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From the Townsend Letter
February/March 2014

Environmental Medicine Update
Breast Lumps: Clinical Pearls and Perils
by Marianne Marchese, ND
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Environmental Factors
Chemicals in food, water, cleaning products, and cosmetics are known to have endocrine-disrupting properties and are linked to breast cancer.19 Studies of cell cultures, laboratory animals, and accidentally exposed humans do show that chemicals can produce estrogenic, androgenic, antiandrogenic, and antithyroid actions in the body. In addition to breast cancer, these endocrine-disrupting chemicals (EDCs) are linked to benign breast masses such as fibrocystic breast disease and fibroadenomas.19–21
: EDCs should be considered in the evaluation and prevention of breast lumps.

Palpable breast masses are common and usually benign, but efficient evaluation and prompt diagnosis are necessary to rule out malignancy. Most breast lumps that women or clinicians feel aren't cancer. It's more common for them to be cysts, fibrocystic disease, or fibroadenomas. Some lumps commonly come and go during a woman's menstrual cycle. Men can have breast lumps and breast cancer as well and should be evaluated the same. Patients should be evaluated initially with a detailed clinical history and physical examination. Most presenting with a breast mass will require imaging and further workup to exclude cancer and address symptoms. Education is important in the prevention and treatment of most breast lumps.

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4.    Yohe S, Yeh IT. "Missed" diagnoses of phyllodes tumor on breast biopsy: pathologic clues to its recognition. Int J Surg Pathol. 2008;16(2):137–142.
5.    Gill HK, Ioffe OB, Berg WA. When is a diagnosis of sclerosing adenosis acceptable at core biopsy? Radiology. 2003;228(1):50–57.
6.    Tse GMK, Law BKB, Ma TKF, et al. Hamartoma of the breast: a clinicopathological review. J Clin Pathol 2002;55:951–954.
7.    Keyoung JA Zuurbier CA, Tsangaris TN, Azumi N, Makariou E. Diabetic Mastopathy. Appl Radiol. 2003;32(9). Accessed Nov. 9, 2013.
8.    Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA. 1999;282:1270–1280.
9.    Salzman B et al. Common breast problems. Am Fam Physician. 2012;86(4):343–349.
10.    Morrow M. The evaluation of common breast problems. Am Fam Physician. 2000;61(8):2371–2378.
11.    Majid AS et al. Missed breast carcinoma: pitfalls and pearls. Radiographics. 2003;23(4):881–895.
12.    Chairat R et al. Are both ultrasonography and mammography necessary for cancer investigation of breast lumps in resource-limited countries? ISRN Oncol. 2013 Aug 28, 2013:257942. doi:10.1155/2013/257942.
13.    Saslow D et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75–89.
14.    Bhatia Y. P-cadherin as myoepithelial cell marker for differential diagnosis of benign and malignant breast lesions. Indian J Pathol Microbiol. 2013;56:6–9.
15.    Fitzgerald A, Berentson-Shaw J. Thermography as a screening and diagnostic tool: a systematic review. N Z Med J. 2012 Mar 9;125(1351):80–91.
16.    Filassi JR et al. Can breast nipple fluid collected with automated aspiration and preserved in based-liquid solution improve the cytological samples? Acta Cytol. 2013;57(3):276–280.
17.    Elsheikh TM. Does the new automated "HALO" nipple aspiration fluid system really deliver as promised? The answer is "No, but...": A literature review of the role of breast fluid cytology in cancer risk assessment. Diagn Cytopathol. 2009 Sep;37(9):699–704.
18.    Henderson M et al. DtectDx Breast: A serum biomarker test for breast cancer detection used in conjunction with traditional mammography screening. J Clin Oncol. 2013;31(suppl 26; abstr 18). 11/10/2013.
19.    Darbre PD. Environmental oestrogens, cosmetics and breast cancer. Best Pract Res Clin Endocrinol Metab. 2006;20:121–143.
20.    Bidgoli SA et al. Association between glycodelin and aryl hydrocarbon receptor in Iranian breast cancer patients: impact of environmental endocrine disrupting chemicals. Asian Pac J Cancer Prev. 2011;12(9):2431–2435.
21.    El-Bayoumy K et al. Comparative tumorigenicity of benzo[a]pyrene, 1-nitropyrene and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine administered by gavage to female CD rats. Carcinogenesis.1995;16(2):431–434.

Dr. Marchese is the author of 8 Weeks to Women's Wellness: The Detoxification Plan for Breast Cancer, Endometriosis, Infertility, and other Women's Health Conditions. Dr. Marchese graduated from the National College of Naturopathic Medicine. She maintains a private practice in Phoenix, Arizona, and teaches gynecology at Southwest College of Naturopathic Medicine. She was named in Phoenix Magazine's 2010 Top Doctor Issue as one of the top naturopathic physicians in Phoenix. Dr. Marchese is a contributing author for the Townsend Letter and lectures on topics related to women's health and environmental medicine throughout the US and Canada. She is past vice president of the Arizona Naturopathic Medical Association and current member of the board of directors for the Council on Naturopathic Medical Education.

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