~Fibrocystic Breast Disease, Part 2 - Treatment
TREATING FIBROCYSTIC BREAST DISEASE
- Intraductal Papilloma
- Mammary Duct Ectasia
Although some physicians consider FBD to be more correctly termed a condition, its symptoms cause significant pain and discomfort for many women. Women who have FBD may find relief from any of several conventional and natural treatments. Some procedures (FNAB) for the conventional treatment of FBD can often be performed in a physician's office. Other procedures (such as a biopsy) are usually performed in an ambulatory or hospital surgical facility.
Breast cysts are relatively simple to treat. Simple breast cysts are aspirated by a physician with a needle and syringe (National Cancer Institute 2001b). A biopsy is often not necessary. Fluid aspirated from a cyst is rarely tested unless it is bloody or the woman is older than 55 years of age. Gross breast cysts that are benign disappear after aspiration. (However, a cancerous lump remains even after fluid is withdrawn.) Following imaging by mammography and ultrasonography, complex cysts require laboratory investigation usually beginning with fine needle aspiration and perhaps biopsy.
In intraductal papilloma, the diseased ducts can be removed surgically if discharge becomes bothersome (National Cancer Institute 2001a; 2001b). The appearance of the breast is usually unchanged.
Mastitis or postpartum mastitis is an infection that is treated with antibiotics (Anon. 1998). Pus-filled abscesses may need to be drained or removed. Lactating women with mastitis should use a breast pump to prevent additional pooling of breast milk and discard the milk. Breast milk should not be used until the infection has responded to antibiotic treatment.
Mammary Duct Ectasia
Mammary duct ectasia is treated with antibiotics, warm compresses, and sometimes surgery (National Cancer Institute 2001b).
HORMONE AND DRUG THERAPY
- Oral Contraceptives
- Hormone Replacement Therapy (HRT)
The anterior pituitary gland secretes follicle-stimulating hormone (FSH) which in turn causes follicle cells in the ovaries to secrete estrogens. The anterior pituitary also secretes luteinizing hormone (LH) which causes the corpus luteum to secrete progesterone and a small amount of estrogens, including estradiol (E2). LH and FSH work together to bring about ovulation and menstruation. The corpus luteum produces progesterone for about 11 days (the luteal phase) after ovulation. About 3 days later, when levels of estrogen and progesterone are at their lowest, menstruation begins.
In an early study comparing women with normal breast tissue to women with benign breast disease, there was a significant imbalance of progesterone over estradiol during the luteal phase in women with benign breast disease (Sitruk-Ware et al. 1979). When the women were grouped according to the type of breast lesion, there was elevated or normal estradiol in women with adenosis tumors and increased nodularity of both breasts. Plasma progesterone was also consistently lower in all groups as compared to the normal women. The authors concluded: "From these results it may be postulated that an imbalance in the secretion of E2 and progesterone by the corpus luteum is a constant finding in women with benign breast disease" (Sitruk-Ware et al. 1979).
Sometimes physicians treat breast pain and swelling associated with FBD by prescribing oral contraceptives which tend to stabilize (or level out) hormone levels. Results of studies indicate that oral contraceptives have positive benefits by decreasing the symptoms of FBD, particularly in younger women (Mishell 1993; Rohan et al. 1999; Scott 1993).
Hormone Replacement Therapy (HRT)
HRT, often recommended to post-menopausal women, may actually increase the symptoms of FBD depending on the hormone combination used. As with any type of hormone administration, however, the results and effects differed widely among women studied. When on HRT, it is important to monitor any changes in breast tissue and to evaluate these changes with your physician as they relate to the positive benefits (cardiovascular, bone density) versus the risks (increased density of breast nodules) of continuing HRT (Lundstrom et al. 2001; Ozdemir et al. 1999). (See the protocol on Female Hormone Modulation Therapy.)
In a 1997 study, doctors treated women with painful FBD by giving them estroprogestins (estrogen-progesterone compounds) for 3 months. They found that 60% of the women reported reduced or improved symptoms (Leonardi 1997). However, like HRT, estrogen replacement therapy (ERT) has also been linked to higher rates of FBD among postmenopausal women; in fact, they are twice as likely to develop FBD as women who have not used estrogen replacement (Pastides et al. 1987). Women on ERT also experience more fibroadenomas. The risk seems to increase the longer the therapy is employed.
Powerful drugs with hormonal effects are also available and are prescribed with caution when pain from FBD is severe. However, physicians are hesitant to use them because of potential side effects and interactions with other drugs or conditions (such as tamoxifen and danazol).
A medicine that blocks the effects of the estrogen hormone in the body, Tamoxifen, is primarily used to treat breast cancer that is estrogen receptor positive (Chatterji 2001/2002). It has also been used in some women who do not have breast cancer, but who are at high risk to develop it. Tamoxifen has been used to relieve significant breast pain associated with FBD. An early double-blind controlled study was done with tamoxifen in 60 patients who had severe mastalgia lasting more than 6 months. The patients were treated with a placebo or 20 mg of tamoxifen for 3 months. There was relief of pain in 71% of the patients receiving tamoxifen, demonstrating that tamoxifen was valuable in the treatment of severe cyclical and non-cyclical mastalgia and that treatment can be achieved with few side effects (Fentiman et al. 1986). How tamoxifen works and its long-term effects are not precisely known. However, the use of tamoxifen requires careful monitoring by a physician to assess side effects, blood levels, and so forth.
Indole-3-carbinol (I3C) is a phytonutrient with similar properties to tamoxifen: I3C partially inactivates estrogen (Bradlow et al. 1994); fights free radicals (Arnao et al. 1996); and interferes with tumor cell production (Bradlow et al. 1999a). See the detailed description below on I3C and how it may be used as an adjunct or an alternative to tamoxifen.
Danazol is a synthetic steroid that is prescribed for pain and infertility caused by endometriosis and for the pain and tenderness of FBD. When prescribed for FBD, danazol may produce partial or complete disappearance of nodules and relief from pain and tenderness (Greenblatt et al. 1982; Mansel et al. 1982; Lopez et al. 1996). However, danazol has undesirable side effects such as allergic reactions (particularly for persons who are allergic to preservatives or anabolic steroids) and drug interactions. For example, danazol may increase the anticoagulant effect of warfarin, a drug frequently prescribed as a blood-thinning agent, increase blood sugar levels in diabetes mellitus, and increase the occurrence of migraine headaches (Meeks et al. 1992). Additionally, this synthetic testosterone derivative may cause women to develop male sexual characteristics such as facial hair (Peress et al. 1982). Danazol is not recommended for pregnant women or women who are breast feeding because of undesirable effects on the infant. However, danazol does help alleviate breast pain. As early as 1985, a study found that the drug eased pain in 70% of women with cyclical pain and in 31% of women with noncyclical pain (Pye et al. 1985). Symptoms often recur after treatment with danazol is stopped.
Another drug, bromocriptine, also helped 20% of women with non-cyclical pain and 47% of women with cyclical pain (Pye et al. 1985). Bromocriptine is a drug that affects the pituitary gland (blocks the release of the hormone prolactin) and is prescribed for menstrual problems and to stop milk production in some women. It is also used to treat other conditions such as infertility, Parkinson's disease, and acromegaly (overproduction of growth hormone). Bromocriptine has side effects, including significant nausea, allergic reactions, and interactions with drugs taken for other conditions (hypertension, mental illness, and liver conditions).
Lisuride (used in Parkinson's disease), a drug with endocrine effects similar to those of bromocriptine, reduced FBD symptoms in 63% of the women studied. Estrogen levels in those patients were reduced and progesterone levels were increased (Lopez-Rosales et al. 1991).
Dehydroepiandrosterone (DHEA) is a steroid hormone chemically related to testosterone and estrogen. It is made by the adrenal glands from cholesterol. DHEA levels in the human body peak in the mid-20s and steadily decline beginning about the mid-30s (Leowattana 2001). Researchers have studied the actions of DHEA for over 20 years and have found that it may have beneficial implications in many areas, such as improving immunity; reducing menopausal symptoms; preventing cancer, heart disease, Alzheimer's disease, and chronic inflammation; improving longevity; and aiding weight loss (Kimura et al. 1998; Kurzman et al. 1998; Murialdo et al. 2000; Leowattana 2001; Corsini et al. 2002; Polleri et al. 2002; Simpson 2002; Takayanagi 2002; Yang et al. 2002). DHEA should only be taken under the supervision of a physician who can monitor blood levels of steroids and cholesterol and existing health conditions (Nestler et al. 1988; Barrett-Connor et al. 1995; Yen et al. 1995). DHEA is contraindicated in both men and women who have hormone-related cancer. (See the DHEA Replacement Therapy Protocol. Life Extension recommends specific dosing and blood testing schedules for all persons desiring to take DHEA safely.)
Continued . . .
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