SONO–MAMMOGRAPHIC EVALUATION OF BREAST LESIONS

SONO–MAMMOGRAPHIC EVALUATION OF BREAST LESIONSCASES IN RESPONSE TO HOMOEOPATHIC DRUGS

Dr. Girish Gupta, B.Sc., G.H.M.S. (Gold Medalist), M.D. (Hom.)Chief Consultant

Dr. Naveen Gupta, B.H.M.S.Physician (Research and Publication)

Dr. (Mrs.) Madhu Chaudhary, B.H.M.S.Project Co–ordinator

ABSTRACT

A total of one hundred and thirty five (135) well diagnosed patients of Breast lesions (Table–1)followed the treatment protocol out of 840 registered for treatment at Gaurang Clinic and Centre for Homoeopathic Research, Lucknow (GCCHR) from February, 1996 to December, 2011.Out of 135 patients, lesionswere totally resolved in 24, reduced in 49, remained as such in 30 and did not reduce in 32 patients. In 12 patients of post–surgical recurrence (5 of Unilateral and 7 of Bilateral) lesions were completely resolved in 1, significantly reduced in 7 and did notreduce in 4 patients.Diagnosis by sono–mammography followed by constitutional treatment with homoeopathic medicines on holistic basis showed excellent response. It opens new vistas in the non–surgical, non–hormonal treatment of breast lesions.The period of treatment varied from case to case depending on the size, type and number of breast lesions.

TABLE–1BREAK–UP OF CASES ACCORDING TO TYPE OF BREAST LESIONS

(Period February 1996–December 2011)(Total number of cases: 135)

S.N. Category Number Percentage

1.

2.

3.

4.

5.

6.

7.

Fibroadenoma

Fibroadenosis

Fibroadenoma with Fibroadenosis

Breast Cyst

Fibroadenosis with Breast Cyst

Fibroadenoma with Breast Cyst

Chronic Inflammatory Granuloma

98

03

13

08

08

04

01

72.59 %

02.22 %

09.63 %

05.93 %

05.93 %

02.96 %

00.74 %

-----------------------------------------------------------------------------------------------------------1. The paper was presented in 18th All India Homoeopathic Congress–2012 organised by HMAI

(West Bengal, State Branch) in technical collaboration with CCH & CCRH, Govt. of India held at Dr. Mahendra Singh Nagar (Science City Auditorium), Kolkata from December 21–23, 2012.

2. The manuscript has been submitted for publication in Asian Journal of Homoeopathy.

FIBROADENOMA98

72.59 %

FIBROADENOSIS3

2.22 %

FIBROADENOMAWITH FI-

BROADENOSIS13

9.63 %

BREAST CYST8

5.93 %

FIBROADENOSISWITH BREAST CYST

85.93 %

FIBROADENOMAWITH BREAST CYST

42.96 %

CHRONIC INFLAMMATORY GRANULOMA

10.74 %

BREAK – UP OF VARIOUS BREAST DISEASE CASES REGISTERED AT GCCHR(Period February 1996 – December 2011)

(Total number of cases: 135)

INTRODUCTION

Fibrocystic disease (Fibroadenoma, fibroadenosis, mammary dysplasia, chronic cystic mastitis) is proliferation of acini and mammary duct along with formation of white fibrous trabeculae and cyst related to ovarian activity. Fibroadenomas are composed of fibrous and glandular tissue, occurring in woman of child bearing age from 20–30 years and are rare in post–menopausal woman.[2][4][5] They are well–defined, round, discrete, encapsulated, soft or firm nodule which may or may not be tender.[1][2]Fibroadenomas are also called breast mice owing to their high mobility in the breast.[3]Premenstrual increase in pain and size of the lump may occur in prepubertal girls and in young women.

EPIDEMIOLOGY

Fibroadenoma has a prevalence of 7–10 percent in women over 40 years. Generally fibroadenomas appear before the age of thirty years and their incidence declines with increasing age. They rarely occur in elder women, so any new solid lesion in an elderly woman should be considered malignant until proven otherwise. Fibroadenomas are partially hormone–dependent and frequently regress after menopause. They are hypovascular compared to typical (especially malignant)neoplasms.[8][10][11]

AETIOLOGY

The exact aetiology of breast lesions is not known. Breast tumors arise from any one of its component tissues (i.e. connective tissue and epithelial structures) out of which the encapsulated fibroadenoma is most common and is thought to be due to the increased oestrogen activity. Similar but less discretely encapsulated lesions may appear with fibrocystic changes (fibroadenosis). Two historical variants of fibroadenoma seen in the same tumor are:–

1. Pericanalicular Fibroadenoma: It is smaller and hard occurring usually in young girls and ladies between 15 to 30 years of age. [5][6]

2. Intracanalicular Fibroadenoma: It is larger in size and soft occurring in middle aged women between 35 to 40 years of age. [5][6]

RISK FACTORS[12]

FIBROADENOMA98

72.59 %

FIBROADENOSIS3

2.22 %

FIBROADENOMAWITH FI-

BROADENOSIS13

9.63 %

BREAST CYST8

5.93 %

FIBROADENOSISWITH BREAST CYST

85.93 %

FIBROADENOMAWITH BREAST CYST

42.96 %

CHRONIC INFLAMMATORY GRANULOMA

10.74 %

BREAK – UP OF VARIOUS BREAST DISEASE CASES REGISTERED AT GCCHR(Period February 1996 – December 2011)


DECREASED RISK:

Highernumber of live births, intake of fruits and vegetablesand moderate exercise lower the frequency of fibroadenomas.

Some studies suggest that breast–feeding lowersthe risk of Fibroadenoma, especiallyif breast–feeding is continued for 1to 2 years.

INCREASED RISK:

Overweightor obesity has been found to increase the risk of Fibroadenoma especially forwomen after menopause. Before menopause ovaries produce most of the estrogenand fat tissue produces a small amount of estrogen. After menopause (when the ovariesstop making estrogen) most of a woman's estrogen comes from fat tissue. Having morefat tissue after menopause can increase the chance of getting breast lesions by raisingestrogen levels.

It has been found trace levelsof parabens which is used as preservative in antiperspirants and other products haveweak estrogen–like properties which when absorbed through skin, interfere with lymph circulation may cause certain structural changes in breast tissue.

Ill fitting bras can also cause obstruction to lymph flow. Women who do not wear or use well fitting bras are more likely to have less densebreasts reducing the risk of breast tumors.

Eestrogen–like properties of substances found in plastics, cosmetics, personal careproducts and pesticides may cause breast tumors.

Use of Oestrogen and Progesterone for contraception or menstrual irregularities or hormone replacement therapy (HRT) increases the risk.

DIAGNOSIS

A fibroadenoma is usually diagnosed by clinicalexamination, ultrasound, mammography and needle biopsy.[9]

OBJECTIVE

To develop evidence based data bank in good sample size on non–hormonal/non–surgical treatment of various breast lesions with Homoeopathic drugs.

To treat cases of post surgical recurrence and save them from second surgery.

MATERIALS AND METHODS

1. Patient: A total of one hundred and thirty five (135) women suffering from various breast lesions who followed the treatment protocol at Gaurang Clinic and Centre for Homoeopathic Research, Lucknow (GCCHR) from February 1996 toDecember, 2011.

2. Sonomammography:Sonomammography was the main parameter to confirm the diagnosis and to assess the response. It was repeated every 3–6 months. In few cases, sonologist and their machine remained the same and in a few, both were changed just to have a crosscheck and to remove any bias element in reporting.

3. Fine Needle Aspiration Cytology (FNAC): It was advised in a few suspected cases of malignancy.

4. Serum Prolactin:Serum Prolactin was advised in a few cases.

5. Repertorisation: All cases of breast lesions were repertorised using Hompath Classic Software.

6. Software: An indigenous software was developed by Computer Programmer to assess the response after Homoeopathic treatment.

7. HomoeopathicMedicines: The drugs employed in the present study after repertorisation are mentioned with individual cases.

DEMOGRAPHICS

1. Out of 135 cases, 80 patients (59.26 %) were having unilateral Fibroadenoma. Out of which 37 patients (27.41 %) were left sided and 43 patients (31.85 %) were right sided. 55 patients (40.74 %) were having bilateral Fibroadenomas (Table–2).

TABLE – 2BREAK–UP OF CASESACCORDING TO SIDE OF LESIONS


Side of breast involved Number Percentage

1.

1(a).

1(b).

Unilateral

Left

Right

80

37

43

59.26 %

27.41 %

31.85 %

http://en.wikipedia.org/wiki/File:Fibroadenom.jpg

2. Bilateral 55 40.74 %

2. 88 patients (65.19 %) were married while 47 (34.80 %) were unmarried. Ladies who have not suckled their children are more prone to have Fibroadenomas as compared to those who breast fed their children regularly (Table–3).

TABLE–3BREAK–UP OF CASES ACCORDING TO MARITAL STATUS


S.N. Marital Status Number Percentage

1.

2.

Married

Unmarried

88

47

65.19 %

34.81 %

3. 30 patients (22.22 %) were from rural background while 105 patients (77.78 %) were urban. Ladies from Urban social background are more prone to have Fibroadenomas as

UNILATERAL LEFT RIGHT BILATERAL0

10

20

30

40

50

60

70

80

80

37

43

5559.26 %

27.41 %31.85 %

40.74 %

BREAK – UP OF CASES ACCORDING TO SIDE OF LESIONS(Period February 1996 – December 2011)


MARRIED UNMARRIED0

10

20

30

40

50

60

70

80

90

88

47

65.19 %

34.81 %

BREAK – UP OF CASES ACCORDING TO MARITAL STATUS(Period February 1996 – December 2011)


compared to those residing in rural areas (Table – 4). Urban patients were defined as those living in District head quarters and metros.

TABLE – 4BREAK – UP OF CASES ACCORDING TO HABITAT


S.N. Social Status Number Percentage

1.

2.

Rural

Urban

30

105

22.22

77.78

3. 30 patients (22.22 %) were from rural background while 105 patients (77.78 %) were urban (Table–4). Urban patients were defined as those living in District head quarters and cities.

TABLE–4BREAK–UP OF CASES ACCORDING TO HABITAT


S.N. Social Status Number Percentage

1.

2.

Rural

Urban

30

105

22.22 %

77.78 %

MARRIED UNMARRIED0

10

20

30

40

50

60

70

80

90

88

47

65.19 %

34.81 %

BREAK – UP OF CASES ACCORDING TO MARITAL STATUS(Period February 1996 – December 2011)


4. 22 patients (16.30 %) were upto 20 years, 111 patients (82.22 %) were between 21–50 years of age while only 2 patients (1.48 %) were above 51 years. Incidence of Fibroadenoma was maximum in reproductive period between 21–50 years of age (Table–5).

TABLE–5BREAK–UP OF CASES ACCORDING TO AGE


S.N. Age of Patient Number Percentage

1.

2.

3.

Upto 20 years

Between 21–50 years

Above 51 years

22

111

2

16.30 %

82.22 %

1.48 %

RURAL30

22.22 %

URBAN105

77.78 %

BREAK – UP OF CASES ACCORDING TO HABITAT(Period February 1996 – December 2011)


UPTO 20 YEARS BETWEEN 21 - 50 YEARS

ABOVE 51 YEARS0

20

40

60

80

100

120

22

111

2

16.30 %

82.22 %

1.48 %

BREAK – UP OF CASES ACCORDING TO AGE(Period February 1996 – December 2011)


5. 15 (17.04 %) patients were nulliparous, 20 (22.73 %) were uniparous,30(34.09 %) were biparous and 23 (26.14 %) patients were multiparous. (Table–6)

TABLE–6BREAK–UP OF CASES ACCORDING TO PARITY


S.N. Parity Number Percentage

1.

2.

3.

4.

Para 0

Para 1

Para 2

Para 3 or more

15

20

30

23

17.04 %

22.73 %

34.09 %

26.14 %

PARA 0 PARA 1 PARA 2 PARA 3 or MORE0

5

10

15

20

25

30

35

15

20

30

23

17.04 %

22.73 %

34.09 %

26.14 %

BREAK – UP OF CASES ACCORDING TO PARITY(Period February 1996 – December 2011)


A FEW MODEL CASES

CASE–1: REGN. No.: V–4220 / 00193; AGE: 30 YEARS

CHIEF COMPLAINTS–

A thirty years old quadriparous female was suffering from:

Multiple painful lumps in both breasts with blood mixed pus discharge from both nipples for the last 4 years.

Amenorrhoea for the last 4 months.

ASSOCIATED COMPLAINTS–

Flatulent distension of abdomen with belching, burning in abdomen with nausea. Anxiety, restlessness with feverish feeling, bodyache and vertigo at times.

OBSTETRIC HISTORY–

G (gravida) 4, P (para) 4, A (abortion) 0, S (still birth) 0, L (living) 4

TREATMENT HISTORY–

Has taken Clavum 625 in the past.

PAST HISTORY–

Tinea palmaris–applied Betnovate

INVESTIGATION–

INITIAL SONOMAMMOGRAPHY REPORT (15/03/2007)

Increased thickness of glandular tissue in both breasts mainly in lateral quadrants and retro–areolar region (Fibroadenosis) along with multiple poorly formed hypoechoic areas in both breasts with evidence of multiple small cysts in lateral quadrants of both breasts measuring 4–7 mm in size suggestive of B/L Fibroadenosis and Fibrocystic disease with multiple small retention cyst.

BIOPSY OF BREAST LUMP (11/11/2006)

Pericanalicular fibroadenoma.

SERUM PROLACTIN (26/08/2006)

33.77 ng / ml (more than normal)

RUBRICS FOR REPERTORISATION

1. Religious dreams2. Anxious dreams

3. Dreams of dead relatives4. Dreams of snakes5. Dreams of falling from high places6. Dreams of unsuccessful efforts7. Desire for company8. Amelioration from consolation9. Disposition to contradict10. Offended easily11. Sentimental12. Tendency to get angered easily13. Anxiety about health14. Weeping tendency15. Desire for salty things

RESULT OF REPERTORISATION

MEDICINE SELECTED– Sulphur

JUSTIFICATION OF PRESCRIPTION–

Religious dreams Anxious dreams Dreams of falling from high places Thermals : Hot patient

DATE–WISE FOLLOW–UP: (REGN. NO.: V–00193)

March 15, 2007:Sulphur 1000 single dose was prescribed followed by Placebo for 2 weeks.

March 28, 2007:Pain and heaviness in breast lumps reduced. Placebo was repeated for 5 weeks.

May 03, 2007:

REMEDIES PHOS PULS CALC C LYCO SULPHTOTALITY 31 28 26 26 25SYMPTOMS COVERED 15/20 12/20 13/20 12/20 14/20

No further improvement. Menses appeared on May 02, 2007 but were painful. Sulphur 1000 single dose was repeated followed by Placebo for 4 weeks.

June 05, 2007:Heaviness and pain in breast lumps and pus discharge from nipples remained as such. Menses reappeared on May 25, 2007 but were very scanty. Dreams of dead relatives and snakes were repeated. Kali carbonicum 30 was prescribed twice daily for 4 weeks since both these classical symptoms are covered by this remedy.

July 09, 2007:Discharge from nipple, pain and heaviness in breast lumps reduced. Placebo was repeated for 4 weeks.

August 14, 2007:No further reduction in discharge from nipple, pain and heaviness in breast lumps. Menses appeared on June 19, 2007 and August 04, 2007 and were scanty. Dreams of dead relatives and snakes reduced.

Sonomammography dated August 12, 2007 revealed glandular breast parenchyma on both sides with fibrous appearance (Fibroadenosis) in between with no evidence of retention cysts. Sulphur 1000 single dose was repeated followed by Placebo for 6 weeks.

September 19, 2007:Patient reported of heaviness and pain in breast lumps and pus discharge from nipples before menses which subsided after the appearance of menses on August 29, 2007. No dreams were reported by the patient. Placebo was prescribed for 8 weeks.

November 26, 2007:Heaviness and pain in breast much reduced. Pus discharge from nipples remained as such. Menses appeared on October 25, 2007 and November 16, 2007. Sulphur 1000 single dose was repeated followed by Placebo for 4 weeks. Patient was advised to get Serum Prolactin repeated.

January 02, 2008:Patient clinically asymptomatic. Menses appeared on December 11, 2007. Serum Prolactin level on December 29, 2007 was found to be 7.44 ng / ml (WNL). Repeat Sonomammography was advised.

January 30, 2008:Patient was overall better. Menses appeared on January 29, 2008. Sonomammography breasts dated January 29, 2008 revealed normal breast parenchyma without any evidence of Fibroadenosis, Fibrocystic disease or retention cysts. The patient was declared as cured.

ULTRASONOGRAPHIC REPORTS AT A GLANCE

Initial USG(15/3/2007)

Follow–up 1(12/8/2007)

Follow–up 2(29/01/2008)

Increased thickness of glandular tissue in both breasts (Fibroadenosis) along with multiple poorly formed hypoechoic areas

Glandular breast parenchyma on both sides with fibrous

Normal breast parenchyma without any

with evidence of multiple small cysts measuring 4–7 mm suggestive of B/L Fibroadenosis and Fibrocystic disease with multiple small retention cyst.

appearance (Fibroadenosis) in between with no evidence of any cysts.

evidence of Fibroadenosis, Fibrocystic disease or retention cysts.

CASE–2: REGN. No.: S–05790; AGE: 32 YEARS

CHIEF COMPLAINTS–

A thirty two years old biparous female was suffering from: Tender lump in right breast for the last 4 years. Recurrent left sided headache < getting head wet, draft of cold air, sun for the last 4

years. Cramps in legs < exertion > hard pressure for the last 2 years.

MENSTRUAL HISTORY–

Menses: early, adequate, lasting 5 days (LMP – 20.09.2011)



PAST HISTORY–

Tinea palmaris–applied Betnovate

INVESTIGATION–


Right breast shows an oval, hypoechoic, ill–defined mass measuring 76 X 74 mms in lower outer quadrant at 6 0’ clock position. 2–3 axillary lymph nodes are also seen.


1. Anger easily2. Anger, talk indisposed to3. Obstinate4. Dictatorial5. Egotism6. Cowardice7. Fastidious8. Hurry tendency9. Irresolute10. Optimism11. Anticipatory anxiety12. Dreams of snakes13. Abrupt14. Censorious15. Desire for spicy food16. Desire for hot food17. Desire for indigestible things


MEDICINE SELECTED– Lycopodium


Anger easily Dictatorial Egotism Cowardice Anticipatory anxiety Abrupt Desire for hot food Thermals: Hot patient

DATE–WISE FOLLOW–UP: (REGN. NO.: S – 05790)

September 26, 2011:Lycopodium 30 weekly was prescribed followed by Spigelia 30 BD for 2 weeks.

October 13, 2011:Tender lump in right breast getting soft. Left hemicrania reduced while cramps in legs remained as such. Only Spigelia 30 BD was repeated for 6 weeks.

November 27, 2011:Tender lump in right breast reduced. Cracked painful right nipple as such. Left hemicrania and cramps in legs remained as such. Lycopodium 30 weekly was continued followed by Spigelia 30 BD for 4 weeks.

December 28, 2011:Tender lump in right breast and cracks on right nipple much reduced. Left hemicrania and cramps in legs also reduced. Same prescription repeated for 4 weeks.

REMEDIES LYCO NUX V SULPH SILTOTALITY 24 24 22 20SYMPTOMS COVERED 13/15 13/15 12/15 12/15

January 25, 2011:No lump in right breast and crack on right nipple was felt by the patient. Left hemicrania and cramps in legs much reduced. Sonomammography dated 23.01.2012 revealed normal breast.



Follow–up 1(23/1/2012)

Right breast shows an oval, hypoechoic, ill–defined mass measuring 76 X 74 mms in lower outer quadrant at 6 0’ clock position. 2–3 axillary lymph nodes are also seen.

Sonomammography of right breast revealed normal breast with no evidence of fibroadenoma

CASE–3: REGN. No.: B–00470; AGE: 37 YEARS

CHIEF COMPLAINTS–

A thirty seven years old triparous female approached GCCHR for treatment of nodular swelling right breast since 12 years which recurred a year after surgery. She was also having acne on face since 18 years and early, profuse, clotted menses lasting 6–15 days since 6 months.



PAST HISTORY–

Surgery for Fibroadenoma right breast in 1996 Tubectomy in 1994

FAMILY HISTORY–

Father: Carcinoma of Kidney, Hypertension, Asthma Mother: Asthma

TREATMENT HISTORY–

Primolut–N, Menoflav, Carvic, Novan DS, Ergitop, Trapic, Morglen Q.

INVESTIGATION–


Two hypoechoic masses of 11 X 11 mms and 20 X 9 mms in supero–lateral quadrant of right breast.


1. Shrieking in anger2. Mildness3. Timidity4. Yielding disposition5. Sentimental6. Weeping easily7. Fear of narrow places8. Sympathetic9. Offended easily10. Brooding

11. Irresolute12. Nervousness13. Cautious14. Desire for open air15. Affectionate16. Perspiration scanty17. Anger easily18. Coldness of palms19. Cold aggravates


MEDICINE SELECTED– Pulsatilla


Mildness Timidity Yielding disposition Weeping easily Nervousness Desire for open air Affectionate Thermals: Hot patient

DATE–WISE FOLLOW–UP: (REGN. NO.:B – 00470)

November 08, 2009:Pulsatilla 30 weekly followed by Placebo for 3 weeks.

December 01, 2009:Nodular swelling right breast as such. Menses appeared on 19/10/09 and 25/11/09. Scanty P/V discharge. Same prescription repeated for 6 weeks.

January 17, 2010:

REMEDIES NUX V NAT M SEPIA PULSTOTALITY 32 28 27 40SYMPTOMS COVERED 18/19 18/19 18/19 17/19

Right breast nodule slightly reduced but P/V discharge increased. Menses appeared on 22/12/09. Pulsatilla 200 once followed by Placebo for 4 weeks.

February 18, 2010:Right breast nodule and P/V discharge reduced. Menses appeared on 4/2/10. Same prescription repeated for another week. Repeat Sonomammography was advised.

February 26, 2010:Breast nodule and P/V discharge further reduced. Sonomammography dated 21/2/10 revealed reduction in size of masses from 11 X 11 mms and 20 X 9 mms to10 X 8 mms and 11 X 8 mms.Patient however left the treatment.



Follow–up 1(21/2/2010)

Two hypoechoic masses of 11 X 11 mms and 20 X 9 mms in supero–lateral quadrant of right breast.

Two hypoechoic masses of8 X 10 mms supraareolar and 8 X 11 mms in retroareolar region of right breast.

RESULTS

1. Out of 135 patients of various breast lesions treated with Homoeopathic drugs, positive response was obtained in 73 (54.08 %) with complete resolution of lesions in 24 (17.78 %), significant reduction in 49 patients (36.30 %) while 30 patients (22.22 %) maintained status quo and 32 patients (23.70 %) did not improve (Table–8). The period of treatment varied from case to case depending upon size, type and number of breast lesions.

TABLE–8STATUS OF BREAST LESIONS PATIENTS AFTER HOMOEOPATHIC TREATMENT


S.N. Status of Patient Number Percentage

1.

1(a).

1(b).

2.

3.

Positive response

Complete resolution

Significant Improvement

Status Quo (as such)

Not Improved

73

24

49

30

32

54.08

17.78

36.30

22.22

23.70

2. Cases of post surgical recurrence can also be treated effectively (Table–9).

TABLE–9STATUS OF CASES OF POST–SURGICAL RECURRENCE


S.N. Category Number Resolved Improved Not Improved

1. Unilateral 5 1 3 1

2. Bilateral 7 0 4 3

0

1

2

3

4

5

6

7

8

CASES OF POST – SURGICAL RECURRENCE(Period February 1996 – December 2011)


UNILATERAL (5) BILATERAL (7)

Total Cases(5)

Resolved(1)

Improved(3)

Not Improved(1)

Total Cases(7)

Resolved(0)

Improved(4)

Not Improved(3)

NOT IMPROVED

STATUS QUO

IMPROVED

TOTAL RESOLUTION

POSITIVE RESPONSE

0 10 20 30 40 50 60 70 80

32

30

49

24

73

23.70 %

22.22 %

36.30 %

17.78 %

54.08 %

BREAK–UP OF VARIOUS BREAST DISEASE CASES REGISTERED AT GCCHR(Period February 1996 – December 2011)


3. In the present study, the medicines were selected on holistic basis and not on pathological diagnosis. A few intercurrent drugs were also administered to give relief in acute symptoms. The three most effective drugs in this study came out to be Calcarea carbonica, Natrum muriaticum and Pulsatilla(Table–10).

TABLE–10DRUG–WISE RESPONSE IN PATIENTS


S.N. MEDICINES NO. OFPATIENTS

STATUSCURED IMP. S.Q. N.IMP.

1. Calcarea carbonica 35 4 15 6 102. Natrum muriaticum 32 3 14 9 63. Pulsatilla 22 5 7 7 34. Silicea 13 2 6 3 25. Lycopodium 12 3 4 1 46. Phosphorus 7 2 1 2 27. Arsenicum album 5 1 2 1 18. Sulphur 3 2 0 0 19. Tuberculinum 2 2 0 0 0

10. Sepia 2 0 0 1 111. Carcinosin 1 0 0 0 112. Lachesis 1 0 0 0 1

135 24 49 30 32

DISCUSSION

In female, oestrogen, progesterone and prolactin are responsible for development of breast under the influence of the hormones of Hypophysis (Pituitary) through feed back mechanism from Hypothalamus.

Oestrogen, secreted from theca interna of the Ovarian follicles and Corpus luteum produces only ductal development of the breast while Progesterone, secreted from Corpus luteum alongwith oestrogen is responsible for the formation of the alveoli and glandular development of the breast. Prolactin secreted by lactotrophs (mammotrophs), which are acidophil cells, acts on breast that has been caused to grow by oestrogen – progesterone stimulation. It acts directly on mammary epithelial cells to produce localized alveolar hyperplasia and synthesis of milk.

In healthy state, equilibrium is maintained between the hormones of Pituitary and Ovary which is controlled by Hypothalamus. Today’s modern and hectic life style, social pressure and various psycho–social factors like worry, anxiety and stress are known to cause hormonal imbalance through Psycho–neuro–hormonal axis.

Various psycho-social factors cause disturbance in hormone level leading to release of neurotransmitters which disturb the equilibrium between the hormones of Pituitary and Ovary

0

1

2

3

4

5

6

7

8

CASES OF POST – SURGICAL RECURRENCE(Period February 1996 – December 2011)


UNILATERAL (5) BILATERAL (7)

Total Cases(5)

Resolved(1)

Improved(3)

Not Improved(1)

Total Cases(7)

Resolved(0)

Improved(4)

Not Improved(3)

resulting in tissue changes in the breast, uterus and ovaries producing fibroadenoma, endometrial hyperplasia, oestrogenic uterine and ovarian tumors as mentioned in few reports [4]

[5][6].Possibility of breast tumors is increased in those ladies who are regularly taking

combination of oestrogen and progesterone for contraception or menstrual irregularities or are undergoing hormone replacement therapy (HRT). Combination of synthetic oestrogen and progesterone cause disproportionate increase in the ductal system, alveoli and fibroglandular tissue of breast leading to formation of Fibroadenoma. It is also observed that spinsters and those who have not suckled their children are at increased risk due to disturbed Prolactin level in blood which is directly related to suckling reflex explaining the fact that those ladies who feed their children are at less risk of having Fibroadenoma.

Homoeopathic remedies reduce the emotional / psychological disturbances if selected on mental symptoms thereby reducing stimulation of Hypothalamus maintaining the equilibrium between various hormones leading to reversal of pathological changes in the breast. There are no or very less chances of recurrence of the tumor after constitutional treatment through Homoeopathic drugs. Surgical removal of the lesions, however, does not remove the “cause” but “effect” of the disease as is evidenced from the recurrence of tumors after surgery.

In the present study, out of 135 patients, 12 were of post–surgical recurrence including 5 of Unilateral and 7 of Bilateral breast lesions also showed encouraging results proving the effectiveness of Homoeopathic drugs even in operated cases.

Gupta et. al. for the first time reported the role of Homoeopathic drugs in cases of Fibroadenoma of breast in a mid–study report entitled “Fibroadenoma of Breast: A Sonomammography supported clinical study on the effect of Homoeopathic drugs”. It was presented in 15thInternational Homoeopathic Congressof AHML held at Colombo, Sri Lanka in November 2004. The present paper is the outcome of this ongoing project which is likely to continue for time unlimited.

CONCLUSION

1. The outcome of this evidence based pilot study is encouraging which opens new vistas in safe treatment of such benign breast lesions with Homoeopathic medicines selected on holistic basis as per basic tenets of Homoeopathy.

2. Majority of benign breast lesions whether cystic or solid, big or small, single or multiple can be treated effectively.

3. Patients of all ages, married or unmarried and even post menopausal respond well to Homoeopathic treatment.

4. The treatment is boon to unmarried ladies who want to avoid surgery.

5. Homoeopathic drugs are safe and cost effective without any side effects. Surgery may lead to cosmetic implications and prolonged hormonal treatment may lead to side effects.

6. Cases of post surgical recurrence can also be treated effectively with constitutional homoeopathic medicines.

REFERENCES

1. Robbins, Stanley L. and Kumar, Vinay, Basic Pathology, 4th edition, Churchill Livingstone, Edinburgh, London, Melbourne and New York 1986, Endocrine system: Pituitary gland, Reprint 1987, The female genital system and breast, pp. 631 – 670.

2. Dawn C. S., Textbook of Gynaecology and Contraception, 1990 (10th edition), Breast diseases, pp. 174 – 175.

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6. Govan, Alasdair D. T., Macfarlane Peter S., Callandar Robin, Pathology Illustrated, IInd edition, Churchill Livingstone, Edinburgh, London, Melbourne and New York 1986, Neoplasia: Simple Epithelial Tumors, Reprint 1987, pp. 179 – 182.

7. Fibroadenomas at Merck Manual of Diagnosis and Therapy Home Edition

8. Tavassoli, F.A., Devilee, P., ed (2003). World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs. Lyon: IARC Press. ISBN92-832-2412-4.

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12. Nelson, Z. C.; Ray, R. M.; Wu, C.; Stalsberg, H.; Porter, P.; Lampe, J. W.; Shannon, J.; Horner, N. et al. (2010). "Fruit and Vegetable Intakes Are Associated with Lower Risk of Breast Fibroadenomas in Chinese Women". Journal of Nutrition 140 (7): 1294–1301. doi:10.3945/jn.109.119719. PMC2884330. PMID20484549.

13. Gupta,G; Gupta, N; Chaudhary, M (2003). “Fibroadenoma of Breast: A Sonomammography supported clinical study on the effect of Homoeopathic Drugs”, Homoeopathy for All, Vol. 4 No. 48, December 15, 2003, pp. 37 – 45.

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SONO–MAMMOGRAPHIC EVALUATION OF BREAST LESIONS