Fibrocystic Breasts

What Is It?

Fibrocystic breasts are characterized as ‘lumps’ or ‘cysts’ found within the breast ^[1]. Fibrocystic breasts arise from estrogen predominance and progesterone deficiency resulting in hyper-proliferation of connective tissue. This condition can be either asymptomatic or present with breast nodularity, swelling, and pain ^{[2, 3]}. Breast nodularity is cyclic and bilateral with cysts of varying sizes. The pain has a tendency to be at its worse prior to menstruation, as tissues appear to be more sensitive to estrogen pre-menstrually ^[2]. The condition progresses with advancing age and is most pronounced in women in their 40s. Fibrocystic breasts regress in postmenopausal women due to the drastic decline in estrogen levels ^[3].

Causes

Fibrocystic breasts result from increased estrogen to progesterone ratios. High doses of xenoestrogens can also accumulate in breast tissue. Xenoestrogens are either natural or synthetic sources of estrogen that are produced outside of the body. In addition, an underactive thyroid gland can make breast cells more sensitive to estrogen. Fibrocystic breasts may also develop from obstructed lymphatic circulation. Toxins and estrogen accumulate when lymphatic and blood flow is impaired because the body is unable to excrete them at a proper rate. Nutrient deficiencies can also worsen symptoms associated with fibrocystic breasts.

Diagnosis

Fibrocystic breasts can resemble other breast conditions and these need to be differentiated. Pain, cyclical breast changes, high mobility, symmetry, and multiplicity of nodules are indicative of fibrocystic changes. Non-invasive procedures such as ultrasonography and mammography can be used to differentiate fibrocystic breasts from breast cancer, fibroadenomas, and other conditions. A fine-needle biopsy is invasive, but can be used to determine a definitive diagnosis if needed ^[2].

Natural Treatments
Dietary Modifications

1. Increase fruit and vegetable intake: a recent study found that a reduced risk of proliferative and atypical breast lesions was associated with consumption of fruits and vegetables ^[1].
2. Increase soy consumption: soy may decrease cellular proliferation in breast tissue. One uncontrolled study showed that consumption of soy-protein for one year resulted in a statistically significant reduction in variability of breast tissue activity, along with subjective reductions in breast tenderness ^[2].
3. Avoid methylxanthines: caffeine, theophylline, and theobromine are all known to inhibit cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate phosphodiesterase and to significantly elevate their levels in breast tissue. Excess levels of these nucleotides stimulate protein-kinase activities leading to an increase in cellular products responsible for fibrosis and cyst fluid. One study showed improvements in 97.5% of 45 women who eliminated methylxanthines from the diet completely, and in 75% of 28 women who limited their consumption. Individuals who continued with regular methylxanthine consumption showed little improvement ^[2].
4. Limit dietary fat and increase fiber: reducing fat in the diet may be beneficial for women with fibrocystic breasts. Reducing fat intake has the positive effect of decreasing circulating estrogen levels within the body. Fiber helps bind excess estrogen within the body and speeds up the process of elimination by decreasing stool transit time ^[1].

Lifestyle Modifications

1. Exercise is beneficial for everyone. The intensity of exercise, however, may need to be varied according to each individual’s unique circumstances. Exercising 40 to 60 minutes per day can help improve lymphatic circulation and estrogen metabolism. Moving armpits and breasts during exercise may have a positive additive effect on lymphatic flow and estrogen metabolism. Rebounding, in particular, is found to be the ideal exercise for reducing complaints and symptomatology associated with fibrocystic breasts ^[4].
2. Avoid storing foods and drinks in plastic containers and bottles. Bisphenol-A (BPA) is a compound found in plastic containers and bottles that can be accidentally consumed by humans. BPA mimics natural estrogen and can inappropriately alter hormone levels. This compound tricks estrogen receptors into a state of inappropriate activation and can have detrimental effects on one’s health, influencing the development of conditions which thrive in estrogen dominant environments ^[5].

Supplements

1. Vitamin E: studies demonstrate that vitamin E is useful in relieving breast pain and tenderness, although the mechanism of action remains unclear ^[1]. Alpha-tocopherol has been shown to relieve many PMS symptoms, as evidenced by several double-blind clinical studies. One study evaluated the effectiveness of vitamin E on breast pain: chewable vitamin E tablets were given twice daily for 4 months. Pain was evaluated in both the group receiving vitamin E and placebo at the end of 2 months. The group receiving vitamin E reported a reduction in severity and duration and pain, with no further improvement at 4 months ^[2].
2. Evening primrose oil (EPO): the pain and tenderness of fibrocystic breasts has been alleviated by EPO ^[4]. EPO is a good source of gamma linolenic acid (GLA); most people are deficient in GLA stores due to the body’s inefficiency of converting linoleic acid (LA) to GLA. GLA is used to produce beneficial hormone-like compounds known as prostaglandins. Prostaglandins are used to help regulate inflammation and pain; these compounds also affect hormone production and function ^[1]. One study showed that 73 women with breast pain randomly received EPO or placebo. After 3 months, pain and tenderness were significantly reduced in those consuming EPO and no improvements were seen in the placebo group. Another study examined the effectiveness of EPO for breast cyst recurrence. There was a slight but statistically significant reduction in recurrence in women receiving EPO ^[2].
3. Beta-carotene: retinoid receptors are present within breast tissue, and these receptors are said to modulate our genetic predisposition by decreasing the risk for both benign and malignant breast changes. Beta-carotene has similar activity as vitamin A in inflammatory disorders, without the potential side-effects of high dose vitamin A. Beta-carotene can be found in supplement form or in the diet by consuming yellow and orange fruits and vegetables ^[1].
4. Iodine (elemental iodine): iodine deficiency may be a causative factor in the pathogenesis of fibrocystic breasts. The breast appears to have an affinity for both thyroid hormone and iodine ^[1]. In fact, breast tissue appears to concentrate iodine to a greater degree than the thyroid gland ^[6]. Iodine is found within the terminal and interlobular duct cells of breast tissue; these areas are also where cystic changes occur. Breast tissue appears to become more sensitive to estrogen in the absence of iodine. Therefore, iodine may play an important role in maintaining normal breast tissue architecture and function: it appears to have anti-inflammatory and anti-fibrotic effects in acute and chronic scenarios ^[2]. In one study, subjective and physician-evaluated clinical improvements were noted in 65% of 1,365 women receiving molecular iodine. The placebo group noted a 33% improvement ^[6]. Food sources include seaweed and seafood; these might be used to supplement a diet low in iodine ^[1].
5. Indole-3-carbinol (I3C) or Diindolylmethane (DIM): I3C and DIM help the liver with estrogen metabolism ^[4]. Studies reveal that I3C leads to beneficial shifts in hormone markers. Meanwhile, further studies need to be performed to confirm similar use and safety of DIM ^[7]. These compounds are found in cruciferous vegetables including broccoli, Brussel sprouts, collard greens, cabbage, cauliflower, and kale ^[4].

Botanicals

1. Diuretic herbs (Taraxacum officinale,Galium aparine, Achillea millefolium, Arctostaphylos uva-ursi): diuretics are useful to help decrease breast swelling and associated discomfort. Diuretics also tend to decrease potassium levels. Potassium is implicated in fibrosis and cyst isolation; therefore diuretic herbs which tend to decrease potassium levels are most indicated and preferred. Taraxacum is believed to contain high concentrations of potassium and is therefore not the ideal diuretic to use ^[1].
2. Phytolacca americana: this herb is applied topically to the breasts as an oil, reducing lumpiness and size of nodules ^[1].
3. Liver support (Taraxacum officinale, Silybum marianum, Arctium lappa, and Chelidonium majus): estrogen is metabolized by the liver, a healthy and functional liver is crucial for proper metabolism of estrogen and toxins ^[1].

Conclusion

Fibrocystic breasts are most common in women of reproductive age. This is likely due to estrogenic effects on breast tissue. The condition can either be asymptomatic or present with breast nodularity, swelling, and pain. Fibrocystic breasts may resemble other types of breast conditions and therefore it is wise to seek professional help if unsure. Non-invasive screening tools exist to help with the differential diagnoses. There are many different ways one can go about seeking treatment and management: the use of dietary and lifestyle modifications, supplementation, and botanicals can all aid with symptom management. Supporting estrogen metabolism and excretion is highly important. Please consult with your health professional before self-diagnosing and undergoing any treatment. The information presented in this article does not substitute for a visit with your naturopathic doctor. Natural substances are not void of side-effects, and can be dangerous for some patients.