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Breast conditions

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Related Terms
  • Areola, atypical ductal hyperplasia, atypical lobular hyperplasia, breast augmentation, breast cysts, breast enlargement, breast pain, breast reduction, breast self-examination, BSE, CBE, clinical breast exam, cyclic mastalgia, cyclical breast pain, ductal lavage, fat necrosis, fibroadenomas, fibrocystic breast disease, fine needle aspiration, galactorrhea, intraductal papilloma, magnetic resonance imaging, malignant, mammary duct ectasia, mammography, mammoplasty, mastalgia, mastitis, microcalcifications, MRI, nipple, noncyclical breast pain, stereotactic biopsy.

Background
  • There are a number of benign (non-cancerous) breast conditions that a woman may experience during her lifetime. It is estimated that 50-90% of all women experience some symptoms such as breast pain, lumps, or nipple discharge by the time they reach menopause.
  • Common benign breast conditions generally fall into several broad categories and include: breast pain or mastalgia, benign breast tumors, solitary lumps, fibrocystic changes, nipple problems and discharge, infections, and inflammation. It is important to note that most women have normal physiological changes, such as minor tenderness, swelling, and lumpiness that they experience before or after their menstrual periods.
  • A benign breast condition is any non-cancerous breast abnormality. According to the American Cancer Society, when breast tissue is examined under a microscope, some type of abnormality is common in nine out of every 10 women. Though not life-threatening, benign conditions may cause pain or discomfort for some patients. Some (not all) benign conditions can signal an increased risk for breast cancer. The most common benign breast conditions include fibrocystic breast condition, benign breast tumors, and breast inflammation. Depending on the type of benign breast condition and the patient's medical situation, treatment may or may not be necessary.
  • Malignant breast conditions are those that are cancerous, including breast cancer (see Breast Cancer condition monograph).
  • Each breast has 15-20 sections, called lobes, each with many smaller lobules. The lobules end in dozens of tiny bulbs that can produce milk. Lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple, which is centered in a dark area of breast skin called the areola. The areola also has oil-producing glands that secrete a lubricant to make breastfeeding easier. The spaces between the lobules and ducts are filled with fat. There are no muscles in the breast, but muscles lie under each breast and cover the ribs.
  • These normal features can sometimes make the breasts feel lumpy. This is especially true in women who are thin or who have small breasts
  • Breasts may also be altered surgically, as in breast reduction and breast enlargement procedures.

Signs and symptoms
  • Common signs and symptoms of breast cancer include a lump in the breast that feels distinctly different from other breast tissue or that does not go away, swelling of the breast that does not go away, thickening of breast tissue, dimpling or pulling of the skin on the breast that resembles the skin of an orange, any change in the breast shape or contour, nipple discharge, retraction of the nipple, a scaly appearance of the nipple, pain or tenderness of the breast, swollen bumps, or puss-filled sores.
  • Fibrocystic changes: This condition can cause the breasts to feel ropy or granular. Fibrocystic changes are extremely common, occurring in at least half of all women. In most cases the changes are harmless. If the breasts are very lumpy, then performing a breast self-exam can be more challenging.
  • Cysts: These are fluid-filled sacs that frequently occur in the breasts of women ages 35-50. Cysts can range from very tiny to about the size of an egg. They can increase in size or become more tender just prior to menstruation and may disappear completely after. Cysts are less common in postmenopausal women due to the drop in hormonal levels.
  • Fibroadenomas: These are solid, noncancerous tumors that often occur in women during their reproductive years. A fibroadenoma is a firm, smooth, rubbery lump with a well-defined shape. It will move under the skin when touched, and is usually painless. Over time, fibroadenomas may grow larger or smaller or even disappear completely.
  • Infections: Breast infections (mastitis) are common in women who are breastfeeding or who have recently stopped breastfeeding, but mastitis may develop when women are not nursing. The breast will likely be red, warm, tender, and lumpy, and the lymph nodes under the arm may swell. The individual may also feel slightly ill and have a low-grade fever.
  • Trauma: Sometimes a blow to the breast or a bruise also can cause a lump in the breast tissue.
  • Calcium deposits (microcalcifications): These tiny deposits of calcium can appear anywhere in the breast and often show up on a mammogram. Most women have one or more areas of microcalcifications of various sizes. They may be caused by secretions from cells, cellular debris, inflammation, trauma, or prior radiation. Calcium deposits are not the result of taking calcium supplements. The majority of calcium deposits are harmless, but a small percentage may be precancerous or cancer.

Diagnosis
  • Breast self-examination (BSE): In about 80% of breast cancer cases, the woman detects the lump herself. Women are advised to examine their breasts on a monthly basis starting around age 20. Women may be able to detect early signs of cancer if they become proficient at BSE and familiar with the usual appearance and feel of their breasts. A study did find that women who perform regular breast self-exams might be more likely to undergo unnecessary biopsies after finding breast lumps. Breast self-examination should be performed once a month at the same time each month, one week after a woman's period.
  • Clinical breast exam (CBE): Unless there is a family history of cancer or other factors that place the individual at high risk, the American Cancer Society recommends having clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly CBE. During this exam, the doctor examines the breasts for lumps or other changes. He or she may be able to feel lumps missed by self-examination and will also look for enlarged lymph nodes in the armpit (axillary).
  • Mammography: Overall mammography is a very effective breast cancer screening tool, and has the ability to detect breast cancers before they can be felt by BSE or CBE. Images on mammograms appear in gradations of black, gray, and white depending on the density of the tissue. Bone shows up as white, fat appears dark gray, and cancerous tumors appear a lighter shade of gray or white. Unfortunately, dense normal breast tissue can also appear light gray on a mammogram, which can make mammograms harder to interpret in younger women, since they tend to have breast tissue that is denser. After menopause, though, breast density usually begins to decrease, making the mammograms of older women easier to read. For this reason, it is important to follow the guidelines for clinical breast examination (CBE) and to practice regular breast self-examination (BSE).
  • If a lump in the breast is found, either by breast self-exam or mammography, other tests will be performed in order to make a diagnosis. The only proven way to reduce the risk of dying from breast cancer is by having regular mammograms after the age of 50.
  • Computer-aided detection (CAD): Radiologists normally view X-rays and mammograms, and their skills and experience play a large part in determining the accuracy of the test results. In CAD, a computer scans the mammogram after a radiologist has reviewed it. CAD helps identify suspicious areas on the mammogram, although many of these areas may later prove to be normal. Using mammography and CAD together may increase the cancer detection rate.
  • Digital mammography: In this procedure, an electronic process is used to collect and display X-ray images on a computer screen. This allows the radiologist to alter contrast and darkness, making it easier to identify subtle differences in tissue. In addition, the images can be transmitted electronically, so women who live in remote areas can have their mammograms read by an expert who is based elsewhere.
  • Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) uses a magnet linked to a computer to take pictures of the interior of the breast. Although not used for routine screening, MRIs can reveal tumors that are too small to detect through physical exams or are difficult to see on conventional mammograms. Some centers may use MRI as an additional screening tool for high-risk women who have dense breast tissue on a mammogram. MRIs aren't recommended for routine screening because they have a high rate of false-positive results, which lead to unnecessary anxiety and biopsies. They are also expensive and not readily available.
  • Ductal lavage: In a ductal lavage, the clinician inserts a tiny, flexible tube (catheter) into the lining of a duct in the breast and withdraws a sample of cells. The cells are then examined for precancerous changes that might eventually lead to disease. These changes show up long before tumors can be detected on a mammogram. Ductal lavage isn't recommended as a screening tool for high-risk women. It is a new procedure with risks, including the rate of false-negative results and its inability to determine the exact location of abnormal cells and whether they will lead to cancer.
  • Breast ultrasound (ultrasonography): A breast ultrasound is used to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to form images of structures deep within the body. Because an ultrasound does not use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. Breast ultrasound is not used for routine screening because it has a high rate of false-positive results.
  • Molecular breast imaging (MBI): Molecular breast imaging (MBI) experimental technique tracks the movement of a radioactive isotope taken up by breast tissue. Images are taken of the breast when the radioactive isotope signals are detected. In preliminary studies, MBI found small tumors that both mammography and ultrasound missed. This procedure uses lighter compression, and may be more comfortable than mammography. The MBI takes about 40-50 minutes as opposed to 15 minutes for a mammogram, and the procedure is more invasive due to the injection. It is still unclear how abnormal findings are biopsied, and the studies remain ongoing.
  • Fine needle aspiration: During a fine needle aspiration, a thin needle is inserted into the lump and a sample is withdrawn. This test helps to determine if the lump is fluid-filled (a cyst, usually not cancerous) or a solid tumor. It can be performed in a doctor's office with local anesthesia. The sample, regardless of whether it is fluid or solid, is sent to the laboratory for further analysis.
  • Core biopsy: During a core biopsy, a larger needle is inserted into a lump or an abnormal area seen on a mammogram, and the tissue sample is removed. The sample is analyzed for cancer cells, and this procedure is usually performed at a hospital with local anesthesia.
  • Surgical biopsy: A surgical biopsy is when the lump and surrounding tissue is removed surgically before being sent to a laboratory for analysis. A surgical biopsy needs to be done in a hospital with either a local or general anesthetic.
  • Stereotactic biopsy: A stereotactic biopsy is used to sample and evaluate an area of concern that can be seen on a mammogram, but cannot be felt or seen on an ultrasound. During the procedure, a radiologist takes a core needle biopsy using the mammogram as a guide. Stereotactic biopsy usually takes about an hour and is performed using local anesthesia.
  • Wire localization: A doctor may recommend a wire localization when a worrisome lump is seen on a mammogram, but it cannot be felt or evaluated with a stereotactic biopsy. Using the mammogram as a guide, a thin wire is placed in the breast and is guided toward the lump. Wire localization is usually performed right before a surgical biopsy and is a way to help the surgeon find the area to be removed and tested.
  • Estrogen and progesterone receptor tests: If a biopsy reveals malignant cells, estrogen and progesterone receptor tests are usually performed on the malignant cells. These tests help determine whether female hormones affect the way the cancer grows. If the cancer cells have receptors for estrogen, progesterone, or both, the doctor may recommend treatment with a drug tamoxifen, which prevents estrogen from binding to these sites.

Complications
  • Because breast conditions, such as fibrocystic changes, may make breast examination and mammography more difficult to interpret, early cancerous lesions may occasionally be overlooked.
  • Breast enlargement and reduction procedures: Breast surgery (enlargement and reduction) has the same risk as any other type of major surgery, including bleeding, infection, and an adverse reaction to the anesthesia. Other possible risks specific to breast reduction surgery include: loss of sensation in the nipples and areola; impaired blood supply to the nipples, leading to nipple damage and scarring; inability to breastfeed; asymmetry in size, shape, position, and contour of the nipples or breasts, which may lead to further surgery to improve appearance; and altered body image and a period of adjustment to get used to the change in the individual's appearance.

Treatment
  • The treatments for breast conditions are directed at relieving symptoms (such as breast pain and tenderness) and correcting hormonal irregularities.
  • Relief of symptoms: Certain measures, such as adequate support of the breasts and wearing a bra at night, may provide relief from many of the symptoms of fibrocystic breast condition. Pain medications, including acetaminophen (Tylenol®) and nonsteroidal antiinflammatory medications (NSAIDs), often reduce the breast pain significantly.
  • Hormonal irregularities: Some women with very irregular menstrual cycles seem to progressively suffer more fibrocystic breast disease. This tendency is most likely due to the prolonged and irregular hormonal stimulation of the breasts. In these patients, it is sometimes helpful to establish menstrual cycle regularity with oral contraceptives. Regular cycles seem to allow the breast tissue to recover more completely at the end of each menstrual cycle. A doctor will determine the length of hormonal therapy.
  • In patients who have had a hysterectomy and who are on hormone therapy, it may be helpful to be "off estrogen" for five days during each monthly cycle rather than remain on continuous estrogen. Again, this schedule is designed to avoid the continuous stimulation of the breast tissues by estrogen. It is important that any such hormone regulation be under the direct supervision of a doctor.
  • Certain common hormonal (endocrine) abnormalities, such as diabetes or thyroid dysfunction, may contribute to fibrocystic breast condition. Since these conditions may aggravate the symptoms of fibrocystic breast condition, they should be diagnosed and treated.
  • Other medications: Studies have reported some benefit from the short term use of the antiestrogenic drug tamoxifen (Nolvadex®) in relieving breast pain. However, tamoxifen use may be associated with a number of adverse effects, especially in postmenopausal women, and its use should be limited to the short term. Adverse effects can include blood clots (thrombosis); endometrial cancer (cancer of the uterine lining); abnormal growth of uterine tissue (endometriosis); stroke (neurological damage due to a lack of blood flow to the brain); fertility issues; and hair and nail thinning.
  • Likewise, the androgenic steroid drug danazol (Danocrine®) has also been shown to reduce breast pain and nodule size in women with fibrocystic breast condition. Danazol is also associated with a number of side effects, including acne and weight gain. Both of these medications may be considered for use in women with severe cyclical breast pain due to fibrocystic condition.

Integrative therapies
  • Note: Below is a list of integrative therapies studied for a variety of breast conditions. A healthcare provider should be consulted before considering these and/or any other adjunct therapies.
  • Unclear or conflicting scientific evidence:
  • Applied Kinesiology: Preliminary study suggests that applied kinesiology (AK) may be an effective and well tolerated treatment for mastalgia. Further research is needed to confirm these results.
  • Side effects from applied kinesiology techniques in themselves are currently lacking. However, medical conditions should not be treated with AK alone, and should not delay appropriate medical treatment.
  • Arginine: It is unclear if arginine can help treat breast cancer patients. Results from early human studies are mixed. High-quality studies are needed. Avoid if allergic to arginine, if you have history of stroke, liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Check blood potassium levels. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Bilberry: Bilberry (Vaccinium myrtillus), a close relative of blueberry, has a long history of medicinal use. There is limited research suggesting a possible benefit of bilberry in the treatment of fibrocystic breast disease. Additional study is needed in this area.
  • Avoid if allergic to plants in the Ericaceae family or to anthocyanosides (a component of bilberry). Avoid with a history of low blood pressure, heart disease, bleeding, diabetes, blood clots, or stroke. Avoid if pregnant or breastfeeding. Stop use before surgeries/dental or diagnostic procedures involving blood tests.
  • Black cohosh: Black cohosh (Actaea racemosa) is used for pre- and postmenopausal symptoms such as hot flashes and irritability. Recent study found that the use of black cohosh had a significant protective effect for breast cancer. Additional confirmatory studies are required.
  • Caution is advised when taking black cohosh supplements, as numerous adverse effects including drug interactions are possible. Black cohosh should not be used if pregnant or breastfeeding unless otherwise directed by a doctor.
  • Chasteberry:The chaste tree (Vitex agnus-castus) is native to the Mediterranean and Central Asia. Its berries have long been used for a variety of abnormalities including corpus luteum deficiency, mastalgia (breast pain), and menstrual abnormalities. Despite preliminary promising results, it remains unclear if chasteberry is an effective treatment in the management of cyclic mastalgia. Additional study is needed in this area.
  • When taken in recommended doses, chasteberry appears to be well tolerated with few side effects. Avoid if allergic or hypersensitive to members of the Vitex (Verbenaceae) family or any chasteberry components. Mild skin reactions have been reported in clinical trials including eczema, itching, rash, skin eruptions, urticaria (hives), and allergic exanthema. Use cautiously in patients taking oral contraceptives or hormone replacement therapy. Use cautiously with dopamine agonists or antagonists. Avoid with hormone sensitive cancers or conditions (like ovarian cancer or breast cancer). Avoid if pregnant, breastfeeding or if undergoing in vitro fertilization.
  • Chlorophyll: Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants; it is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussels sprouts, cabbage, lettuce, and spinach), algae (Chlorella and Spirulina), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley). The benefits of chlorophyll in benign breast disease may be attributed to its ability to alter liver enzyme pathways involved in estrogen metabolism. A combination product containing chlorophyll has been shown to be beneficial for fibrocystic breast disease, but more research is needed to confirm these preliminary results.
  • It appears that chlorophyll is generally safe and without many side effects or toxicities in non-allergic people. Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.
  • Coenzyme Q10: Although supplementation of CoQ10 has been reported to improve general health, it has not been proven to reduce cancer, and it has not been compared to other forms of breast cancer treatment. Although its use is not clearly defined, CoQ10 levels are generally decreased in breast cancer patients; therefore, further testing needs to be done.
  • Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), or blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Evening primrose oil: Evening primrose oil (EPO, Oenothera biennis) contains an omega-6 essential fatty acid, gamma-linolenic acid (GLA), which is believed to be the active ingredient. EPO has been studied in a wide variety of disorders, particularly those affected by metabolic products of essential fatty acids. The limited available research does not demonstrate that evening primrose oil has a significant effect on treating breast cysts. Although primrose oil is used for breast pain in several European countries, high-quality human studies are currently unavailable. Not enough information is available to advise the use of evening primrose oil for breast cancer. People with known or suspected breast cancer should consult with a qualified healthcare professional about possible treatments.
  • Avoid if allergic to plants in the Onagraceae family (willow's herb, enchanter's nightshade) or gamma-linolenic acid. Avoid with seizure disorders. Use cautiously with mental illness drugs. Stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.
  • Flaxseed oil: Flaxseed (not flaxseed oil) contains lignans that may possess estrogen receptor agonist or antagonist properties, and may inhibit enzymes involved with the synthesis of sex hormones. Human studies have reported reduced levels of serum estrogens associated with flaxseed use. It has been hypothesized that the hormonal effects of flaxseed may improve the symptoms of cyclic mastalgia, a condition characterized by breast pain and tenderness in women. Preliminary human evidence suggests that 25g of flaxseed daily reduces these symptoms. However, further study is warranted before a conclusion can be made. There is a lack of information from human studies indicating that flaxseed (not flaxseed oil) is effective in preventing or treating breast cancer.
  • Flaxseed has been well-tolerated in studies for up to four months. Use cautiously with a history of a bleeding disorder or with drugs that increase bleeding risk (like anticoagulants and non-steroidal anti-inflammatories (like aspirin, warfarin, Advil®)), high triglyceride levels, diabetes, mania, seizures, or asthma. Avoid if allergic to flaxseed, flaxseed oil or other plants of the Linaceae family. Avoid large amounts of flaxseed by mouth and mix with plenty of water or liquid. Avoid flaxseed with a history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with a history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed in open wounds or abraded skin surfaces. Avoid if pregnant or breastfeeding. Avoid with prostate cancer, breast cancer, uterine cancer or endometriosis. Avoid ingestion of immature flaxseed pods.
  • Gamma linolenic acid: Gamma linolenic acid (GLA) is a dietary omega-6 fatty acid found in many plant oil extracts. Commercial products are typically made from seed extracts from evening primrose (average oil content 7-14%), blackcurrant (15-20%), borage oil (20-27%), and fungal oil (25%). GLA is not found in high levels in the diet. It has been suggested that some individuals may not convert the omega-6 fatty acid linoleic acid to longer chain derivatives, such as GLA, efficiently. Thus, supplementation with GLA-containing oils, such as borage oil and evening primrose oil, is occasionally recommended to increase GLA levels in the body. Evidence for efficacy of GLA treatment is very limited, although since the 1990s, GLA has been recommended historically as a therapy for mastalgia. Additional research is needed in this area.
  • Gamma linolenic acid may also increase bleeding in sensitive individuals, including those with bleeding disorders or those taking blood thinning medications such as aspirin or warfarin (Coumadin®). Avoid if pregnant or breastfeeding.
  • Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Several laboratory and human studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. However, due to a lack of well-designed human research using lycopene supplements, its effectiveness for breast cancer prevention remains unclear.
  • Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.
  • Peppermint: Using peppermint gel during breastfeeding may be effective for prevention of cracked nipples. Additional research is needed to confirm these early findings.
  • Peppermint oil may be safe in small doses, although multiple adverse effects are possible. Allergic/hypersensitivity reactions may occur from using peppermint or menthol by mouth or on the skin, including throat closing (laryngeal spasm), breathing problems (bronchial constriction/asthma symptoms), or skin rash/hives/contact dermatitis. People with known allergy/hypersensitivity to peppermint leaf or oil should avoid peppermint products. Lung injury has occurred following an injection of peppermint oil. Peppermint oil taken by mouth may cause headache, dizziness, heartburn, anal burning, slow heart rate, or muscle tremor. Very large doses of peppermint oil taken by mouth have resulted in muscle weakness, brain damage, and seizure. Peppermint oil should be used cautiously by people with G6PD deficiency or gallbladder disease. Use in infants or children is not recommended due to potential toxicity. Peppermint oil and menthol should be avoided during pregnancy and breastfeeding due to insufficient information and potential for toxicity.
  • Physical therapy: Physical therapy was first documented in China around 3000 BC with the use of joint manipulation and massage to relieve pain. The goal of physical therapy or physiotherapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Physical therapy programs are often used following mastectomy (breast cancer surgery), which may include arm mobilization, shoulder strengthening, prevention and treatment of upper extremity edema (swelling), and education about arm function. Limited available study suggests that physical therapy may increase shoulder range of motion following breast cancer surgery, but more high quality trials are needed.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Resveratrol: Early human study found that resveratrol may inhibit the development of breast cancer. However, there is currently insufficient evidence to recommend resveratrol for this use.
  • Avoid if allergic or hypersensitive to resveratrol, grapes, red wine or polyphenols. Resveratrol is generally considered safe and is commonly found in food and beverages. Use cautiously with bleeding disorders, abnormal blood pressure. Use cautiously with drugs that are broken down by the body's cytochrome P450 system or digoxin (or digoxin-like drugs). Avoid if pregnant or breastfeeding.
  • Soy: It has been theorized that the presence in soy (Glycine max) of "phytoestrogens" (plant-based compounds with weak estrogen-like properties) such as isoflavones may be beneficial to pre-menopausal women with cyclical breast pain. However, due to limited human study, there is not enough evidence to recommend for or against the use of dietary soy protein as a therapy for this condition. Several large population studies have asked women about their eating habits, and reported higher soy intake (such as dietary tofu) to be associated with a decreased risk of developing breast cancer. This type of research can only be considered preliminary, because people who choose to eat soy may also partake in other lifestyle decisions that may lower the risk of cancer and be the cause of the benefits seen in these studies (for example, lower fat intake, more frequent exercise, lack of smoking). Until better research is available, it remains unclear if dietary soy or soy isoflavone supplements increase or decrease the risk of developing breast cancer.
  • Caution is advised when taking soy supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Soy should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor. Soy can act as a food allergen similar to milk, eggs, peanuts, fish, and wheat. The use of soy is often discouraged in patients with hormone-sensitive malignancies such as breast, ovarian, or uterine cancer, due to concerns about possible estrogen-like effects (which theoretically may stimulate tumor growth). Other hormone-sensitive conditions such as endometriosis may also theoretically be worsened. In laboratory studies, it is not clear if isoflavones stimulate or block the effects of estrogen, or both (acting as a "receptor agonist/antagonist"). It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. Preliminary studies suggest that soy isoflavones, unlike estrogens, do not cause the lining of the uterus (endometrium) to build up. Until additional research is available, patients with these conditions should be cautious and speak with a qualified healthcare practitioner before starting use.
  • Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th century China. Tai chi techniques aim to address the body and mind as an interconnected system, and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility and strength. Tai chi chuan has been studied in breast cancer patients to improve functional capacity (specifically aerobic capacity, muscular strength, and flexibility). Larger studies are needed to make a firm recommendation.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury.
  • Vitamin A: Vitamin A is a fat-soluble vitamin, which is derived from retinoids and carotenoids. Retinoids like retinal and retinoic acid are found in animal sources (like the liver, kidney, eggs and dairy products). Carotenoids like beta-carotene are found in plants like dark or yellow vegetables and carrots. Research results are not clear as to whether vitamin A is beneficial in the treatment or prevention of breast cancer.
  • Patients receiving chemotherapy or radiation therapy for cancer should speak with their doctor(s) before taking antioxidants such as vitamin A during treatment, due to possible interference. Vitamin A toxicity can occur if taken at high dosages, and caution should be used with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Vitamin B12: Vitamin B12 (or cyanocobalamin) is an essential water-soluble vitamin that is commonly found in a variety of foods such as fish, shellfish, meats, and dairy products. Researchers at Johns Hopkins University report that women with breast cancer tend to have lower vitamin B12 levels in their blood serum than do women without breast cancer. In a subsequent review of these findings, it was hypothesized that vitamin B12 deficiency may lead to breast cancer because it may result in less folate being available to ensure proper DNA replication and repair. Higher dietary folate intake is associated with a reduced risk of breast cancer. The risk may be further reduced in women who also consume high amounts of dietary vitamin B12 in combination with dietary pyridoxine (vitamin B6) and methionine. However, there is currently insufficient evidence that dietary vitamin B12 alone reduces the risk of breast cancer.
  • Avoid if allergic or hypersensitive to cobalamin, cobalt, or any other vitamin B12 product ingredients. Avoid with coronary stents (mesh tube that holds clogged arteries open) and Leber's disease. Use cautiously if undergoing angioplasty and with anemia. Vitamin B12 is generally considered safe when taken in amounts that are not higher than the Recommended Dietary Allowance (RDA). There is currently not enough scientific data available about the safety of larger amounts of vitamin B12 during pregnancy and/or breastfeeding.
  • Vitamin D: Limited research suggests that synthetic vitamin D analogs may play a role in the treatment of human cancers. However, it remains unclear if vitamin D deficiency raises cancer risk, or if an increased intake of vitamin D is protective against some cancers. Until additional trials are conducted, it is premature to advise the use of regular vitamin D supplementation for cancer prevention. High-dose vitamin D supplementation may be associated with a slightly reduced risk of developing breast cancer. Additional study in this area is warranted.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Vitamin E: Reliable scientific evidence that vitamin E is effective for the prevention or treatment of breast cancer is currently lacking. High quality human study is needed in this area.
  • Caution is merited in people undergoing chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anti-cancer effects of these therapies. This remains an area of controversy and studies have produced variable results. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. Caution is advised when taking vitamin E supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid above the recommended daily level in pregnant women and breastfeeding women.
  • Fair negative scientific evidence:
  • PSK: The available evidence does not support the use of PSK, in conjunction with hormone therapy, chemotherapy, and/or surgery, to increase survival rates in breast cancer patients.

Prevention
  • Physical activity: Regular exercise may reduce the complications of breast conditions and reduce the risks of developing breast cancer.
  • Diet: Reducing fat (especially trans fatty acids found in fried foods and snacks) and red meat while increasing vegetables, fruits, and whole grains may reduce the chances of developing breast conditions. One large study of almost 2,500 women found that a lifestyle intervention reducing total dietary fat intake, with modest influence on body weight, might improve relapse-free survival of breast cancer patients receiving conventional cancer management. In one study, during 12 years of follow-up of 90,659 premenopausal women, greater red meat intake correlated with an elevated risk of breast cancers that were estrogen and progesterone receptor positive, but not to those that were estrogen and progesterone receptor negative.
  • An increase in soluble fiber has also been reported to reduce the chances of developing breast conditions, such as breast cancer.
  • The phytochemical (plant-chemical) indole-3-carbinol, found in cruciferous vegetables like cabbage and broccoli, might directly contribute to breast cancer protection. An increase in soy and soy products as sources of isoflavones was found to be inversely associated with high mammographic density, a marker for breast cancer risk. Estrogenic activity by soy may be linked to breast cancer development in some studies, with other studies report no correlation between dietary phytoestrogens and breast cancer.
  • Healthcare professionals recommend that women avoid caffeine and caffeine-containing foods, such as cola and chocolate. Caffeine has been implicated as contributing to both the symptoms and scarring (fibrocystic) changes in fibrocystic breast condition.
  • Weight loss: A lower body mass index (BMI) has been correlated with a lower chance of developing breast cancer.
  • Decrease alcohol consumption: Although a glass of wine may be beneficial for heart health, findings from a prospective study suggest that moderate alcohol consumption may increase the risk of breast cancer. Some components of alcoholic beverages, such as hops, have estrogenic activity, which may be linked to breast cancer development in some studies. However, some studies have reported no correlation between dietary phytoestrogens and breast cancer.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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Selected breast conditions
  • Mastalgia (breast pain): Mastalgia is breast pain and is generally classified as either cyclical (associated with menstrual periods) or noncyclical. Noncyclical pain may come from the breast or come from somewhere else, such as the nearby muscles or joints, but may be felt in the breast. Pain can range from minor discomfort to severely incapacitating pain in some cases. Many women with mastalgia worry more about the consequences of cancer than about the pain itself.
  • Cyclic breast pain is the most common type of breast pain and is associated with the menstrual cycle as well as hormonal changes not associated with the menstrual cycle, such as during chronic stress. Some women begin to have pain around the time of ovulation, which continues until the beginning of their menstrual cycle. The pain may be barely noticeable or so severe that the woman cannot wear tight-fitting clothing or tolerate close contact of any kind. The pain may be felt in only one breast or may be felt as a radiating sensation in the under-arm region.
  • Noncyclical breast pain is fairly uncommon, feels different than cyclical mastalgia, and does not vary with the menstrual cycle. Generally, the pain is present all the time and is in only one specific location.
  • One cause of noncyclical breast pain is trauma, or a blow to the breast. Other causes can include arthritic pain in the chest cavity and in the neck that can radiate down to the breast.
  • Fibrocystic breast disease: Fibrocystic breast disease or benign breast disease is a condition of the breasts that involves inflammation of breast tissue, causing lumps. Although some breast lumps are cancerous (malignant), most (80-85%) are benign (non-cancerous). Approximately 33% of all women between the ages of 30-50, and 50% of women of all ages, may at some point develop fibrocystic breast disease or another benign breast condition. Other familiar terms include benign breast disease, chronic mastitis (inflammation), and mammary dysplasia. Breast lumpiness, which is sometimes described as "ropy" or "granular," can often be felt in the area around the nipple and areola and in the upper-outer part of the breast. Such lumpiness may become more obvious as a woman approaches middle age and the milk-producing glandular tissue of her breasts increasingly gives way to soft, fatty tissue. Unless the woman is taking replacement hormones, this type of lumpiness generally disappears completely after menopause.
  • There are times when breast lumpiness becomes more noticeable. During the menstrual cycle, many women experience swelling, tenderness, and pain before and sometimes during their periods. At the same time, one or more lumps or a feeling of increased lumpiness may develop because of extra fluid collecting in the breast tissue. Pregnancy also can bring changes. During pregnancy, the milk-producing glands become swollen and the breasts may feel lumpier than usual.
  • Breast cysts: Breast cysts (fluid filled sacs) occur most often in women ages 35-50. Breast cysts often enlarge and become tender and painful just before the menstrual period and are usually found in both breasts. Some cysts are so small they cannot be felt; rarely, cysts may be several inches across.
  • Although a cyst is not cancerous, it is important for a woman who notices any lump or change to see a healthcare provider.
  • Fat necrosis: Fat necrosis is the name given to painless, round, and firm lumps formed by damaged and disintegrating fatty tissues. This condition typically occurs in obese women with very large breasts. Fat necrosis often develops in response to trauma, such as a bruise or blow to the breast, even though the woman may not remember the specific injury. Sometimes the skin around the lumps looks red or bruised.
  • Fibroadenomas: Fibroadenomas are solid and round benign tumors that are made up of both structural and glandular tissues. Usually, these lumps are painless and found by the woman herself. Fibroadenomas feel rubbery and can easily be moved around. Fibroadenomas are the most common type of tumors in women in their late teens and early twenties. Fibroadenomas tend to occur twice as often in African-American women.
  • Galactorrhea: Galactorrhea occurs when a woman's breast makes milk even though she is not breastfeeding a baby. Galactorrhea may occur spontaneously or when the breasts are touched. Men may also have galactorrhea, but it is much less common. Causes can include hormonal imbalances, pregnancy, pituitary tumor, or medications such as hormones, antidepressants, or blood pressure medicines.
  • Hyperplasia/atypical hyperplasia: Recent studies show that certain types of microscopic changes put a woman at higher risk of developing breast cancer. These changes include excessive cell growth or hyperplasia. Hyperplasia can increase the risk of developing breast cancer. Approximately five percent of benign breast biopsies reveal both excessive cell growth, such as hyperplasia, and cells that are abnormal. The location of these abnormal cells can be in the lobules (atypical lobular hyperplasia) or the milk ducts (atypical ductal hyperplasia). A diagnosis of atypical hyperplasia moderately increases breast cancer risk. If a biopsy finds hyperplasia, surgery can remove the abnormal cells.
  • Intraductal papilloma: One of the most common sources of a bloody or sticky discharge is an intraductal papilloma, a small, wart-like growth that projects into breast ducts near the nipple. Any slight bump or bruise in the area of the nipple can cause the papilloma to bleed. Single intraductal papillomas usually affect women nearing menopause.
  • If the discharge becomes bothersome, the diseased duct can be removed surgically without damaging the appearance of the breast. Multiple intraductal papillomas, in contrast, are more common in younger women. They often occur in both breasts and are more likely to be associated with a lump than with nipple discharge. Multiple intraductal papillomas, or any papillomas associated with a lump, need to be removed.
  • Mammary duct ectasia: Mammary duct ectasia is a disease of women nearing menopause. Ducts beneath the nipple become inflamed and can become blocked. Mammary duct ectasia can become painful, and it can produce a thick and sticky discharge that is gray to green in color. A woman who notices pain or discharge should see her doctor.
  • Mastitis: Mastitis is an infection most often seen in women who are breastfeeding. A duct may become blocked, allowing milk to pool, causing inflammation, and setting the stage for infection by bacteria. Bacteria can also enter via cracked nipples. The breast appears red and feels warm, tender, and lumpy. In its earlier stages, mastitis can be treated effectively by antibiotics. If a pus-containing abscess forms, it will need to be drained or surgically removed.
  • Breast augmentation: In breast augmentation surgery (or medical augmentation mammoplasty), an individual is able to enhance the size and shape of her breast tissue through the implementation of breast implants. Augmentation of the breast consists of insertion of a silicone bag under the breast or under the breast and chest muscle and then filling the bag with saline (salt water). This expands the breast area to give a fuller breast (increased cup size), give a better contour, and give more cleavage. Breast implants are predominantly obtained by women who want to change their appearance.
  • Many women seek breast implants to correct a perceived flaw in their body. Some women want to correct the disproportionate shape and/or size between their breasts. Others undergo this surgical treatment to give their bodies an overall more proportional shape. Breast augmentation surgeries have increased by 476% since 1992, the largest increase in plastic surgery procedures.
  • Breast reduction surgery is for women who have large breasts and want to resolve one or more of the following associated problems: chronic back, neck, and shoulder pain; poor posture; skin rash under the breasts; deep grooves in the shoulders from bra strap pressure; restricted levels of activity; low self-esteem; and difficulty wearing or fitting into certain bras and clothing.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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