FIBROCYSTIC BREAST DISEASE

Diagnostic Summary

• Very common: 20-40% of premenopausal women
• Pain or premenstrual breast pain and tenderness common, although the condition is often asymptomatic.
• Cyclic and bilateral with multiple cysts of varying sizes giving breast nodular consistency.

General Considerations

Benign fibrocystic breast disease (FBD) (“cystic mastitis”) is a component of premenstrual syndrome (PMS); risk factor for breast cancer, but not as significant as family history, early menarche, and late or no first pregnancy.

• Pathogenesis: increased oestrogen-to-progesterone ratio; during menstrual cycle there is recurring biphasic stimulation of the breast – (1) proliferation of breast tissue by oestrogen’s, (2) alveolar secretory activity by progesterone – followed by period of involution; in many women these changes are slight and clinically signs are asymptomatic; in others, significant inflammation occurs.
• Histology: proliferation and hyperplasia of alveolar epithelium, increased secretory activity, ectasia of milk ducts, and periductal fibrosis – elevated prolactin in women with FBD, but insufficient to cause amenorrhoea; oestrogen (endogenous and exogenous) causes increase in prolactin; prolactin inhibits luteal function.

Differential Diagnosis

Fibrocystic breast disease cannot be definitively differentiated from breast cancer or breast fibroadenoma on clinical criteria alone; pain, cyclic variations in size, high mobility, and multiplicity of nodules – indicative of FBD; non-invasive procedures (ultrasonography and medical thermography) are helpful, but definite procedure is biopsy. Medical thermography is available and conducted from the Irish Centre of Integrated Medicine.

Therapeutic Considerations

• Methlyxanthines: caffeine, theophylline and theobromine inhibit action of camp and cGMP phosphodiesterase and elevate their levels in breast tissue; increased cyclic nucleotides excessively stimulate protein-kinase, causing overproduction of cellular products (fibrous tissue, cyst fluid); an excess of cyclic nucleotides in breast is one of the biochemical findings in breast cancer; caffeine promotes carcinogenesis in mammary gland of rats; limiting dietary methylxanthines (coffee, tea, cola, chocolate, caffeinated medications) improved 97.5% of 45 women who completely abstained, and 75% of 28 who limited consumption; women may have varying thresholds of response to methylxanthines; stress plays a role – fibrocystic breasts are more responsive to epinephrine, which increases adenylate cyclase activity and camp.

• Vitamin E: alpha-tocopherol may relieve FBD symptoms in some patients; mode of action is obscure – normalises circulating hormones in PMS and FBD patients. An appropriate dose prescribed by your Practitioner normalises elevatedFSH and LH in FBD.

• Vitamin A: an appropriate dose prescribed by your Practitioner over a period of 3 months has caused complete or partial remission of FBD in five of the nine patients who completed the study; some developed mild side-effects, causing two of the original 12 to withdraw due to HA, and one patient had dosage reduced; beta-carotene may be a better source of retinal – much less toxic and similar activity in ovarian and inflammatory disorders.

• Thyroid and iodine: hypothyroidism and/or iodine deficiency are linked to higher incidence of breast cancer; thyroid hormone replacement in hypothyroid (and some euthyroid) patients may give improvement; thyroid supplement (Synthroid) decreases mastodynia, serum prolactin, and breast nodules in euthyroid patients – subclinical hypothyroidism and/or iodine deficiency may be etiological factors in FBD; iodine caseinate may be effective treatment for FBD; theory; absence of iodine renders epithelium more sensitive to oestrogen stimulation; hypersensitivity produces excess secretions, distending ducts and producing cysts and later fibrosis; in animal models, iodides correct cystic spaces and partially correct excess cellular reproduction; elemental iodine corrects entire disease process; oral iodine has acute and chronic anti-inflammatory and antifibrotic effects; human studies: iodides effect 70% of subjects, but with high rate of side-effects (altered thyroid function in 4%, iodinism in 3%, and acne in 15%); elemental iodine gives benefits but no significant side-effects – short-term increased breast pain corresponding to softening of breast and disappearance of fibrous tissue plaques; dosage of molecular iodine = 70-90 ug/kg body weight (iodine caseinate or liquid iodine).

• Liver function: primary site for oestrogen clearance; any factor (cholestasis, ‘toxic liver syndrome’, environmental pollution) compromising liver can cause oestrogen excess; lipotropic factors and B vitamins are necessary for oestrogen conjugation.

• Colon function: breast disease is linked to a Western diet and bowel function; epithelia dysplasia in nipple aspirates of breast fluid and frequency of bowel movements (BMs) are also linked; women having < 3BMs per week have a 4.5-fold greater risk of FBD compared with women having 1+ BM q.d.; link = colon bacteria transforming endogenous and exogenous sterols and fatty acids into toxic metabolites (polycyclic carcinogens and mutagens); fecal microbes can synthesize oestrogen’s and metabolise oestrogen sulphate and glucuronate conjugates; the result is absorption of bacteria-derived and previously conjugated oestrogen’s; diet influences microflora, transit time, and concentration of absorbable metabolites; vegetarian women excrete two to three times more conjugate oestrogen’s than omnivores; omnivorous women have 50% higher unconjugated oestrogen’s; Lactobacillus supplements lower fecal beta-glucuronidase.

• Fiber: inverse correlation between dietary fiber and risk benign, proliferative, epithelial breast disorders; increasing dietary fiber may reduce risk for benign disease and breast cancer.

Therapeutic Approach

At the ICIM Medics, unless a women has pure FBD, the approach outlined in the article PMS is indicated.

• Diet: primarily vegetarian with large amounts of dietary fiber; eliminate all methylxanthines until symptoms alleviated, then reintroduce in small amounts, avoid exogenous oestrogen’s (oral contraceptives, high-oestrogen animal products); emphasize whole, unprocessed foods (whole grains, legumes, vegetables, fruits, nuts, and seeds); drink 48+oz water q.d.

• Supplements:
- B-complex
- Lipotropic factors
Choline
Methionine
- Vitamin B6
- Vitamin C
- Vitamin E
- Beta-carotene
- Iodine (molecular iodine)
- Zinc
- Flaxseed oil
- Lactobacillus Acidophillus

Appropriate dosage must be discussed with your Medical Practitioner.

Tags: Breast Cancer