An association between caffeine, or methylxanthines, and fibrocystic breast disease has been reported but remains controversial. In one study of a group of 102 women who had mammograms performed to measure the level of fibrocystic breast disease, a strong correlation was found with both caffeine and total methylxanthine ingestion and fibrocystic breasts as determined by a series of questionnaires. Similar results were found in a large case control study of 634 women. Other studies, however, have found only weak associations. Normal fluctuations in hormonal effects on breast tissue and difficulty in consistently measuring caffeine or methylxanthine intake make it difficult to conclusively demonstrate a causal relationship. In a review of the literature presented on AltMedex, the following studies are cited: A controlled clinical trial showed no clinically or statistically significant effects of alcohol- or methylxanthine-free diets on signs and symptoms of fibrocystic breast disease. One hundred sixty-two women with clinical and thermo-graphic diagnoses of fibrocystic breast disease completed the study with evaluation at 6 months. It was concluded that abstinence from alcohol or methylxanthine-containing beverages is not likely to substantially reduce severity of fibrocystic breast disease within a few months. A case control study examined the relationship between coffee consumption and the development of benign breast disease involving the analysis of 854 cases of histologically diagnosed benign breast disease and 1748 control subjects. No association between coffee consumption and benign breast disease was found; neither was a dose-response relationship between methylxanthine consumption and benign breast disease development noted. These results suggest no association between caffeine intake and the development of benign breast disease. In a randomized study, 158 women with breast concerns were divided into two groups; one group abstained from consumption of methylxanthine-containing foods and beverages. The second group (controls) had no dietary restrictions. The patients were re-examined at 4 months for palpable breast findings. One hundred forty patients completed the study. There was a statistically significant decrease in clinically palpable breast findings in the abstaining group compared with controls, but the absolute change was minor and may be of little clinical significance. This study offered little support for the claim that caffeine-free diets are associated with clinically significant improvement in benign breast disease. In a study of 66 patients, restriction of dietary caffeine ingestion can cause improvement in fibrocystic breast disease. Graphic stress telethermometry (GST) was performed as an objective monitor for fibrocystic breast. At baseline, an average score of 83.5 on graphic stress telethermometry was observed in these women. Following dietary methylxanthine restriction, these scores were observed to be an average of 69.5 at 2 months and 55.5 at 6 months. Forty-two of the 66 patients had decreases in graphic stress telethermometry scores of more than 20 points at 6 months. Eighty-five percent of the patients showed improvement in graphic stress telethermometry patterns at 6 months, 15% of patients showed no change, and none showed worsening in graphic stress telethermometry patterns. Subjectively, at 6 months, 22 of 66 patients reported marked improvement, 30 of 66 moderate improvement, 6 of 66 mild improvement, and 8 of 66 no change in symptoms of fibrocystic breast disease. At pretreatment, 78% of patients had 2+ or 3+ nodularity on palpation. At the 6-month examination, 89% of patients had no or 1+ nodularity on palpation (91% had improvement, 9% had no change, and none had worsening). In 85 US women with clinical and mammographically confirmed fibrocystic disease, complete abstention from methylxanthine consumption resulted in complete resolution of fibrocystic breast disease in 82.5% and significant improvement in 15% of the patients studied.
Vitamin E and B6 Supplementation
Supplementation with vitamin E (400 to 800 IU) may be beneficial for reducing mastalgia and nodularity of fibrocystic breasts and pyridoxine (vitamin B6 / 50 to 100 mg) to reduce breast tenderness and pain. Women are also encouraged to increase dietary fiber and complex carbohydrates, reduce dietary fat to 15% to 20% of their diet, and move toward a more plant-based diet, rich in phytoestrogens. A recent review examined various dietary therapies, and their potential effects in treating fibrocystic breasts. The review found that some dietary therapies, including vitamin E and B6, do not have adequate evidence to support their use in fibrocystic breasts. Studies were either of poor quality or had too few study participants to make definitive conclusions. Because of the dynamic nature and very high placebo response (20%) in fibrocystic breast complaints, only well-designed studies with large numbers of participants can address the efficacy of these treatments. Indeed, better-designed studies of vitamin E have all showed no significant effect on any parameter of fibrocystic breast. Studies on reducing caffeinated products from the diet have been variable, some showing positive outcome, others showing no benefit at all. This review found no studies that had examined the effect on fibrocystic breasts of low-fat diets, increased dietary fibers, soy isoflavones, or a more plant-based diet. However, there are considerable mechanistic data, including increasing unabsorbable estrogen conjugates for excretion, reducing the recirculation of estrogen, and positively affecting bowel microflora populations that support the use of these dietary strategies. The general health benefits of adjunct therapies such as adding vitamin E, reducing poor-quality fat intake, or reducing caffeine consumption suggest that these may be worthwhile strategies to try.