ICIM Articles: Fibrocystic Breast Disease

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 (see article on PMS (premenstrual syndrome) which will be in the next write up)

• 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 Irish Centre of Integrated Medicine, unless a women has pure FBD, the approach outlined in the article PMS (which shall appear in the next write up) 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 and to book for medical thermography or to know more about this diagnostic, go to our home page and read the section on Medical Thermography on our website.

This article is to be used for information and guide line purpose. Any advice and/or suggestions from this article should be supervised by your health professional. ICIM can offer a medical professional at the centre to guide you through your health complaints. Contact ICIM for more information.

ICIM Medics, St. Johns Grove, Johnstown, Naas, Co. Kildare, Ireland.

Tel: 00353 (0)45 844 819 - www.icim.ie - info@icim.ie

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