Breast mastopathy: symptoms, signs and treatment in an article by mammologist M. E. Provotorov.

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Treatment of fibrocystic mastopathy

To ensure that the symptoms of the disease are relieved, it is advisable to conduct a competent diagnosis and consult a doctor. An integrated approach is used to treat this disease, including changes in diet, the use of comfortable underwear, the use of vitamins, anti-inflammatory and sedatives, and in some cases the use of hormonal and homeopathic medications.

Nutrition correction

It is advisable to completely eliminate products that can affect the formation of fibrous tissue and the appearance of fluid in the structure of the cyst. Doctors often recommend giving up coffee completely and limiting the consumption of tea, chocolate, and sweets. Many experts believe that any pathology of the mammary glands occurs as a secondary phenomenon after the formation of disorders in the intestines. It is advisable to completely eliminate constipation and normalize the bacterial flora.

If you have been diagnosed with mastopathy, it is advisable to eat foods that contain the maximum amount of fiber. Eat vegetables and fruits, greens daily. Drink enough water. Get rid of bad habits, in particular, drinking alcoholic beverages.

Pathogenesis.

The mammary glands of women, due to their physiological characteristics, are in a state of constant change in the processes of proliferation and involution associated with the phases of the menstrual cycle and the corresponding different levels of sex hormones. The processes of proliferation of the mammary glands are influenced by progesterone and estrogens, as well as gonadotropic hormones of the anterior pituitary gland, and primarily follicle-stimulating hormone (FSH).

When studying the hormonal status of women with various forms of fibrocystic mastopathy, as a rule, the following are revealed:

absolute or relative gestagenic insufficiency
absolute or relative hyperestrogenism
changes in the level of gonadotropins, violation of the FSH/LH ratio

During pregnancy, the processes of mammary gland hyperplasia are greatly influenced by hormones produced by the placenta.

The activity of the endocrine glands, which influence the processes of physiological proliferation of the mammary gland epithelium, is regulated by the diencephalic-pituitary system and the cerebral cortex. During the life of women, a large number of various harmful effects are encountered that disrupt this harmonious neurohumoral regulation (abortion, inflammatory diseases of the genital organs, functional and organic diseases of the nervous system, etc.) and leading to the development of dishormonal disorders, sharp fluctuations in hormonal balance, changes in the secretion of genital and gonadotropic hormones. Disturbances in hormonal balance cause hormonal changes in the mammary glands, which in some cases does not go beyond physiological options, and in others, subject to activation of the receptor apparatus of the glands, can turn into a pathological process. These reasons contribute to the development of follicular cysts, persistent follicles in the ovaries, the development of anovulatory cycles, and hormonal imbalance, primarily towards hyperestrogenization. under the influence of hormonal changes, the processes of physiological evolution and involution in the mammary glands are disrupted, and foci of pathological proliferation of the epithelium develop. Summed up over many years, these changes lead to the development of mastopathy, and in some cases, malignancy develops against their background. The connection between the risk of developing mastopathy and breast cancer with exposure to exogenous estrogens used in the form of oral contraceptives is currently being studied quite widely.

There is convincing evidence of a combination of changes in thyroid function with a sharp decrease in the level of corpus luteum hormones. There is an understanding of the influence of thyroid function on both the thyroid-stimulating function and the luteinizing function of the pituitary gland. In this regard, in some patients with mastopathy, a change in the state of the thyroid-stimulating function of the pituitary gland can cause inhibition of the secretion of luteinizing hormone and disruption of the ovarian cycle, which results in the occurrence of pathological dishormonal processes in the mammary glands. It follows that the use of microdoses of potassium iodide to stimulate the secretion of luteinizing hormone seems to be a rational means for treating patients with mastopathy in a complex of measures such as the treatment of functional and autonomic neuroses, concomitant gynecological diseases, along with advice on a normal sex life, the need to end pregnancy with childbirth and feeding chest.

The liver plays a major role in hormonal metabolism. Despite a number of unclear issues, clinical observations and experimental studies have confirmed the fact that liver dysfunction is accompanied by changes in hormonal balance. The changes that occur in the mammary glands may be associated with hyperestrogenization caused by impaired estrogen inactivation in various liver diseases.

Thus, atypical proliferative changes in the mammary glands may depend on a combination of various factors:

Concomitant or previous diseases of the genitals;
Adverse reproductive factors;
Liver diseases;
Thyroid dysfunction;
Long-term, severe psychotraumatic situations.

Prevention and possible complications

Compliance with preventive measures reduces the risk of the disease and promotes a speedy recovery if it occurs. These include: giving up bad habits, avoiding stressful situations, choosing the right underwear, maintaining an active lifestyle, reducing salt consumption, timely treatment of diseases of the pelvic organs.

It is important to competently select hormonal contraceptives and regularly visit an oncologist and mammologist (at least once a year). Breastfeeding a child for more than 6 months reduces the risk of developing cancer by 2 times.

All women, including healthy ones, need to learn how to check their mammary glands on their own. This advice is especially relevant in the periclimacteric period (after the age of 45). This is done by visually examining the breast in the mirror and feeling it while lying down and standing. If any abnormal lump is detected, you should consult a doctor.

Despite the benign course, fibrocystic changes are a favorable background for the development of malignant diseases. With active proliferation (growth) of affected cells, the risk of cancer is 32%. With less activity of the pathological process, the risk decreases to 1%.

What it is?

Fibrocystic mastopathy is a violation of the ratio of the connective and epithelial components of breast tissue, accompanied by changes of a proliferative and regressive nature.

It is customary to distinguish two forms of the disease:

Non-proliferative form. With this form of the disease, cysts of different sizes form inside the breast: from a few millimeters to several centimeters. At the initial stage of development of the disease, the formation of structures resembling bunches of grapes occurs. As the pathology progresses, the process of increased collagen production begins, which leads to the compaction of connective tissue, its proliferation and the formation of scars. As a result, the lobules that represent the mammary gland stretch and cysts form inside them. The non-proliferative form of the disease does not carry a high risk of malignancy of the pathological process. It is no more than 0.86%.
The proliferative form is characterized by the launch of the proliferation process, that is, the growth of epithelial and connective tissue through cell division. With proliferation of moderate severity, the risk of degeneration of the pathological process into malignant is 2.34%. With a pronounced degree of proliferation, these values increase to 31.4%.

If we look at the statistics of the disease in general, there is a tendency towards an increase in pathology among women all over the world. During reproductive age, the disease affects on average up to 40% of women. If you have a history of multiple gynecological diseases, then the risk of encountering mastopathy ranges from 70 to 98%.

The high-risk group includes women who suffer from hyperplastic pathologies of the genital organs. During menopause, diffuse fibrocystic mastopathy is less common. Up to 20% of women suffer from it. After menopause occurs, new cystic formations most often do not appear. This statistical fact is also further evidence of the direct involvement of hormones in the development of the disease.

Diagnostics

Considering the technical capabilities of diagnostic medicine, identifying diffuse cystic mastopathy is not difficult. All middle-aged women must undergo screening or preventive examination. From the age of 35, breast ultrasound is performed once a year; from the age of 40, X-ray mammography is prescribed once a year.

If a woman has signs of diffuse fibrocystic mastopathy, then diagnostic testing methods are prescribed by the doctor. Possible options:

Consultation with an endocrinologist and oncologist.
Anamnesis collection ─ general data, complaints, family history.
Breast examination, palpation.
Examination for gynecological diseases, taking smears.
Ductography is an X-ray examination of the milk ducts using a contrast agent.
Ultrasound examination, which evaluates benign and malignant formations with high accuracy.
Biopsy of a lump or cyst ─ histological examination of the tissues of the formation.
X-ray mammography is a study with a low radiation dose and minimal stress on the body.
MRI (magnetic resonance imaging) with contrast.
Blood tests for hormones: TSH, fT4, LH, FSH, prolactin, estradiol, progesterone.
Ultrasound of the thyroid gland and adrenal glands.
Microscopic examination of nipple discharge

There is no degeneration of diffuse fibrocystic mastopathy into cancer. The danger is that the disease prevents timely recognition of the presence of a malignant process in the breast.

Why is mastopathy dangerous?

Diffuse fibrocystic pathology (FCM) is a benign process that is characterized by abnormal development of mammary gland tissue. Some types of cells actively multiply (that is, proliferation occurs), others regress - as a result, the ratio of the connective tissue component and the actual active secretory tissue changes.

Despite the declared benignity of fibrocystic changes, mastopathy is a favorable background for the development of malignant oncological diseases, and therefore is classified as a precancerous condition. With active proliferation of cells in the affected gland, the risk of cancer reaches 32%. With less activity of the pathological process, the risk is reduced to 1%, but this indicator cannot be neglected.

The vast majority of cases of diagnosis of fibrocystic pathology occur in women of childbearing age whose mammary glands are active. During perimenopause, significantly fewer such pathologies are observed. Women pay almost no attention to the primary signs of the disease, since they are not expressed by serious pain and are perceived as temporary discomfort. However, with age, the disease progresses and can lead to dangerous consequences.

Diagnosis of mastopathy - forms of diagnosis

— DFCM SF – mixed form of diffuse FCM

— DFCM GC – diffuse FCM with a predominance of the glandular component

— DFCM CC – diffuse FCM with a predominance of the cystic component

— Nodular and diffuse nodular mastopathy

— Fibroadenoma

According to statistics, women with this pathology are almost 5 times more likely to develop breast cancer, so the problem of diagnosing and treating mastopathy is currently very relevant.

Treatment with folk remedies

Mastopathy is a disease known since ancient times, so there are a lot of folk recipes. But it is important to remember that this method can only cure the disease in the early stages of its development and taking into account the doctor’s recommendations.

Tinctures. Prepared using herbs that are infused with alcohol. You can prepare them yourself or buy them ready-made at the pharmacy:

alcohol tincture of boron uterus;
tincture of pine nut shells;
propolis tincture.

Decoctions. They help normalize hormonal levels, cope with tumors and get rid of associated inflammatory diseases occurring in the body. The herbs are infused in boiling water and taken orally. For the treatment of diffuse fibrocystic mastopathy, it is recommended to drink herbal decoctions:

burdock root;
boron uterus;
red brush to regulate the functioning of the thyroid gland;
yarrow;
chagi.

Lotions and compresses. Herbal compresses should be applied to the chest overnight for several weeks to achieve the following results:

burdock leaf compress;
cabbage compress with honey;
flatbread made from rye flour;
pumpkin compress;
compress of grated beets and honey.

The use of traditional methods for the treatment of fibrocystic mastopathy should also be carried out under the supervision of the attending physician. Herbal medicine implies the ability to prepare decoctions from several herbs at once or use ready-made mixtures that can be purchased at a pharmacy.

Terminology and classification of mastopathy

In the literature you can find many terms denoting various forms and stages of dyshormonal hyperplasia: “mastalgia”, “masoplasia”, “mastodynia”, “Mintz disease”, “fibroadenomatosis”, “mastopathy”, etc. In this regard, it is advisable to use the International Histological classification of breast tumors.

It is clinically convenient to distinguish two forms of mastopathy: diffuse and nodular. This division of the disease is convenient, since it determines the therapeutic tactics of the doctor.

Diffuse mastopathy

Diffuse mastopathy is clinically manifested by painful swelling of the mammary glands (mastodynia), which can intensify in the 2nd phase of the cycle, discharge from the nipples (serous, dirty greenish, etc.). When palpating the mammary glands, rough lobulation, heaviness and fine granularity are determined, expressed in one or both mammary glands. Pain and lumps in the mammary glands and discharge from the nipples with diffuse mastopathy are not constant and can periodically increase and decrease, especially after the onset of menstruation. This form occurs more often in young, menstruating women.

Nodular mastopathy

Nodular mastopathy is the next stage of the disease. It is characterized by the appearance of permanent foci of compaction in one or both mammary glands, and these compactions can be single or multiple. In addition to these seals, signs of diffuse mastopathy remain: rough lobulation, granularity, heaviness, discharge from the nipples. Symptoms such as “umbilification”, “lemon peel”, thickening of the areola fold, nipple retraction are absent with fibrocystic mastopathy, regional lymph nodes should not be enlarged.

The division of mastopathy into diffuse and nodular forms is convenient for clinicians, however, morphologically, in benign dysplasia, two main forms are distinguished: non-proliferative and proliferative. Facultative precancer includes proliferative forms of mastopathy with hyperplastic growths of the epithelium and dysplasia.

Early detection of pathological changes in the mammary gland has been the goal of breast cancer screening programs carried out in a number of countries since 1970. The ability of mammography to detect very small tumors (less than 1 cm) earlier than during examination is not in question the effectiveness of this method. Great hopes are placed on ultrasound of the mammary glands, especially in women under 30 years of age. It is also necessary to promote breast self-examination in women of all age groups.

Tactics and methods of treatment

Some forms of mastopathy do not require treatment, they just need to be monitored. If the disease progresses, then conservative treatment is prescribed. It is necessary to treat not mastopathy itself, but to eliminate its causes: inflammation of the female genital organs, endocrine pathologies, liver diseases.

For the conservative treatment of diffuse mastopathy, hormonal drugs that normalize the balance are prescribed (as a rule, with mastopathy, an excess of estrogen and a deficiency of progesterone) and drugs that normalize metabolism are prescribed. vitamin and mineral complexes.

For nodular mastopathy, conservative treatment is ineffective. Cysts, fibroids, and large fibroadenomas are removed surgically. Many operations are performed using a minimally invasive method through mini-punctures.