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Mastopathy is a pathology within the mammary glands diagnosed in nearly half of women, most often between the ages of 35 and 55. The disease occurs mainly in the period of sexual maturity, and it is much less common in postmenopausal women not using hormone therapy. Only every fifth woman seeks advice and assistance from a doctor. Although the causes are not fully understood, an imbalance of sex hormones with estrogen dominance, hyperprolactinemia or disturbances in thyroid hormones is of great importance.
The most important questions: what is it and can it be cancer?
Some authors define mastopathic disorders as a large group of diseases of the mammary gland with a wide spectrum of both clinical symptoms and histopathological changes. Another name for mastopathy is fibrocystic degeneration, and it derives from the characteristic histological picture of the lesions. They include changes in the milk ducts and their end sections, from which cysts form, and changes in interlobular connective tissue. Depending on the changes taking place in the epithelium, according to Prechtel, there are three stages of hyperplasia, where stage I is mild dysplasia without epithelial hyperplasia. In stage III, however, epithelial hyperplasia is observed, showing atypia. It should be clarified here that in the case of atypical hyperplasia in the lesion, the risk of developing breast cancer in one breast is nearly 4 times higher than in women with non-proliferative lesions. It is worth emphasizing that fibrocystic changes without epithelial proliferative changes, with or without atypia, are not associated with a higher risk of breast cancer. Unfortunately, the current family history changes the situation when someone from the closest family has been diagnosed with breast cancer or proliferative changes. Women with risk factors should undergo both thorough clinical and mammography examinations and biopsy.
What may be worrying about breast self palpation?
It should be noted here how important a role is played by self-examination of the breasts, because the best examiner is the woman herself. Unfortunately, getting to know your breasts takes some time. Systematic examination should be performed monthly, preferably in the first days after menstruation. Self-control will allow you to get to know your breasts well enough to examine unevenness, thickening or scary lumps without fear, which can be a characteristic feature of the breasts without the presence of pathologies. Most importantly, a woman can react quickly when she senses each new creation in her breast.
In this mastopathy, asymptomatic smooth-sided nodules or nodular indurations that slide under the skin may appear. Most often, both breasts are swollen, painful and very sensitive to touch, and spontaneous soreness occurs about a week before the menstrual period. Testable nodules or indurations can vary in size. Additionally, discharge from the nipple may appear. Careful self-observation will allow to determine whether pain symptoms occur cyclically and whether the discomfort is related to the premenstrual phase of the cycle. The above periodicity of changes is characteristic of fibrocystic changes and facilitates diagnosis.
How to make a diagnosis?
The location of pain in the cycle phase, along with examination of the breasts and the finding of bilateral cystic lesions, is the first step in differentiating from suspected neoplastic lesions. Further important is the observation of changes in the size and number of nodules, for which imaging tests are necessary. We have two commonly available methods: mammography and ultrasound. Ultrasound examination is used especially in differentiating a cystic lesion from a solid one, thanks to the characteristic features of a simple cyst image, such as: thin, smooth walls and a round, regular shape. The presence of a simple cyst in ultrasound examination excludes breast cancer. However, any change with a suspicious appearance, whether in a mammography or ultrasound examination, requires an invasive examination and collection of material for examination.
In the case of cysts, a minimally invasive fine-needle aspiration biopsy is performed, thanks to the use of thin aspiration needles. The fluid content obtained in the puncture is subjected to cytogenetic examination. A tissue biopsy is required if the fluid is difficult to obtain or the fluid obtained is bloody and thick, or if the lesion persists after aspiration. Histopathological examination is primarily to exclude the presence of cancer cells in the lesion. A negative result is intended to reassure both you and your doctor and allows you to continue observing your breasts.
What are the treatment options and their effectiveness?
These changes do not require specific examination, apart from clinical examination and ultrasound or mammography, depending on the age of the woman. Grade I and II mastopathy requires treatment if subjective symptoms are bothersome for the patient. It should be remembered that it is usually only symptomatic treatment. Soreness and discomfort can be modified pharmacologically through hormonal treatments that only a doctor can initiate.
However, more and more knowledge and experience is gained in the field of herbal therapy, nutrient supplementation and dietary changes. Epidemiological studies on a large group of women suggest that eliminating or reducing the consumption of coffee, tea and / or chocolate from the diet significantly reduces breast symptoms. Other reports indicate a beneficial effect of daily vitamin E or B6 supplementation, although there is no conclusive research on this matter. Unfortunately, it is organizationally difficult to prove the effectiveness of herbal therapy or diet in clinical trials. Although the work is ongoing.
In addition to the disease entity known as mastopathy, there is also the term mastalgia, which should be differentiated. In the case of mastalgia, we are talking about breast pain, occurring cyclically and non-cyclically, or about retrosternal ailments. The etiology of pain in this case is not so well understood, and the role here is attributed to inflammatory factors and cytokine concentrations. In the absence of hyperplastic changes in the mammary glands, pain itself is an unlikely symptom of a malignant neoplastic process, therefore the patient should be reassured and symptomatic treatment should be instituted. Since mastalgia is one of the symptoms associated with mastopathy, both dietary changes and fat reduction, vitamin supplementation and herbal remedies are beneficial in treating both. When it comes to breast soreness, it is also important to choose the right bra. In addition, in some cases, warm or cold compresses are recommended to relieve pain.
It should be noted that exacerbations of pain and tenderness, resulting from the formation or changes in the size of the cyst, may appear at any stage of life until the menopause, if the woman decides not to take estrogen hormones.
Another important issue concerns making patients diagnosed with fibrocystic degeneration aware of the need for monthly breast self-examination, which will allow, as already explained above, to feel a new change and visit a doctor in a short time for more detailed diagnosis and possible treatment. Regular follow-up by a doctor is important, including regular imaging examinations.
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