By J. E. Hinners, MD MPH
If you are a woman, then you have over a 50% chance of developing definite signs of fibrocystic breast disease (FBD) at some point in your life. 90% of women will develop closely related cellular breast changes.
What is fibrocystic breast disease?
Fibrocystic breast disease is a condition where “benign” (harmless) fluid-filled cysts develop in the breast. These cysts can occur anywhere in the breast and are moveable, tender, grape-like sacs that increase in size and pain most prominently about one week to several days before menstrual flow. After menstrual flow begins, the cysts begin to decrease in size, and breast pain diminishes.
On first discovery, these cysts can often be alarming, as frequently a palpable “lump” can be felt and mistaken for a cancerous lump. To be on the safe side, it always better to check with your physician to make sure that the lumps are indeed these harmless, fluid-filled cysts.
While benign, the pain and discomfort of this condition can be enormous motivators for seeking relief.
Treatment is usually symptomatic: pain relievers, supportive bras, and heating pads. This condition usually subsides once menopause hits.
Association with coffee?
Classic common advice (including from physicians) for women with FBD is to decrease coffee and other caffeine intake (such as tea, chocolate, etc.)–if not avoid it altogether. These products contain methylxanthines, the supposed evil culprit that worsens fibrocystic breast disease.
Do “they” realize what they’re asking here..? ? ?
For a woman who has a *relationship* with coffee, this kind of advice is truly heartbreaking and life-altering.
So for such sacrifice – we might as well ask:
What is the scientific theory behind this supposed link?
While the exact mechanism of this theory is unknown, studies suggest that those with FBD do have heightened sensitivity to catecholamines (the chemicals in your body responsible for your “fight or flight” response). Coffee contains methylxanthines, which can increase the amount of catecholamines circulating through your body.
What evidence do we have that proves this coffee avoidance advice is effective and worthwhile for the woman with FBD?
A quick glance at the medical journal databases makes it pretty clear that this question was a hot topic especially in the ’80’s. Several studies were conducted at that time, and not many others were conducted afterwards.
Some studies showing POSITIVE ASSOCIATIONS between coffee and benign breast disease:
- One case-control study compared 288 women with histologically confirmed breast nodules to two different sets of control groups without the disease (285 hospital patients and 291 outpatients). Women who drank as little as 1-2 cups of coffee per day were found to be at least two times as likely to have fibrocystic breast disease as the control groups.
- One case-control study evaluated 90 pairs of female twins where one twin claimed a history of benign breast disease (biopsy-confirmed) and the other twin had no such history. A significantly positive association was found between coffee consumption and benign breast disease.
- Another case-control study compared 634 women with benign breast disease to 1,066 women without the disease and found a significant odds increase in having fibrocystic breast disease in women who consumed 31-500 mg of caffeine per day.
- One study used questionnaires for 102 women who visited a radiologist for mammograms. Fibrocystic breast disease was found to be positively correlated to total methylxanthine and caffeine ingestion.
Some studies showing NO ASSOCIATION between coffee and benign breast disease:
- One randomized control trial of 158 women with benign breast disease compared clinical and mammogram changes between methylxanthine-consumers and those who abstained from methylxanthine for 4 months. Changes observed in the methylxanthine-free group were statistically significant, but the degree of change was so slight that it was not considered to be clinically significant. Before/after mammograms could not offer any significant changes.
- One case-control study compared 323 women with benign breast disease to 1,458 controls. Women with benign breast disease did not have significantly different coffee and tea consumption patterns than women without disease.
- One case-control histologically examined 864 benign breast disease cases compared to 755 matched surgical controls and 723 matched neighborhood controls for differences in methylxanthine intake. No association was found between coffee or methylxanthine intake and benign breast disease.
- One prospective study examined 72 women with palpable breast lumps over a 6-month period and found that 87% of breasts changed in position or in number of nodules; 48 of these women were menopausal, however, and authors concluded that it would be difficult to establish an association between methylxanthine intake and fibrocystic breast disease.
- One case-control study compared 1,569 cases with benign breast disease to 1,846 controls over a 7-year period. No association was found between methylxanthine consumption and disease risk or breast pain.
These lists of studies are not comprehensive, but you might get the gist of my own conclusion from this initial research.
My conclusion is that the results are inconclusive, as the findings are mixed!
You could probably make a good case for either side of the issue, as there is evidence on either side. If you’re willing to swallow the sacrifice of less or no coffee (and other caffeine products), then it can’t hurt to stay on the safe side and avoid coffee and caffeine, in general.
However, if coffee is too close to your heart and not worth giving up for less breast pain, nobody can really claim that you’d be going against conclusive evidence at this point. Each individual should consult her physician on this questionable point, as each individual has her own unique set of health factors to weigh in the equation.
Additional information about fibrocystic breast disease can be found here.