Let’s play a little word association game:
I say ‘Fibroids’ – you say, ‘Oestrogen’.
I say ‘Cyclic Breast Pain’ and you say, ‘Ouch!’ [because it just slipped out] but then you say, ‘Prolactin’, right? Me too.
Prolactin driven breast pain’s most characteristic form is the premenstrual ‘oh my goodness get these off me!!’ kind, with patients experiencing anything from burning, aching, bruised feelings and acute hypersensitivity to touch, which builds in intensity for days leading up to their bleed. Of course cyclic mastalgia can progress to being full-time mastalgia in women whose breasts start to exhibit structural tissue change in the form of cysts, fibrosis and ultimately fibrocystic breast disease. If you’ve ever experienced even a day of mastalgia it is truly hard to conceive there are so many women (about 50% of premenopausal women!!) living with it daily.
Adding to our concerns about this so-called ‘benign breast disease’ (BBD) is that researchers are now certain it’s a significant risk factor for breast cancer, with women with any form of BBD experiencing at least a doubling of risk of a subsequent breast cancer diagnosis, while those women with proliferative BBD exhibiting a risk of 3.5X that of women without BBD. Castells et al 2015
This is alarming, in particular, because the term ‘benign’ while factually correct, underplays this risk and secondly, because there are no specific recommendations in place for tailored monitoring of these women for breast cancer. BBD describes tissue integrity changes in the breasts of these women and accordingly we should be pulling out all stops to resolve this and minimise the likelihood of a progression to something more sinister.
If I told you scientists have known for about half a century that exposing animals to high levels of perchlorates, the most potent goitrogen, reliably induces breast cysts and tumours – what would you make of this? That thyroid health is essential for breast health? Or that iodine itself is directly necessary for breast tissue integrity and healthy physiology? These are in fact two distinct schools of thought – but of course there is some overlap between them with both iodine and prolactin being shared common ground. While these animal studies and some more recent human evidence is compelling, we have a long way to go before we can say we truly understand this association. So what do we do in the meantime? Treat every BBD woman with high dose iodine? Scrutinise every patient with BBD for suboptimal thyroid function and address that more holistically? Avoid using a ‘one size fits all’ mentality and review our patients for all potential drivers of high prolactin…absolutely.
But whatever we do, we need to make breast tissue normalisation the conversation & objective rather than normalising women’s breast pain, cysts and fibrosis.
If you want to learn more about how to investigate and address cyclic mastalgia and fibrocystic breast disease in your patients Rachel’s latest Update in Under 30 recording: Breast pain, cysts, prolactin & iodine – connecting the dots, will hit the spot. Rachel summarises the scientific literature and makes connections from this that will surprise you and improve your overall understanding about breast health. Or you can save over $150 and sign up for a year’s subscription and get the Update in Under 30 goods monthly!