Cyclical mastalgia--is it a manifestation of aberration in lipid metabolism?

Several therapeutic and investigative studies suggest the possibility of the role of lipid profile aberrations in the pathophysiology of cyclical mastalgia. This prospective study is aimed to look for such aberrations. Fifty-seven patients of benign breast disease were included in this study who were symptomatic for at least 6 months prior to presentation. Detailed serum lipid profile work up was performed on day 1, 15 and 25 of menstrual cycle. The patients with symptoms of maximal severity (or limited to) during leuteal phase of menstrual cycle were included in group I (n = 32). Those who had mastalgia, but did not have above mentioned cyclical variation, were included in group II (n = 25). Since noncyclical mastalgia is a group of heterogeneous disorders of varied etiology, the patients in group II were treated as controls. At day 25, there was an elevation in mean values of HDL-C (P = 0.03) and HDL-C/LDL-C ratio (P = 0.01), and reduction in TC/HDL-C ratio (P < 0.03), in group I. This has not been the case with group II patients. When the patients of mastalgia were treated with low fat dietary regimen, there was a significant difference in the responses of these two groups (P value < 0.0001). Based on the results of lipid profile study and dietary intervention, we conclude that cyclical mastalgia is an entity which is distinctly different from noncyclical mastalgia and needs a different therapeutic approach. Our data, both investigative and therapeutic, suggests that cyclical mastalgia may be a result of cyclical aberrations in lipid metabolism, and the physiological treatment in the form of an appropriate dietary regimen holds a considerable promise.

Efficacy of low fat diet in the treatment of benign breast disease.

BACKGROUND. Previous studies have shown that lipid abnormalities have a role in the pathogenesis of benign breast disease. However, few investigators have tried to reduce dietary fat to treat this disorder. METHODS. Between 1990 and 1993, we conducted a prospective cohort study to find out the efficacy of a low fat diet (less than 15% fat-derived calories) in the treatment of benign breast disease in patients who had been symptomatic for 6 months or more. The study was conducted in two phases. In the first phase 36 patients were alternately assigned to control and treatment groups for 6 months and in the second phase 121 patients (including all those in phase I) were given treatment (median follow up 25 months, range 3 to 39 months). Detailed lipid profiles were studied at the time of presentation and at 4 and 5 months. RESULTS. Phase I results showed that after 6 months none of the patients in the control group had experienced any alteration in their symptoms and signs but in the treatment group 12 out of 17 improved. In phase II improvement in pain (68 out of 97; 70%), nodularity (51 out of 79; 64%) and discharge (15 out of 19; 80%) was seen. There was a significant decline in the mean values of total cholesterol and high-density lipoproteins at the end of 5 months of treatment. CONCLUSION. A low fat diet improves the symptoms as well as the lipid profile in patients with benign breast disease.