Fibrocystic breast disease and caffeine: medical folklore or fact?

There is one down side of weight loss – my breast have gone from DD to C. And yes, they were magnificent, but a DD would look out-of-place on my now size 8 frame (at least that’s what I tell myself).

I find my smaller, less “dense” breasts a little easier to examine. Doing my monthly check I found a slightly irregular area. A lumpy area, not a discrete lump. It’s really hard to tell if it is a little fibrocystic changes or just breast tissue. Given my weight loss, let’s just say that the breast architecture has changed and it all feels a little different. It was surprised it find this newfound area to be a little tender, although I’ve been poking it a lot, so there’s that.

My mammogram is set for Thursday (my last one was 18 months ago. Like you, I am confused about the optimal interval for mammograms and so I have split the difference between every year/every two years). However, I wondered if there was something I could do in the meantime to stop the pain and make the area shrink, thereby giving me some more reassurance that it is a just breast tissue or a little cystic area. Of course, several colleagues suggested the following: stop caffeine and take some vitamin E.

Hmmm, I thought. This week I have definitely had a lot of coffee, even for me, so might I be approaching  caffeine toxicity? Something that heretofore I would have denounced as heresy, but hey, maybe there is a connection?

Eager to be the good patient and to do something I perceived as constructive while waiting for my mammogram, I picked up some vitamin E and renounced caffeine.

Coffee. Tea. Diet coke. All gone. (Not dark chocolate thought, I’m curious not insane).

I am 24 hours in. My head is feeling a little fuzzy. My left breast feels marginally less tender, but I bet there is a powerful placebo response at work here here…20 minutes after taking the vitamin E, you know before it entered my circulation, I felt better. I have also committed to not poke at it, so there is the remote possibility that lessening the local trauma is a positive move.

But after my knee jerk reaction, I wondered, what exactly is the evidence for giving up caffeine to reduce fibrocystic breast conditions?

Uh, er, well, it’s, um, not very good. As expected the placebo response rate is high and there are no randomized double-blinded placebo controlled trials. These are some of the “better” studies I found on PubMed:

• An open label trial where 82% of 113 women managed to give up caffeine for a year, 61% had reduced or no breast pain.
• A study looking at women with known fibrocystic conditions indicated a significant waxing and waning of nodules/cysts despite stable caffeine consumption over six months with 15% resolving their cystic changes.
• A retrospective study of more than 300 women showed no associated with caffeine consumption and breast cysts
• A case-control study published in JAMA looking at more than 800 histologically confirmed cases of fibrocystic breast diseases found no association with coffee consumption.
• And a study with over 1,500 patients and 1,500 controls found no association between caffeine, breast tenderness and fibrocystic conditions.

As an aside, caffeine consumption also appears to have no effect on breast cancer risk, although a diet low in fat and high in fiber and fruit may lower the risk of breast cancer and it most certainly lowers the risk of heart disease (the reason why Komen’s Buckets for the Cure partnership with Kentucky Fried Chicken is both gauche and the height of hypocrisy).

Admittedly, the studies are not the highest quality, but that’s all there is. The end result is there appears to be no convincing evidence to link caffeine consumption with breast cysts and one small open label study with no control group that suggests a 60% reduction in breast pain. We don’t know if it is a placebo response (remember, in some studies placebo response can be 50% or higher) and other papers do not support the connection between fibrocystic breast pain and caffeine.

So with so little evidence supporting the caffeine/breast cysts-breast pain connection, why do doctor’s recommend it?

Medical folklore is strong. Someone heard something somewhere and it gets repeated, like any mythology. If a staff surgeon is repeating it to 20 residents at a lecture, it gets disseminated exponentially. And of course, some women will feel better because there will always be a placebo response rate because many people feel better just doing something. I suspect many doctors and nurses hear some of their patients say they have less breast pain after quitting caffeine, so that reinforces the recommendation the next time the situation arises.

And the American College of OB/GYN doesn’t help too much from an evidence stand point, because in the ACOG Educational Patient Pamphlet for Fibrocystic Breast Changes the first recommendation to improve symptoms  to “avoid caffeine for a few months.”

So what’s a coffee lovin’ evidence based medicine gal to do?

First of all, I’ll let you in on a little secret…I feel better. And it is so totally placebo response rate (I felt better 20 minutes after popping the vitamin E, you know, before it entered my blood stream). I am also sure that not poking myself every 10 minutes to check has also played a role.

I’m going with the evidence and back to my caffeine (my love…I could never leave you); however, given that I have been Diet Coke-free for over 24 hours I’m going to take this opportunity to ditch the soda. There’s a ton of evidence to support that move. And I may amend my habits and restrict consumption to before noon, you know, to help with the whole good night’s sleep thing.

And the vitamin E? Well, I’m going to look into that next.