Breast Cancer: Insights from Western and Chinese Medicine

Understanding Breast Cancer in Western Medicine

Nature and Types of Breast Cancer
Most breast cancers are adenocarcinomas, meaning they originate in glandular (epithelial) tissues. The disease has many histological variants, each with its own prognosis. For example, inflammatory carcinomas (marked by redness, heat, and swelling) have a worse outlook, aligning with the Chinese medicine concept of “Toxic Heat.” Poorly differentiated cancer cells and lymph node involvement also signal a poorer prognosis.

Who Is Affected?
Breast cancer most commonly strikes women between the ages of 35 and 55, with incidence peaking around 60 before declining. About 1% of cases occur in men.

Key Symptoms and Signs

·       Painless lump: Most common early sign—usually firm, with ill-defined margins.

·       Other signs: Skin dimpling, breast deformity, “orange-peel” skin, hot/swollen/painful breast, axillary (armpit) lumps, nipple discharge.

·       Later stages: Ulceration, pus/blood discharge, and spread to lymph nodes or distant organs.

Staging and Prognosis
Breast cancer is classified into four stages:

·       Stage I: Tumor <2cm, no lymph node involvement (75% 5-year survival).

·       Stage II: Tumor 2–5cm, some lymph node enlargement, no metastasis.

·       Stage III: Tumor >5cm, skin changes, ulceration, fixed to chest wall, enlarged lymph nodes.

·       Stage IV: Tumor invades skin/chest wall, lymph nodes enlarged, metastasis present (15% 5-year survival).

Metastasis
Common sites include bones, lungs, liver, and brain. Liver involvement is particularly serious.

Risk Factors

·       Diet: High-fat diets (especially milk) may increase risk.

·       Menstrual history: Early menarche, late menopause, and more menstrual cycles.

·       Lifestyle: Use of contraceptive pills (controversial).

·       Other: Family history, hormonal factors, and environmental influences.

Differential Diagnosis

·       Fibrocystic disease (cystic mastitis): Benign, cyclical, often worse in winter/spring.

·       Fibroadenoma: Benign, common in young women, mobile, painless.

·       Papilloma: Causes nipple discharge, can be precancerous.

Breast Cancer in Chinese Medicine

Historical Perspective
Traditional Chinese medicine (TCM) did not distinguish between benign and malignant lumps but recognized some as severe and hard to treat. Terms like ru yan (breast cancer) and ru shi yang (breast stone carbuncle) described hard, immovable lumps.

Aetiology (Causes)

·       Emotional factors: Worry, sadness, anger, and repressed emotions cause Qi stagnation, leading to Blood stasis and eventually masses.

·       Disharmony of Chong and Ren vessels: Imbalance after menopause, with Qi rebelling upwards.

·       Diet: Excessive dairy, fats, and sweets lead to Phlegm formation.

·       Overwork: Weakens Liver and Kidney Yin, contributing to stagnation.

Pathology

·       Stage 1: Qi stagnation, Blood stasis, Phlegm accumulation, underlying Spleen deficiency.

·       Stage 2: Stagnation leads to Fire and Toxic Heat, injuring Yin and causing deficiency.

·       Stage 3: Strong pathogenic factors with extreme deficiency, making treatment difficult.

Diagnosis

·       Palpation: Soft lump = Phlegm; hard lump = Blood stasis/Toxic Heat.

·       Skin changes: Redness = Fire/Toxic Heat; whiteness = Phlegm; purple = Blood stasis.

·       Nipple discharge: Toxic Heat injuring Blood Luo channels.

Channels Involved

·       Stomach channel: Runs over the breast.

·       Liver channel: Influences the nipple.

·       Penetrating (Chong) vessel: Connects uterus and breast, crucial in hormonal regulation.

Patterns and Treatment Principles

·       Liver-Qi stagnation: Soothe Liver, move Blood, dissolve knottedness.

·       Spleen-Yang deficiency with Phlegm: Warm Yang, strengthen Spleen, resolve Phlegm.

·       Chong and Ren disharmony: Regulate and nourish these vessels.

·       Liver-Qi stagnation turning to Fire: Clear Liver, eliminate stagnation, resolve Phlegm and Poison.

·       Toxic Heat: Drain Fire, resolve Poison, move Qi and Blood.

·       Liver and Kidney Yin deficiency: Nourish Liver and Kidneys, tonify Qi and Blood.

After Surgery
Focus on tonifying Qi, Blood, or Yin, and regulating Chong and Ren. Use pulse and tongue diagnosis to guide treatment.

Managing Side Effects of Chemo/Radiotherapy

·       Chemotherapy: Tonify Qi and Blood, resolve Dampness.

·       Radiotherapy: Nourish Blood and Yin, cool and move Blood to prevent fibrosis.

·       Digestive issues: Use formulas to harmonize Stomach and Spleen.

·       Skin issues: Clear Heat, resolve Poison, nourish Yin.

Prevention

·       Risk groups: Women at menopause, on HRT, nulliparous, or with emotional stagnation.

·       Preventive measures: Emotional management, acupuncture, diet low in dairy and fats, herbal formulas to move Qi and resolve Phlegm.

Acupuncture Points

·       Regulate Chong and Ren: LU-7 Lieque + KI-6 Zhaohai; SP-4 Gongsun + P-6 Neiguan.

·       Breast points: G.B.-21 Jianjing, LIV-14 Qimen, LIV-3 Taichong, G.B.-41 Zulinqi, ST-18 Rugen.

·       Nourish Blood and tonify Chong/Ren: Ren-4 Guanyuan, KI-13 Qixue.

·       Calm Mind and settle Hun/Po: Ren-15 Jiuwei, P-7 Daling, P-6 Neiguan, BL-23 Shenshu, BL-52 Zhishi.

Tongue Diagnosis and Prognosis

·       Purple color in chest area: Poor prognosis.

·       Red points with sticky-yellow coating: Toxic Heat.

·       Sudden loss of coating: Possible metastasis.

Energetic Levels and Metastasis
Breast cancer starts between skin and membranes (connective tissue), often metastasizing first to bones (Kidney level), then to deeper organs like liver or lungs. Nourishing the Kidneys and bones is crucial for prevention.

Final Thoughts

Breast cancer is a complex disease requiring a multifaceted approach. Integrating Western medical understanding with TCM principles offers a comprehensive strategy for diagnosis, treatment, and prevention. Addressing emotional health, diet, and lifestyle, alongside medical and herbal interventions, can improve outcomes and quality of life for those affected.

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