SONOMAMMOGRAPHIC EVALUATION OF BREAST LESIONS CASES 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 Coordinator 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 postsurgical 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 sonomammography followed by constitutional treatment with homoeopathic medicines on holistic basis showed excellent response. It opens new vistas in the nonsurgical, nonhormonal treatment of breast lesions.The period of treatment varied from case to case depending on the size, type and number of breast lesions. TABLE1 BREAKUP OF CASES ACCORDING TO TYPE OF BREAST LESIONS (Period February 1996December 2011) (Total number of cases: 135) S.N. 1. 2. 3. 4. 5. 6. 7. Category Fibroadenoma Fibroadenosis Fibroadenoma with Fibroadenosis Breast Cyst Fibroadenosis with Breast Cyst Fibroadenoma with Breast Cyst Chronic Inflammatory Granuloma Number 98 03 13 08 08 04 01 Percentage 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.

BREAK UP OF VARIOUS BREAST DISEASE CASES REGISTERED AT GCCHR (Period February 1996 December 2011) (Total number of cases: 135)
FIBROADENOMA WITH BREAST CYST 4 2.96 % FIBROADENOSIS WITH BREAST CYST 8 5.93 %

CHRONIC INFLAMMATORY GRANULOMA 1 0.74 %

BREAST CYST 8 5.93 % FIBROADENOMA WITH FIBROADENOSIS 13 9.63 % FIBROADENOSIS 3 2.22 % FIBROADENOMA 98 72.59 %

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 postmenopausal woman.[2][4][5] They are welldefined, 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 [3] mobility in the breast. Premenstrual increase in pain and size of the lump may occur in prepubertal girls and in young women. EPIDEMIOLOGY Fibroadenoma has a prevalence of 710 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] DECREASED RISK: Highernumber of live births, intake of fruits and vegetablesand moderate exercise lower the frequency of fibroadenomas. Some studies suggest that breastfeeding 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 estrogenlike 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. Eestrogenlike 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 nonhormonal/nonsurgical 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 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 (Table2). TABLE 2 BREAKUP OF CASESACCORDING TO SIDE OF LESIONS (Total number of cases: 135) Side of breast involved 1. 1(a). Unilateral Left Number S.N. 80 37 Percentage 59.26 % 27.41 % in the present study after

1(b). 2.

Right

55

43

31.85 %

Bilateral

40.74 %

BREAK UP OF CASES ACCORDING TO SIDE OF LESIONS (Period February 1996 December 2011) (Total number of cases: 135)
80 80 70 60 50 37 40 27.41 % 30 20 10 0 UNILATERAL LEFT RIGHT BILATERAL 31.85 % 43

59.26 % 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 (Table3). TABLE3 BREAKUP OF CASES ACCORDING TO MARITAL STATUS (Total number of cases: 135) S.N. 1. 2. Married Unmarried Marital Status Number 88 47 Percentage 65.19 % 34.81 %

BREAK UP OF CASES ACCORDING TO MARITAL STATUS (Period February 1996 December 2011) (Total number cases: 135) 3. 30 patients (22.22 %) were from rural of background while 105 patients (77.78 %) were
urban. Ladies from Urban social background are more prone to have Fibroadenomas as compared to those residing in rural areas (Table 4). Urban patients were defined as 88 those living in District head quarters and metros. TABLE 4 BREAK UP OF CASES ACCORDING TO HABITAT 65.19 % number of cases: 135) (Total Social Status Rural Urban Number 30 105 47 Percentage 22.22 34.81 % 77.78

90 80 70S.N. 60 1. 50 2. 40 30 20 10 0

MARRIED

UNMARRIED

3. 30 patients (22.22 %) were from rural background while 105 patients (77.78 %) were urban (Table4). Urban patients were defined as those living in District head quarters and cities. TABLE4 BREAKUP OF CASES ACCORDING TO HABITAT (Total number of cases: 135) S.N. 1. 2. Rural Urban Social Status Number 30 105 Percentage 22.22 % 77.78 %

BREAK UP OF CASES ACCORDING TO HABITAT (Period February 1996 December 2011) (Total number of cases: 135)

RURAL 30 22.22 %

URBAN 105 77.78 %

4. 22 patients (16.30 %) were upto 20 years, 111 patients (82.22 %) were between 2150 years of age while only 2 patients (1.48 %) were above 51 years. Incidence of Fibroadenoma was maximum in reproductive period between 2150 years of age (Table5). TABLE5 BREAKUP OF CASES ACCORDING TO AGE (Total number of cases: 135) S.N. 1. 2. 3. Age of Patient Upto 20 years Between 2150 years Above 51 years Number 22 111 2 Percentage 16.30 % 82.22 % 1.48 %

BREAK UP OF CASES ACCORDING TO AGE (Period February 1996 December 2011) (Total number of cases: 135)
111 120

100

82.22 %

80

60

40

22 16.30 %

20

1.48 %

0 UPTO 20 YEARS BETWEEN 21 - 50 YEARS ABOVE 51 YEARS

5. 15 (17.04 %) patients were nulliparous, 20 (22.73 %) were uniparous,30(34.09 %) were biparous and 23 (26.14 %) patients were multiparous. (Table6) TABLE6 BREAKUP OF CASES ACCORDING TO PARITY (Total number of cases: 88) S.N. 1. 2. 3. 4. Para 0 Para 1 Para 2 Para 3 or more Parity Number 15 20 30 23 Percentage 17.04 % 22.73 % 34.09 % 26.14 %

BREAK UP OF CASES ACCORDING TO PARITY (Period February 1996 December 2011) (Total number of cases: 135)
34.09 % 35 30 25 20 20 15 10 5 0 PARA 0 PARA 1 PARA 2 PARA 3 or MORE 17.04 % 15 22.73 % 23 30 26.14 %

A FEW MODEL CASES CASE1: REGN. No.: V4220 / 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 palmarisapplied 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 dreams

2. Anxious dreams 3. Dreams of dead relatives 4. Dreams of snakes 5. Dreams of falling from high places 6. Dreams of unsuccessful efforts 7. Desire for company 8. Amelioration from consolation 9. Disposition to contradict 10. Offended easily 11. Sentimental 12. Tendency to get angered easily 13. Anxiety about health 14. Weeping tendency 15. Desire for salty things

RESULT OF REPERTORISATION REMEDIES TOTALITY SYMPTOMS COVERED MEDICINE SELECTED Sulphur JUSTIFICATION OF PRESCRIPTION Religious dreams Anxious dreams Dreams of falling from high places Thermals: Hot patient PHOS 31 15/20 PULS 28 12/20 CALC C 26 13/20 LYCO 26 12/20 SULPH 25 14/20

DATEWISE FOLLOWUP: (REGN. NO.: V00193) 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: 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) Increased thickness of glandular tissue in both breasts (Fibroadenosis) along with multiple poorly formed hypoechoic areas with evidence of multiple small cysts measuring 47 mm suggestive of B/L Fibroadenosis and Fibrocystic disease with multiple small retention cyst. Followup 1 (12/8/2007) Glandular breast parenchyma on both sides with fibrous appearance (Fibroadenosis) in between with no evidence of any cysts. Followup 2 (29/01/2008) Normal breast parenchyma without any evidence of Fibroadenosis, Fibrocystic disease or retention cysts.

CASE2: REGN. No.: S05790; 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)

OBSTETRIC HISTORY G (gravida) 4, P (para) 2, A (abortion) 2, S (still birth) 0, L (living) 2

PAST HISTORY Tinea palmarisapplied Betnovate

INVESTIGATION INITIAL SONOMAMMOGRAPHY REPORT (26/09/2011) Right breast shows an oval, hypoechoic, ill defined mass measuring 76 X 74 mms in lower outer quadrant at 6 0 clock position. 23 axillary lymph nodes are also seen.

RUBRICS FOR REPERTORISATION 1. Anger easily 2. Anger, talk indisposed to 3. Obstinate 4. Dictatorial 5. Egotism 6. Cowardice 7. Fastidious 8. Hurry tendency 9. Irresolute 10. Optimism 11. Anticipatory anxiety 12. Dreams of snakes 13. Abrupt 14. Censorious 15. Desire for spicy food 16. Desire for hot food 17. Desire for indigestible things

RESULT OF REPERTORISATION REMEDIES TOTALITY SYMPTOMS COVERED MEDICINE SELECTED Lycopodium JUSTIFICATION OF PRESCRIPTION Anger easily Dictatorial Egotism Cowardice Anticipatory anxiety Abrupt Desire for hot food Thermals: Hot patient LYCO 24 13/15 NUX V 24 13/15 SULPH 22 12/15 SIL 20 12/15

DATEWISE FOLLOWUP: (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. 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.

ULTRASONOGRAPHIC REPORTS AT A GLANCE Initial USG (26/9/2011) Right breast shows an oval, hypoechoic, ill defined mass measuring 76 X 74 mms in lower outer quadrant at 6 0 clock position. 23 axillary lymph nodes are also seen. Followup 1 (23/1/2012) Sonomammography of right breast revealed normal breast with no evidence of fibroadenoma

CASE3: REGN. No.: B00470; 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.

OBSTETRIC HISTORY

G (gravida) 3,

P (para) 2,

A (abortion) 1,

S (still birth) 0,

L (living) 2

PAST HISTORY Surgery for Fibroadenoma right breast in 1996 Tubectomy in 1994

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

TREATMENT HISTORY PrimolutN, Menoflav, Carvic, Novan DS, Ergitop, Trapic, Morglen Q.

INVESTIGATION INITIAL SONOMAMMOGRAPHY REPORT (09/11/2009) Two hypoechoic masses of 11 X 11 mms and 20 X 9 mms in supero lateral quadrant of right breast.

RUBRICS FOR REPERTORISATION 1. Shrieking in anger 2. Mildness 3. Timidity

4. Yielding disposition 5. Sentimental 6. Weeping easily 7. Fear of narrow places 8. Sympathetic 9. Offended easily 10. Brooding 11. Irresolute 12. Nervousness 13. Cautious 14. Desire for open air 15. Affectionate 16. Perspiration scanty 17. Anger easily 18. Coldness of palms 19. Cold aggravates

RESULT OF REPERTORISATION REMEDIES TOTALITY SYMPTOMS COVERED MEDICINE SELECTED Pulsatilla JUSTIFICATION OF PRESCRIPTION Mildness Timidity Yielding disposition Weeping easily Nervousness Desire for open air Affectionate Thermals: Hot patient NUX V 32 18/19 NAT M 28 18/19 SEPIA 27 18/19 PULS 40 17/19

DATEWISE FOLLOWUP: (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: 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.

ULTRASONOGRAPHIC REPORTS AT A GLANCE Initial USG (09/11/2009) Two hypoechoic masses of 11 X 11 mms and 20 X 9 mms in superolateral quadrant of right breast. Followup 1 (21/2/2010) 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 (Table8). The period of treatment varied from case to case depending upon size, type and number of breast lesions. TABLE8 STATUS OF BREAST LESIONS PATIENTS AFTER HOMOEOPATHIC TREATMENT (Total number of cases: 135) S.N. 1. 1(a). 1(b). 2. 3. Status of Patient Positive response Complete resolution Significant Improvement Number 73 24 49 30 32 Percentage 54.08 17.78 36.30 22.22 23.70

Status Quo (as such) Not Improved

BREAKUP OF VARIOUS BREAST DISEASE CASES REGISTERED AT GCCHR (Period February 1996 December 2011) (Total number of cases: 135)
54.08 % POSITIVE RESPONSE 73 17.78 % 24 36.30 % IMPROVED 49 22.22 % 30 23.70 % 32 0 20 40 60 80

TOTAL RESOLUTION

STATUS QUO

NOT IMPROVED

2. Cases of post surgical recurrence can also be treated effectively (Table9). TABLE9 STATUS OF CASES OF POSTSURGICAL RECURRENCE (Total number of cases: 12) S.N. Category Number Resolved Improved Not Improved

1. 2.

Unilateral Bilateral

5 7

1 0

3 4

1 3

CASES OF POST SURGICAL RECURRENCE (Period February 1996 December 2011) (Total number of cases: 12)
8 7 6 5 4 3 2 1 0 UNILATERAL (5) BILATERAL (7)

Total Cases (7)

Total Cases (5) Improved (4) Improved (3) Not Improved (3)

Resolved (1)

Not Improved (1) Resolved (0)

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(Table10). TABLE10 DRUGWISE RESPONSE IN PATIENTS (Total number of cases: 135) S.N. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. MEDICINES Calcarea carbonica Natrum muriaticum Pulsatilla Silicea Lycopodium Phosphorus Arsenicum album Sulphur Tuberculinum Sepia Carcinosin Lachesis NO. OF PATIENTS 35 32 22 13 12 7 5 3 2 2 1 1 135 STATUS IMP. S.Q. 15 14 7 6 4 1 2 0 0 0 0 0 49 6 9 7 3 1 2 1 0 0 1 0 0 30

CURED 4 3 5 2 3 2 1 2 2 0 0 0 24

N.IMP. 10 6 3 2 4 2 1 1 0 1 1 1 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. Todays modern and hectic life style, social pressure and various psychosocial factors like worry, anxiety and stress are known to cause hormonal imbalance through Psychoneurohormonal 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 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 postsurgical 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 midstudy 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. 3. Chaudhuri S. K., Concise Medical Physiology, 1988 (1st edition), Reprint 1989, Development of breast, pp. 337 338. 4. Samson Wrights Applied Physiology, revised by Keele, Cyril A. and Neil Eric, 12th edition, Oxford University Press, New York 1971, The mammary glands, pp. 554 556. 5. Govan, Alasdair D. T., Macfarlane Peter S., Callandar Robin, Pathology Illustrated, IInd edition, Churchill Livingstone, Edinburgh, London, Melbourne and New York 1986, Genito urinary system: Diseases of Breast, Reprint 1987, pp. 712 718. 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. 9. DeMay, M. Practical Principles of Cytopathology (Revised ed.). ASCP Press. pp. 2007. ISBN0-89189-549-3. 10. Pathology Outlines Website. [1] Accessed 12 February 2009. 11. Rosen, P.P. Rosen's Breast Pathology (3rd ed.). ISBN978-0-7817-7137-5. 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): 12941301. 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.