Fibrocystic Breast Disease

     Fibrocystic breast disease (FBD) is the most common cause of breast lumps in women of childbearing age. It is found so commonly in normal breasts, that many doctors consider it to be normal variant. Although fibrocystic changes may be referred to as fibrocystic disease, this is not a disease, but rather a condition. The condition is characterized by round, freely movable lumps in the breast tissue that are tender to the touch. In contrast, cancerous lumps usually do not move freely and are often not tender to the touch. FBD is found more commonly in women who have a family history of the condition, who have had no children, who are Jewish, white, well-to-do, who experience severe PMS or menstrual irregularities, and in women who have had miscarriages. Postmenopausal women are rarely affected by the condition, lending support to the belief that FBD is the result of reproductive hormones acting upon the glandular tissue of the breasts. Other related terms include "benign breast disease", "diffuse cystic mastopathy", "cystic disease", "chronic cystic mastitis", and "mammary dysplasia."

Causes of FBD

     The exact cause of FBD is not completely understood, but is believed to be a result of the way breast tissue responds to monthly changes in the levels estrogen and progesterone, hormones produced during a woman's reproductive years. Prolactin, the milk-releasing hormone produced in the pituitary gland, is also thought to play a role in the condition. 

     Hormonal stimulation of the breast tissue enlarges the milk glands and ducts, and leads to water retention within the breasts. Repeated cycles of hormonal stimulation, or overstimulation by specific hormones, can increase the firmness of the breast tissue and cause fluid-filled sacs known as cysts to form in obstructed or enlarged milk glands. Other factors that have been implicated in the development of FBD include a diet high in fat, intake of caffeine, alcohol and salt, and cigarette smoking. Dr. John Lee, a medical doctor with experience in treating FBD believes that fibrocystic breasts are most often the result of estrogen dominance; relatively high levels of estrogen and low levels of progesterone.

Symptoms of FBD

     The symptoms of FBD can range from mild to severe. They tend to peak just prior to each menstrual period, and improve shortly after the period ends. The following are the most common symptoms found in women suffering from fibrocystic disease of the breasts.

• One or more round, freely movable lumps in the breast tissue that are tender to the touch.
• Lumps may be accompanied by generalized breast pain, especially before menstrual periods.
• Lumps have a tendency to enlarge before menstrual periods and diminish in size when the period has ended. Cancerous lumps do not shrink in size.
• Nipple discharge- lumps in the breast can press against a milk gland and stimulate the production of prolactin, resulting in milk secretion.
• Changes in nipple sensation such as itching.
• Fibrocystic changes are found more frequently in the upper-quadrant and underside of the breast.
• A word of caution: Because FBD is considered a minor risk factor for cancer, absolutely no breast lump -- especially in women who get them often -- should ever be ignored. Any lump(s) discovered in breast tissue should be thoroughly investigated by a trained physician. Fortunately, only about 5 percent of fibrocystic conditions have the type of changes that would be considered a risk factor of developing breast cancer.

Diagnosis of FBD

• Fibrocystic changes within the breast are often diagnosed using a combination of the following procedures.
• Detailed medical history
• Physical exam
• Mammography- an x-ray of the breast
• Ultrasound- used in conjunction with mammography, breast ultrasound can help to detect small tumors that may otherwise be obscured by dense fibrous tissue in the breast.
• Needle aspiration- this simple office procedure involves inserting a needle into the lump and removing fluid that can later be sent to a lab for analysis.
• Biopsy- this surgical procedure, performed under local or general anesthesia, allows the doctor to remove the entire lump from the breast so the cells can be examined microscopically for any cancerous changes.

Conventional Treatment of FBD

• Aspirin and other pain relievers
• Oral contraceptives: A 1999 study found a reduced risk of all types of benign breast disease in women using oral contraceptives. Int J Cancer 1999, 82(2):191-6
• Diuretics
• Testosterone analogs to suppress estrogen levels
• Surgical removal of the lump or lumps (biopsy)

Natural Approach to FBD

General Recommendations

• Engage in regular exercise: Regular exercise may help to reduce breast tenderness. A 1987 controlled study found that women who ran an average of 45 miles per menstrual cycle (1.6 miles daily), reported less breast tenderness as well as improvement in other symptoms such as anxiety. Fertil Steril 1987, 47(3):402-8
   
• Wear a well-fitting, support bra (day and night)
   
• Avoid smoking
   
• Maintain an ideal body weight: Women who gain more than 22 pounds of body weight from early womanhood have been shown to have an increased risk of breast cancer, whereas "lean" women have a greater risk of being treated for benign breast disease. Cancer 1989, 64(5):1049-53
   
• Perform monthly breast self examinations (BSE): Performing a monthly breast exam can not only help to monitor changes in existing lumps, but more importantly, to detect any newly formed lumps in the breast. The following recommendations have been set forth by the American Cancer Society for the early detection of breast cancer in asymptomatic women 20 years and older.

• Perform a breast self exam once a month, seven to ten days after the menstrual period (this is the 
  time when the breasts are least tender). Postmenopausal women should choose a set day each 
  month to perform BSE.
• Have a yearly breast exam by a trained physician yearly.
• Beginning at age 40, women should have a mammogram every 1-2 years. Women age 50 and 
  over should have a mammogram each year, or as advised by their doctor.

Dietary Guidelines

• Eliminate all methylxanthines from the diet: Population studies, experimental evidence and clinical evaluations have all found a link between the consumption of caffeine and fibrocystic breast disease. Caffeine, theophylline and theobromine are all known as methylxanthines. These compounds act as stimulants to many glands in the body, including the milk glands in breast tissue. This increased activity can result in the production of fluid-filled lumps and cysts. 
  
  In one study, 97.5 percent of the women who completely eliminated methylxanthines (coffee, black & green tea, cola, chocolate and some over-the-counter medications) from their diet, demonstrated improvement in FBD, while 75 percent of those who limited their intake of methylxanthines showed little improvement. To derive benefit, all methylxanthines must be removed from the diet for at least 6 months. 
  
  Not all studies have found an association between caffeine consumption and fibrocystic breast disease. In a large case-controlled study conducted by the National Cancer Institute (NCI) involving more than 3,000 women, no evidence of an association between caffeine intake and benign tumors and fibrocystic breast disease was found. When there is research to support both sides what conclusion can be made? That for some it works, and for others it doesn't. Because there is a chance that eliminating caffeine and other methylxanthines may help relieve the symptoms of FBD, we suggest trying it. Surgery 1987, 101:720-30, Surgery 1982, 91:260 
   
• Follow a low-fat diet: A diet high in fat, especially saturated fat, has been associated with the development of painful breast lumps and cysts. A study appearing in the American Journal of Clinical Nutrition suggests that women who have breast pain associated with FBD, may benefit significantly from a low-fat diet. In the study, all 10 women following a low-fat diet reported reductions in breast pain after three months. Am J Clin Nutr 1985, 41(4):856
   
• Increase intake of dietary fiber: When women with fibrocystic disease are put on a high-fiber diet, their estrogen levels decrease. This type of diet is beneficial for two reasons: One, it can help to promote regular bowel movements and two, it reduces circulating estrogen levels. Women having less than three bowel movements per week have been found to have a 4.5 times higher risk of FBD than those having at least one daily bowel movement. Microorganisms found in the feces have the ability to resynthesize estrogen from previously excreted and detoxified estrogen. Women who consume a diet rich in plant foods excrete 2-3 times more estrogen than women following an omnivorous diet. Additionally, omnivorous women have been found to have 50 percent higher levels of undetoxified or free estrogen in their blood than those consuming a plant-based diet. Foods high in dietary fiber include fresh fruits and vegetables, legumes, raw seeds and nuts. Cancer Res 1981, 41:3771-3
   
• Limit intake of alcohol: The liver is the primary organ in the body responsible for estrogen removal. Any factor which interferes with the proper functioning of the liver such as excessive intake of alcohol, can lead to estrogen excesses in the body. Women with FBD should consume alcohol in moderation (1-2 drinks per day) or choose to avoid it all together.
   
• Limit intake of salt: Restricting the amount of sodium (< 1,000 mg daily) in the diet can help to reduce fluid-retention and improve symptoms associated with FBD such as pain and tenderness.

Nutritional Measures

• Vitamin E (400-800 IU daily): Several double-blind studies have shown that vitamin E, taken for several months, can help to improve symptoms associated with FBD including reducing the size and number of painful cysts. In one study, 75 women with FBD were treated for two months with either vitamin E in doses of 150, 300, or 600 IU daily, or a placebo. The results proved vitamin E to be significantly more effective than the placebo. Vitamin E is believed to help normalize hormonal imbalances commonly seen in women with fibrocystic disease. However, not all studies have shown vitamin E therapy beneficial in the treatment of FBD. J Am Coll Nutr 1983, 2(2):115-22
   
• Vitamin A (100,000-150,000 IU daily): In a 1984 study involving 12 women with FBD, three months of high-dose vitamin A therapy was shown to significantly reduce pain in 9 of the women, and decrease the size of cysts by 50 percent in 5 of the women. Several women taking part in the study experienced severe headaches during treatment, while others reported milder side effects. Due to the risk of toxicity associated with large doses of vitamin A, it should be used only in cases unresponsive to other therapies and only under the supervision of a physician. Vitamin A should never be taken in doses greater than 5,000 IU per day if there is a chance of pregnancy, due to the risk of serious birth defects. Prev Med 1984, 15(5):549-54
   
• Iodine (30-90 mg daily): Iodine deficiency may play a role in FBD possibly by increasing the susceptibility of breast tissue to the effects of estrogen. In animal studies, iodine deficiency has been shown to cause the equivalent of fibrocystic disease. Results from several double-blind studies involving humans show that while treatment with iodides was effective in about 70 percent of patients, it was associated with a high rate of side effects such as altered thyroid function, iodism (iodine poisoning) and acne. Furthermore, the form of iodine used in these studies (diatomic iodine) is not readily available. Due to the possibility of serious side effects, iodine supplements should only be used under the supervision of a physician. Can J Surg 1993, 36:453-60
   
• Evening primrose oil (1,500-3,000 mg twice daily): Several studies have investigated the use of evening primrose oil in the treatment of FBD. Evening primrose oil is a rich source of the essential fatty acids linoleic acid and gamma linolenic acid (GLA), both of which have been shown effective in reducing inflammation. In one study involving over 290 women with severe breast pain, 45 percent of the women supplemented with evening primrose oil experienced significant reductions in breast pain. The results of a second study involving 41 women were equally as effective. These beneficial effects were maintained in women who continued to use evening primrose oil after the study had ended. It may take as long as six months of treatment for optimal results. J Royal Soc Med 1992, 85:12-5

Herbal Remedies

     Because many women with FBD also tend to suffer from premenstrual syndrome (PMS), there is often an overlap in herbal recommendations. To learn more about these herbs, see "premenstrual syndrome."