Mastopathy is pathological fibrocystic changes in breast tissue characterized by the appearance of dense, often painful fine–grained formations. They are concerned about swelling, tenderness of the gland, more pronounced before menstruation, serous, sometimes bloody discharge from the nipple. Has a tendency to relapse, is a cancer risk factor. Diagnosis of mastopathy requires mammography, breast ultrasound, if necessary – diaphanoscopy, MRI of the mammary glands, pneumocystography, puncture biopsy. Treatment of mastopathy is carried out by conservative methods. If there is a danger of malignancy of nodular mastopathy, surgical removal of the node is carried out.
Mastopathy is a concept that combines a group of diseases of the mammary glands characterized by the development of pathological changes in the gland tissue with a violation of the ratio of epithelial and connective tissue components. According to the WHO nosological classification of 1984, mastopathy is understood as fibrocystic breast disease. The incidence of mastopathy of various etiologies in young women ranges from 30-45% and increases markedly after 40-45 years.
Mastopathy is a benign change in the gland tissue, which has a direct dependence on neurohumoral regulation. This means that the factors of mastopathy development are both pathologies associated with disorders of the state of nervous regulation (stress, neurosis, depression), and disorders of hormonal balance and internal homeostasis of the body.
There is currently no complete understanding of the causes and mechanisms of the development of mastopathy, but there is every reason to assert that hormonal status plays a significant role in the occurrence of this disease. Factors contributing to the development of mastopathy: early menopause, menstrual cycle disorders (hormonal dysfunctions, polycystic ovary syndrome, improper use of hormonal contraceptives), prolonged absence of childbirth, numerous (more than three) abortions of pregnancy, irregular sex life (or lack thereof), diseases of the genitals, lactation for less than three months, endocrine pathologies (hypo– and hyperthyroidism, violation of the functions of hypothalamic and pituitary regulation, the work of the adrenal glands, liver, pancreas), hereditary predisposition.
There is an assumption that the most significant pathogenetic factor in the development of mastopathy is progesterone deficiency with an excess of estrogens. At the same time, there is an increase in the proliferation (reproduction) of epithelial cells and connective tissue cellular elements. In addition, prolactin production plays a significant role in the pathogenesis of mastopathy. Prolactinemia increases the sensitivity of breast tissues to estrogens.
The most common classification of mastopathy in clinical practice distinguishes three forms: mastalgia (mastoplasia or mastodynia), diffuse fibroadenomatosis and localized fibroadenomatosis. Mastalgia is characterized by a predominance of severe pain syndrome and is an indication for the appointment of analgesics.
Diffuse adenomatosis is the development of diffuse seals and cysts in the gland tissue. It is divided into two types: fibrous mastopathy, when connective tissue seals are mainly formed in the gland tissue, and fibrocystic mastopathy, if cysts (cavities filled with fluid) form in the gland in addition to foci of fibrosis.
With localized fibroadenomatosis, pathological changes are detected in a limited area of the gland (segment, quadrant) and do not spread throughout the parenchyma of the organ. The detection of a localized formation in the mammary gland is an indication for a biopsy to exclude a malignant tumor.
The most characteristic symptom of mastopathy is the detection of a seal in the mammary gland during palpation. Often, this seal can be painful, the pain usually increases in the second phase of the menstrual cycle and immediately before menstruation. The seal may be single, several nodules may be detected, the entire gland may feel compacted. Mastopathy is characterized by the defeat of both glands, mainly their upper parts.
The predominance of the fibrous component is detected by touch as a seal, cystic changes in the first stages may not be detected at all during palpation (microcysts of the ducts). Pain in the mammary glands, as a rule, has a dull, aching or dragging character. Its occurrence is associated with compression of nerve endings in glandular tissue by fibrous growths, as well as their partial sclerosis. The intensity of the pain syndrome depends on the severity of the pathology, most often the occurrence and intensification of pain is associated with the menstrual cycle (before menstruation at the peak of estrogen production, the pain increases). Sometimes there is an irradiation of pain in the shoulder blade, arm.
10-15% of women have no complaints of soreness, although pathological changes of a significant degree of severity are found on examination. This is associated with different levels of pain sensitivity in women and individual branching of the nervous system of the mammary glands. About 10% of mastopathies are accompanied by an increase in lymph nodes in the armpits. Sometimes palpation of lymph nodes is moderately painful.
Breast enlargement in volume, their periodic swelling (in the second period of the menstrual cycle) is associated with the formation of venous congestion in the vascular network of the glands and swelling of connective tissue. The glands can increase by 15%. At the same time, a feeling of discomfort and soreness during palpation (increased breast sensitivity) is characteristic. The combination of these signs is called premenstrual syndrome.
Sometimes there are discharge from the nipples of varying degrees of profusion and of a different nature. They can be detected only when pressing on the nipple, and can be quite pronounced. In consistency, as a rule, the discharge is transparent or whitish, may have a greenish, reddish-brown color. The greatest danger is bloody discharge, since it can be a sign of the development of a malignant process. The appearance of any discharge from the nipples, regardless of their nature, is the reason for contacting a mammologist.
You also need to pay attention to the detection of a node (or several). Palpation of a dense limited nodular formation may be a sign of localized nodular mastopathy, or it may turn out to be developing breast cancer. When detecting nodes that are suspicious from the point of view of malignancy in the mammary gland, their biopsy is always prescribed.
One of the most significant elements of timely detection of pathologies and neoplasms in the mammary glands is self-examination (independent palpation of the mammary glands). To identify formations, determine their shape, size, quantity, as well as to identify diffuse pathological changes in the gland tissue, instrumental diagnostic methods are used.
Mammography is an X-ray examination of the mammary glands. Mammography is optimally performed in the first phase of the menstrual cycle. A breast shot is taken in two projections: frontal and lateral. This study is one of the most informative and specific. With ambiguous mammography results, it is supplemented with digital tomosynthesis.
In addition, breast ultrasound is currently used. As a rule, fibrocystic changes in the gland tissue affect the echogenicity of its structures and can be detected and studied quite qualitatively using this technique.
MRI of the breast marks the zones of increase and decrease in the temperature of the gland tissues. The method of diaphanoscopy consists in screening the mammary gland with a light source. In this case, the neoplasm in its thickness will be marked as a darker spot. Ductography is used to study the system of milky ducts. A contrast agent is injected into the mammary gland through the nipple, after which radiography is performed. The image visualizes the ductal system, areas of deficiency of filling with contrast agent may be signs of neoplasms. Pneumocystography is performed under the control of ultrasound. Air is injected into the cyst cavity using a thin needle, which allows you to straighten the walls and carefully examine them for wall formations.
When a nodular formation is detected, a breast biopsy is performed – extraction by puncturing a tissue sample with a thin needle for histological examination. To identify the etiological factors of mastopathy, hormonal status research methods are used. Colposcopy and cytological examination of the cells of the vaginal epithelium allows us to conclude about the total hormonal background, since the shape and structure of cells directly depend on the action of sex hormones.
They directly determine the content of hormones in the blood: progesterone and estrogens, follicle-stimulating, luteinizing hormones, as well as thyroid hormones and thyroid-stimulating hormone, adrenal hormones. Sometimes a test is performed for the presence of autoantibodies to thyroid cells to detect autoimmune thyroiditis.
To determine the overall hormonal state of the body, studies of the endocrine system organs are carried out to identify possible pathologies (ultrasound of the thyroid gland, adrenal glands, liver, pancreas; radiography of the Turkish saddle, CT of the pituitary gland). To exclude immune and metabolic pathologies, an immunogram is made and a biochemical blood test is performed.
Correction of the hormonal balance of the body plays a significant role in the treatment of mastopathy. When choosing treatment tactics, consultation of a gynecologist and an endocrinologist is necessary. These specialists jointly perform a thorough analysis of the endocrine system and prescribe drugs corresponding to the identified pathologies.
With severe estrogenism (and significant soreness), drugs that reduce the effect of these hormones on the mammary gland (tamoxifen, toremifene citrate) can be prescribed. To normalize the menstrual cycle, oral contraceptives are used (chosen in accordance with the hormonal status). For the treatment of functional disorders of the thyroid gland, agents regulating the production of thyroid hormones are used. Vitamin complexes help to improve liver function and normalize metabolic processes.
Among other things, local progesterone preparations are used (they act directly on the gland tissue, helping to reduce the proliferation of connective tissue and epithelial cells, relieving swelling), homeopathic remedies. Patients suffering from mastopathy are recommended to limit the use of coffee and strong tea, give up smoking, enrich the diet with fruits, vegetables, foods with a high content of fiber and vitamins. If a malignant formation is suspected, surgical removal of the node is performed, in other cases they are limited to conservative treatment.
As a rule, mastopathy is not prone to complications and malignancy. With proper correction of the hormonal state, the prognosis is positive, but hormonal failures can provoke relapses.
Many factors contributing to the development of mastopathies make it difficult to develop a unified and consistent prevention scheme. However, it is worth avoiding the most significant factors: stressful situations (taking therapeutic sedatives of natural origin – valerian, motherwort – is recommended as a preventive measure for stress), creating a psychologically comfortable environment, a positive way of thinking.
Proper balanced nutrition without excess calories, prevention of excess weight and obesity, however, without a passion for mono-diets and questionable methods of weight loss, contribute to the maintenance of internal homeostasis and the proper functioning of the neurohumoral regulatory system. One of the components of the diet that negatively affect the hormonal status of women is caffeine. Women should limit, and if possible completely exclude caffeine from their diet and in no case abuse strong coffee on an empty stomach.
Older women using oral contraceptives should give up smoking. Also useful in terms of the prevention of breast pathologies will be the restriction of the use of alcoholic beverages. A significant factor in maintaining a woman’s health is regular sex life and physical activity.