Fibrocystic breast disease
Fibrocystic breast disease is a generalized term for benign breast disorders such as lumps and pain. It is, however, a misnomer since it has neither a well-defined set of symptoms, nor a clear etiology. The term benign breast disease is preferred. Benign lumps are usually smooth, regular, and mobile. The following classifications are useful:
Lumps: Physiologic nodularity - lumps vary with the phase of the menstrual cycle, common in young women; Mastoplasia - a ropy, thickening of the breast tissue, most common in the upper outer quadrant, persists throughout the menstrual cycle; Cysts - distended, fluid filled masses caused by an imbalance between secretion and absorption in the breast lobule, common in the decade preceding menopause; Fibroadenoma - benign solid tumor, smooth margins, mobile, most common tumor in teenagers and young women, may occur at any age after thelarche; Phyllodes tumors - painless, solid, smooth, lobular, bulky; stromal hyperplasia; 10% are malignant
Nipple discharge: Although considered one of the warning signs for breast cancer, 90% of patients with nipple discharge have benign disease; Bilateral duct ectasia - most common cause of nipple discharge; benign inflammatory condition; bilateral, sticky, multicolored discharge; usually has to be expressed; Bilateral galactorrhea (prolactin-secreting pituitary tumors) - usually in association with amenorrhea; drugs (isoniazid, methyldopa, thiazides, reserpine, tricyclic antidepressants); trauma; Unilateral intraductal papilloma - spontaneous discharge from one duct. Carcinoma must be excluded.
Pain: Cyclical mastodynia - hormonal, an exaggeration of the normal premenstrual tenderness; Non-cyclical - sclerosing adenosis, cysts, chest wall muscle spasm, costochondritis, neuritis, stress, referred pain
Inflammatory conditions: Fat necrosis - a solid lump with or without pain that can mimic carcinoma; Superficial phlebitis of the thoracoepigastric vein (Mondor's disease) - local tenderness and induration; Abscess - exquisite pain and tenderness, erythema (common), not always a definite mass, common with lactation and squamous metaplasia of lactiferous ducts (Zuska's disease), usually caused by staphylococcal organisms
Growth disorders: Accessory nipples (polythelia); Absence of the breast (amastia); Absence of the nipple (athelia); Hypoplasia (often associated with hypoplasia of the thorax and pectoral muscles, and abnormalities of the hand, i.e., Poland's syndrome); Gigantomastia - occurs during puberty and pregnancy; Gynecomastia - occurs in men in association with puberty, senescence, liver disease, and testicular tumors, and medications such as digoxin and cimetidine
It is estimated that at least 50% of women have benign breast symptoms during their lifetime. Symptoms tend to occur in menstruating women. Mastoplasia - most common in women from mid 20's to 55 years of age; Cysts - usually seen in women in their 40's; Cyclical mastodynia - common in menstruating women; Non-cyclical pain - can occur at any age after breast development.
The etiology of benign breast disease is unknown. Possible causes include: Luteal phase defect in progesterone; Increased estrogen (17 beta estradiol); Hyperprolactinemia; End organ hypersensitivity to estrogen; Sensitivity to methylxanthines; Dietary fat intake
The effect of consumption of methylxanthine-containing substances, e.g., coffee, tea, cola, and chocolate is controversial
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