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Background |
Selected breast conditions |
Signs and symptoms |
Diagnosis |
Complications |
Treatment |
Integrative therapies |
Prevention |
Author information |
Bibliography
Breast conditions
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.
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.
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.
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:
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 disease of the breast. More study is needed. Despite preliminary results, it remains unclear if bilberry is an effective treatment in the management of cyclic mastalgia. Additional study is needed in this area.
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. Mild skin reactions have been reported in clinical trials including eczema, itching, rash, skin eruptions, urticaria (hives), and allergic exanthema.
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 may be beneficial for this condition, 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.
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, no high-quality human studies are currently available in this area.
Several reports describe seizures in individuals taking evening primrose oil (EPO). Some of these seizures developed in people with a previous seizure disorder, or in individuals taking EPO in combination with anesthetics. Based on these reports, people with seizure disorders should not take EPO. EPO should be used cautiously with drugs used to treat mental illness such as chlorpromazine (Thorazine®), thioridazine (Mellaril®), trifluoperazine (Stelazine®), or fluphenazine (Prolixin®), due to an increased risk of seizure. Patients who plan to undergo surgery requiring anesthesia should stop taking EPO two weeks ahead of time because of the possibility of seizure.
Flaxseed oil: Flaxseed (Linum usitatissimum) and its derivative flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid, which is a biologic precursor to omega-3 fatty acids such as eicosapentaenoic acid.
Taking flaxseed (not flaxseed oil) by mouth may reduce the absorption of other medications. Drugs used by mouth should be taken one hour before or two hours after flaxseed to prevent decreased absorption. Flaxseed oil may also increase bleeding in sensitive individuals, including those with bleeding disorders or those taking blood thinning medications such as aspirin or warfarin (Coumadin®).
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 cyclic breast pain.
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®).
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.
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"). Until additional research is available, patients with these conditions should be cautious and speak with a qualified healthcare practitioner before starting use.
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.
Traditional or theoretical uses lacking scientific evidence:
Integrative therapies with historical or theoretical uses in breast conditions but lack sufficient clinical evidence include: arnica (Arnica montana), black cohosh (Actaea racemosa), black currant (Ribes nigrum), boswellia (Boswellia serrata), chamomile (Matricaria recutita, Chamaemelum nobile), cleavers (Gallium aparine), dandelion (Taraxacum officinale), dong quai (Angelica sinensis), ginkgo (Ginkgo biloba), iodine, omega-3 fatty acids, fish oil, alpha-linolenic acid, pokeweed (Phytolacca americana), red clover (Trifolium pratense), rutin, and vitamin A (retinol).
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
Natural Standard is an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed, tapping into the collective expertise of a multidisciplinary Editorial Board. The mission of this collaboration is to provide objective, reliable information that aids clinicians, patients, and healthcare institutions to make more informed and safer therapeutic decisions. Natural Standard is widely recognized as one of the worlds premier sources of information in this area.Bibliography
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National Cancer Institute (NCI). www.cancer.gov. Accessed December 28, 2007.
Natural Standard: The Authority on Integrative Medicine. Copyright © 2008. www.naturalstandard.com. Accessed December 28, 2007.
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Susan G. Komen Foundation. www.komen.org. Accessed December 28, 2007.
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.
Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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