s ‘genetic make-up’. Many other diseases, such as asthma or diabetes, reflect the interaction between the genes of the individual and environmental factors. Other diseases, like sickle cell anaemia, are more prevalent in certain population subgroups.

Global risks for mortality and demographic factors

The number of total global deaths for any cause in 2004 was 59 million people.

The table below shows the ten most common risk factors that caused a large portion of total global deaths in 2004 according to the World Health Organisation (WHO). The top six leading risk factors are all linked to potential development of long-term diseases, such as heart disease, diabetes, and cancers.

Table: WHO numbers of the 10 leading global risks for mortality (death), 2004
Rank	Risk factor	% of total deaths
1	High blood pressure	12.8
2	Tobacco use	8.7
3	High blood glucose	5.8
4	Physical inactivity	5.5
5	Overweight and obesity	4.8
6	High cholesterol	4.5
7	Unprotected sex	4.0
8	Alcohol use	3.8
9	Childhood underweight	3.8
10	Indoor smoke from solid fuels	3.0

The ranking seen in the table above differs if income and other demographic factors are considered.

Income

For high and middle-income countries, the most important risk factors are those related to long-term diseases, whereas in low-income countries, factors such as childhood malnutrition and unprotected sex are much more widespread.

Age

Risk factors also change with age. Some risk factors almost exclusively affect children such as malnutrition and indoor smoke from solid fuels. For adults, there are considerable differences depending on age:

Unprotected sex and addictive substances (e.g. tobacco and alcohol) account for most of the health problems in younger adults
Risk factors for long-term diseases and cancers mainly affect older adults.

Gender

Gender differences also exist. For example, men are much more likely to be at risk of factors associated with addictive substances. Women are prone to suffer from iron deficiency during pregnancy.

Reducing exposure to risk factors

Reducing contact (exposure) to risk factors would greatly improve global health and life expectancy by many years. This would therefore reduce healthcare costs. See also the SCORE Project fact sheet as an example of how risk factors would greatly influence health and life expectancy.

Risk Factors for Cancer

It is usually not possible to know exactly why one person develops cancer and another doesn’t. But research has shown that certain risk factors may increase a person’s chances of developing cancer. (There are also factors that are linked to a lower risk of cancer. These are sometimes called protective risk factors, or just protective factors.)

Cancer risk factors include exposure to chemicals or other substances, as well as certain behaviors. They also include things people cannot control, like age and family history. A family history of certain cancers can be a sign of a possible inherited cancer syndrome.

Most cancer risk (and protective) factors are initially identified in epidemiology studies. In these studies, scientists look at large groups of people and compare those who develop cancer with those who don’t. These studies may show that the people who develop cancer are more or less likely to behave in certain ways or to be exposed to certain substances than those who do not develop cancer.

Such studies, on their own, cannot prove that a behavior or substance causes cancer. For example, the finding could be a result of chance, or the true risk factor could be something other than the suspected risk factor. But findings of this type sometimes get attention in the media, and this can lead to wrong ideas about how cancer starts and spreads.

When many studies all point to a similar association between a potential risk factor and an increased risk of cancer, and when a possible mechanism exists that could explain how the risk factor could actually cause cancer, scientists can be more confident about the relationship between the two.

The list below includes the most-studied known or suspected risk factors for cancer. Although some of these risk factors can be avoided, others—such as growing older—cannot. Limiting your exposure to avoidable risk factors may lower your risk of developing certain cancers.

Age
Alcohol
Cancer-Causing Substances
Chronic Inflammation
Diet
Hormones
Immunosuppression
Infectious Agents
Obesity
Radiation
Sunlight
Tobacco

Risk Factors for Type 2 Diabetes

Your chances of developing type 2 diabetes depend on a combination of risk factors such as your genes and lifestyle. Although you can’t change risk factors such as family history, age, or ethnicity, you can change lifestyle risk factors around eating, physical activity, and weight. These lifestyle changes can affect your chances of developing type 2 diabetes.

Read about risk factors for type 2 diabetes below and see which ones apply to you. Taking action on the factors you can change can help you delay or prevent type 2 diabetes.

You are more likely to develop type 2 diabetes if you

are overweight or obese
are age 45 or older
have a family history of diabetes
are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
have high blood pressure
have a low level of HDL (“good”) cholesterol, or a high level of triglycerides
have a history of gestational diabetes or gave birth to a baby weighing 9 pounds or more
are not physically active
have a history of heart disease or stroke
have depression
have polycystic ovary syndrome , also called PCOS
have acanthosis nigricans—dark, thick, and velvety skin around your neck or armpits

You can also take the Diabetes Risk Test to learn about your risk for type 2 diabetes.

To see if your weight puts you at risk for type 2 diabetes, find your height in the Body Mass Index (BMI) charts below. If your weight is equal to or more than the weight listed, you have a greater chance of developing the disease.

If you are not Asian American or Pacific Islander		If you are Asian American		If you are Pacific Islander
At-risk BMI ≥ 25		At-risk BMI ≥ 23		At-risk BMI ≥ 26
Height	Weight	Height	Weight	Height	Weight
4’10”	119	4’10”	110	4’10”	124
4’11”	124	4’11”	114	4’11”	128
5’0″	128	5’0″	118	5’0″	133
5’1″	132	5’1″	122	5’1″	137
5’2″	136	5’2″	126	5’2″	142
5’3″	141	5’3″	130	5’3″	146
5’4″	145	5’4″	134	5’4″	151
5’5″	150	5’5″	138	5’5″	156
5’6″	155	5’6″	142	5’6″	161
5’7″	159	5’7″	146	5’7″	166
5’8″	164	5’8″	151	5’8″	171
5’9″	169	5’9″	155	5’9″	176
5’10”	174	5’10”	160	5’10”	181
5’11”	179	5’11”	165	5’11”	186
6’0″	184	6’0″	169	6’0″	191
6’1″	189	6’1″	174	6’1″	197
6’2″	194	6’2″	179	6’2″	202
6’3″	200	6’3″	184	6’3″	208
6’4″	205	6’4″	189	6’4″	213

What can I do to prevent type 2 diabetes?

You can take steps to help prevent or delay type 2 diabetes by losing weight if you are overweight, eating fewer calories, and being more physically active. Talk with your health care professional about any of the health conditions listed above that may require medical treatment. Managing these health problems may help reduce your chances of developing type 2 diabetes. Also, ask your health care professional about any medicines you take that might increase your risk.