Experience with Homoeopathy in a case of Fibroadenoma of Breast

Dr Rekha Thomas MD (Hom)

Reader, Deptt. of Obstetrics & Gynaecology, Nehru Homoeopathic Medical College &
Hospital, Govt of NCT of Delhi. Email: drrekhathomas@gmail.com


Abstract
Fibroadenoma is one of the most common benign tumours of the female breast,
which presents in young women as a mobile lump. A 31 years old female presented
with painful lump in the left breast at OPD of Nehru Homoeopathic Medical College
& Hospital. FNAC confirmed the diagnosis of fibro adenoma. Calcarea carbonica was
prescribed in centesimal potency on the basis of totality of symptoms and the lump
disappeared in one year and two months which was confirmed by mammography.


Key words
Fibroadenoma, Homoeopathy, Calcarea carb


Introduction
Fibroadenoma is a most common benign fibro epithelial tumour characterized by
proliferation of both glandular and stromal elements of the breast. They are
assumed to be aberrations of normal breast development or the product of
hyperplastic processes rather than true neoplasms. They may develop at any age
but more common in young women in the age-group of 15-30 years.

Histo-pathologically, we identify two varieties of fibroadenoma pericanalicular and
intracanalicular. The former variety consists of fibrous tissue surrounding a few
small tubular glands. Clinically this variety of fibroadenoma is smaller in size,
harder in consistency and occurs mostly in young girls aged between 15 and 30
years. Intracanalicular fibroadenoma contains more glands which become stretched
into elongated spidery shapes and become indented by fibrous tissue. This type of
Fibroadenoma is larger in size, comparatively softer on palpation and is commonly
seen in middle aged women between 35 and 50 years.

The exact cause of fibroadenoma of breast is unknown. However, it is believed to
be estrogen dependent. Risk factors for fibroadenoma were examined in a case-
control study involving 117 fibroadenoma cases ascertained by a major private
pathology laboratory in Adelaide, Australia, between January 1983 and October
1985, but no evidence of an association with age at menarche or menopausal
status was established (1).

The risk of fibroadenoma decreases with an increasing number of full-term
pregnancies and increases with use of oral contraceptives at an early age (<20
years). Alcohol consumption and dietary fat intake were not found to be associated
with increased risk, while in multivariate analyses, duration of cigarette smoking
and daily vitamin C intake were both shown to have inverse associations. (1)

Although fibroadenoma does share some risk factors with breast cancer, there is
insufficient evidence to suggest that it represents a precursor state. A study
demonstrated a 1.3 to 2.1 increased risk of breast cancer in women with
fibroadenoma compared with the general population. The incidence of a carcinoma
evolving within a fibroadenoma was reported to be 0.002% to 0.0125%. (1)

The lumps of fibroadenoma are painless, freely mobile within the breast, firm in
consistency with round smooth margins and more commonly found in the lower half
of the breast. Pain may be occasionally complained of when there is associated
fibroadenosis or fibrocystic disease. Multiple fibroadenomas may be seen in 10%of
cases.

Currently, the accurate diagnosis of breast lesions depends on a triple assessment
approach comprising clinical, imaging and pathological examinations.(2)
1. Clinical palpation
2. Mammography-The yield of mammography in young women is low, and its role
in the diagnosis of fibroadenomas is limited. However, it may disclose features of
infiltrative lesions in older women
3. Ultrasonography-Useful in all age groups especially before the age of 35 when
mammography alone may not be reliable. Sensitivity of USG in the diagnosis of
fibroadenoma is expected to be more than 80%.
4. Doppler Ultrasonography- Displays the vascular pattern of a tumour and
indicates the probability of a malignancy.
5. FNAC To differentiate benign from malignant lesions is one of the major goals of
FNAC, which shows a high sensitivity of up to 68-97% in fibroadenomas
The preferred management of multiple fibroadenomas is complete excision.
However, after its removal, recurrence is quite common. It has been recommended
that young patients should be observed with frequent clinical evaluations, and the
lesions excised in women over the age of 35 years. If multiple fibroadenomas are
excised through one incision, it may lead to undesirable scarring or to extensive
ductal damage. (3)
Homoeopathy, on the other hand does not consider fibroadenoma as a surgical
disease. Since most cases of fibroadenoma are asymptomatic presenting with no
other symptoms barring lump and occasional pain, they need to be treated as one
sided diseases. Hahnemann has mentioned such clinical conditions in aphorisms
172- 184 of Organon of Medicine.(4) Since they chiefly belong to the category of
chronic diseases, they need to be thoroughly investigated (detailed case taking)
and suitable anti-miasmatic treatment administered in order to eradicate the lump
as well as its tendency. A number of write-ups and case studies showing successful
homoeopathic treatment of fibroadenoma are available online. (5,6)

I share my experience in a case of solitary fibroadenoma of breast treated with a
single homoeopathic remedy.

Case study
A 31 years old fair complexioned female of average height and heavy built
presented on 1
st
December 2010 at OPD of Nehru Homoeopathic Medical College &
Hospital with a painful lump in left breast since 2 years. The pain aggravated before
and during menses. Allopathic treatment had provided temporary pain relief only.

She also complained of hair-fall in patches since 3 years.

Past illnesses
Since childhood she had a tendency for recurrent sore throat and coryza with a
sensation of obstruction in ear and nose.

Family history
Father: Hypertension

Personal history
Married for 9 years; G2P2A0L2
Diet: Non vegetarian
Profession: House wife
Education: 12
th
std.

Generals
Thirst: 1litre per day.
Desire: sweet++, sour, egg++
Perspiration: profuse; more on palms and soles; offensive
Sleep: 6 hours; not refreshing.
Thermal reaction: Chilly++; cold extremities

Mental Generals
Very anxious, especially about her health.
Fearful of her disease turning into a serious one.
Worries about the health of family members.
Always fears that something bad will happen to her and her family members.
Very sensitive.
Fears being alone in house.

Physical examination
A freely mobile lump of about 2.5 x 3cm was found in the upper inner quadrant of
left breast, which was slightly tender but firm in consistency.

Investigations undergone
FNAC report dated 20.5.10 confirmed fibroadenoma of breast (see below)



Repertorisation
The case was repertorised using Radar Homoeopathic software with the following
rubrics:
Mind- anxiety- health about
Mind-fear- happen something will
Stomach- desires- sweet
Stomach-desires- egg
Extremities- perspiration- foot
Extremities- perspiration- hand
Perspiration-odor -offensive
Chest- nodules, sensitive mammae, in

The result of repertorisation was:
Sulphur -15/6
Calcarea carb-14/6
Lycopodium-14/6
Phosphorus-14/6
Carbo veg 12/6
Arsenic 11/6

On referring to the homoeopathic materia medica, Calcarea carb was selected for
her.

Prescription & follow up

Date Observation Prescription
1.12.10 Painful lump in left breast Calcarea carb 200/1dose
Rubrum Met /3weeks
22.12.10 Pain in lump better. Size
same

S/L 200 /1 dose
Rubrum Met 30/BD/3weeks

23.03.11 Pain in lump better .Size of
lump has reduced
S/L 200 /1 dose
Rubrum Met 30/BD/3weeks
3.8.11 She complained of
reappearance of pain in
breasts
Calcarea carb 200/1dose
Rubrum Met 30/BD3weeks

23.11.11

pain in breast before and
during menses
Calcarea carb 1M/1dose
Rubrum Met 30/BD3weeks
11.2.12 Pain better
No lump in breast
Mammography on 11.2.12 reveals
Normal study (see below)
Rubrum met 30/3weeks.
Patient has been followed up for a period
of 2 years, during which she did not
show any recurrence.





Discussion
Generally diseases like fibroadenoma are considered to be surgical conditions.
However, a study of Organon of Medicine, which is the Bible of Homoeopathy,
especially footnote to 7 and 186, tells that surgical treatment is required only in
certain congenital conditions (viz. imperforate anus) or injuries to body from
without, wherein the affected parts require mechanical aid (viz. fractures,
lacerations).(7)

In the same book, a thorough study of 172 to 193 reveal that in one sided
diseases if we want the treatment to be judicious, sure, efficacious and radical the
treatment must be directed against the sick person, with accurately chosen internal
remedies.(4,7) And this shall not only do away with surgery, painful scars and
disfigurement but also prevent future recurrence.

As regards importance of repertorisation, I take the liberty of quoting Dr P. Schmidt
who said, No one can know everything and that is why one must admit that no
conscientious homoeopathic doctor can practice homoeopathy in a serious and
really scientific way without a repertory. In chronic cases of this nature which are
usually treated with surgery, repertorisation gives an idea about close running
remedies, helps to overcome bias and does away with the use of organ
remedies.(8)

A study of materia medica and repertory shows that Calcarea carb is well
represented and shows numerous symptomatology, which if indicated shall help in
the treatment of fibroadenomas. In the above mentioned case, the physical
constitution, mental makeup, a strong liking for eggs and profuse perspiration
strongly suggested the remedy.


Conclusion
To ascertain the most appropriate homoeopathic remedy in one sided diseases, it is
most important to understand the person as a whole who is suffering from the
disease.

As Paracelsus said, No knowledge is perfect unless it includes an understanding of
the origin, that is the beginning; and as all mans diseases originate in his
constitution, it is necessary that his constitution should be known if we wish to
know his disease.(9)


References
1. Yu H, Rohan TE, Cook MG, Miller AB. Riskfactors for fibroadenoma:a case-control
study in Australia. AmJ Epidemiol.1992 Feb1; 135(3); pp 247-58 as accessed at
http://aje.oxfordjournals.org/content/135/3/247 on 10.05.14
2. Rohan TE, Cook MG, Baron JA. Cigarette smoking and benign proliferative
epithelial disorders of the breast in women: a case-control study. Journal of
Epidemiology and Community Health; 1989. 43, pp 362-368 as accessed at
http://www.ncbi.nlm.nih.gov/pubmed/2614327 on 16.5.14
3. Greenberg R, Skornick Y, Kaplan O. Management of Breast fibroadenomas. J Gen
Intern Med. Sep 1998; 13(9); pp 640-645. as accessed at
www.ncbi.nlm.nih.gov/pubmed/9754521 on 10.05.14
4. Hahnemann S. Organon of Medicine, 5
th
& 6
th
edition combined. B Jain Publishers
(P) Ltd, Delhi. 2009; pp 173- 177
5. www.homoeoconsult.com/fibroadenoma as accessed on 24.07.2014
6. www.askdrshah.com/fibroadenoma as accessed on 24.07.2014
7. Hahnemann S. Organon of Medicine, 5
th
& 6
th
edition combined. B Jain
Publishers (P) Ltd, Delhi. 2009; pp 56, 177-181
8. Tiwari SK. Essentials of Repertorization,Fourth edition.B. Jain publishers (P) Ltd;
Delhi. 2005; pp 7
9. www.homeoint.org/books5/clarkeconstit/preface.htm as accessed on 26.07.2014