Response to different medical treatment options for mastalgia in fibrocystic breast disease

Background: Fibrocystic breast disease is the most common type of benign breast disease and mastalgia is the most common symptom of fibrocystic breast disease. Various types of medical management are given as a gold standard treatment for that. The aim of this study was to compare the effects of different commonly used medical management options of mastalgia of fibrocystic breast disease on the quality of life of patients and their side effects as well. Methods: This quasi-experimental study was carried out in Out-patients Department of General Surgery, BIRDEM General Hospital, Dhaka, from July 2018 to June 2019. Total 45 patients with fibrocystic breast disease were selected according to the eligibility criteria and were allocated to two groups by alternative random selection. In non-pharmacological treatments receiving group, lifestyle modification advices along with evening primrose oil were given. On the other hand, in pharmacological treatment receiving group, bromocriptine and danazole were given according to some selection criteria of the patients. Response of treatments to each group and side effects were determined at one month, three months and six months follow-up respectively. Mastalgia was measured by visual analogue scale (VAS) score and quality of life was calculated by modified WHO-QOL scoring in each follow-up. Results: Patients had an average age of 30.24±6.93 years with a majority in the age group 31-35 years (33.3%). Most patients were married (64.4%), housewives (62.20%), from middle-class groups (62.20%), multiparous (57.78%) and the majority had absence of the family history of breast diseases (84.45%). Majority of them presented with cyclical mastalgia (57.78%), bilateral mastalgia (60%) and mastalgia with lumpiness (44.4%). Among the patients who received non-pharmacological treatment, mastalgia improved in 34.78% cases and patients received pharmacological treatment, mastalgia improved in 72.73% cases. Different domains of quality of life were improved significantly in patients who received pharmacological treatment. Though majority of the patients had side effects due to pharmacological treatment, they were well tolerated. Conclusion: Despite having various side effects, pharmacological management by danazol or bromocriptine was well tolerated to our patients and a dramatic improvement was observed on quality of life than the nonpharmacologically treated patients. BIRDEM Med J 2022; 12(1): 22-29

Clinical Response to Different Medical Treatment Options for Mastalgia in Fibrocystic Breast Disease among Women at a Tertiary Care Hospital in Dhaka City

Background: Various types of medical management are given for mastalgia in fibrocystic breast disease. Objective: The aim of this study was to compare the effects of different commonly used medical management options of mastalgia of fibrocystic breast disease on the quality of life of the respondents and their side effects as well. Methods: This prospective longitudinal study was carried out in Out-patients Department of General Surgery, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh from July 2018 to June 2019. The patients with fibrocystic breast disease were selected according to the eligibility criteria and are allocated to two groups by alternative random selection. In non-pharmacological treatments receiving group, lifestyle modification advices along with Evening Primrose Oil were given. On the other hand, in pharmacological treatment receiving group, Bromocriptine and Danazole were given according to some selection criteria of the patients. Response of treatments to each group & side effects were determined at one month, three months and six months follow up respectively. Results: A total number of 45 patients were recruited for this study. Majority of them presented with cyclical mastalgia (57.78%), bilateral mastalgia (60%) and mastalgia with lumpiness (44.4%). Among the patients who received non- pharmacological treatment, mastalgia improved in 34.78% cases and patients received pharmacological treatment, mastalgia improved in 72.73% cases. Different domains of quality of life were improved significantly in patients who received pharmacological treatment. Conclusion: In conclusion pharmacological management by Danazol or Bromocriptine has well tolerated to the patients. Journal of Current and Advance Medical Research, July 2021;8(2):95-99

Vitex agnus-castus Ze 440 extract in the therapy of cyclic mastodynia in women with non-tumor breast damage

Cyclic mastalgia of varying intensity occurs every month in at least 70% of women, persistent pain in the mammary glands of moderate and severe degree is occur in about 50% of patients with benign mastopathy. The cause of mastodynia is the morphofunctional rearrangement of the glandular and stromal components of tissues with the expansion of ducts and proliferation of epithelial structures due to a lack of progesterone and an increase in prolactin levels. Therapy for cyclical and chronic mastalgia is empirical and not always effective. Herbal medicine with Vitex agnus-castus is a reasonable alternative to hormonal treatment for women suffering from cyclic mastalgia in combination with other manifestations of premenstrual syndrome. The main effect of such drugs is an increase of luteinizing hormone and progesterone synthesis, effect on the hypothalamic-pituitary system, prolactin and endorphins release, which can increase the level of endogenous opioids.Purpose of the study: to study the effect of the phytopreparation Prefemin (Vitex agnus-castus extract Ze 440) on the intensity of chronic pain syndrome in women with diffuse non-tumor breast lesion. Materials and methods. The study involved 30 women aged 22 to 43 years with various types of benign breast diseases and chest pain lasting at least 3 months. In 12 patients there was diffuse fibroadenoma, in 18 – diffuse cystofibroadenoma (small cystic variant) and duct ectasia.Results. Therapy with Prefemin (Ze 440) allowed to completely eliminate pain syndrome in 93.3% of women and to reduce the frequency of mastodynia in the group with moderate severity in 90.0% of patients with diffuse fibroadenoma and cystofibroadenoma.Conclusions. Phytopreparation Prefemin, which is obtained from the medicinal plant Vitex agnus-castus, has demonstrated high efficacy in the mastalgia treatment in women with diffuse fibrocystic breast disease. This drug was well tolerated and there were no side effects.

Preconception prevention of lactation disorders in women with fibrocystic breast disease

Study objective: to establish the clinical efficacy of 1.0% micronized progesterone gel Progestogel® at the preconception stage in order to prevent lactation disorders in women with fibrocystic breast disease (FBD).Materials and methods. The main group consisted of 30 women with diffuse forms of FBD who applied on each mammary gland 2.5 g 1.0% micronized progesterone gel Progestogel® for 6 months daily at the stage of pregnancy planning. The comparison group included 30 women with diffuse forms of FBD who did not use Progestogel® at the stage of pregnancy planning. The control group consisted of 30 healthy pregnant women without pathological changes in mammary glands. Stages of observation included preconception period, pregnancy, postpartum period, lactation period and long-term period (6 month after the end of lactation).Results. Preconception preparation with transdermal 1.0% micronized progesterone gel Progestogel® in patients with diffuse forms of FBD promoted long-term breastfeeding and a regressive course of the breast pathological process. Examination of this group of patients in the long-term period (6 month after the end of lactation) showed no clinical manifestations of the breast disease (pain syndrome and edema) in 24 (80.0%) women and regression of ultrasound signs of FBD in 21 (70.0%) patients. Manifestation of both clinical and echographic signs of the breast disease was diagnosed in 26 (86.7%) women in the comparison group. Transdermal 1.0% micronized progesterone gel in the preconception preparation associated with no complications of the early lactation period in 83.3% of patients and provided a long (12 months) lactation process in 66.7% of patients.Conclusion. Progestogel® is an effective pathogenically substantiated means of safe therapy for diffuse forms of FBD. The protective effect of 1.0% micronized progesterone gel Progestogel® associated with regression of clinical and echographic manifestations of FBD in 80.0% of women.

Polycystic Ovary Syndrome and Fibrocystic Breast Disease: An Updated Review

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. There is no clear association between PCOS and benign breast disease (BBD). The latter is a frequent benign disorder, affecting women between 20 and 50 years of age. To date, the classification remains controversial, and the risk of developing breast cancer that is associated with these changes is different depending on the histopathological findings. The most frequent changes are breast cysts, which are noted in up to 50% of patients older than 30 years of age. This up-to-date review presents the relationship between PCOS and BBD. In conclusion, there is no clear association between benign breast disease and PCOS. Further studies on a large population with prospectively collected data using updated PCOS criteria are necessary.

Traditional Chinese Medicine for Mammary Dysplasia (Fibrocystic Breast Disease): A Case Report

Breast cancer (BC) is one among the most common and fatal malignancies affecting women of all ages, though prognosis are good if caught early. Fibrocystic breast disease, which is interchangeably mentioned as fibrocystic breast, is nothing but a benign (noncancerous) condition which gives a lumpy feeling to women. It is not a rapidly progressing disease or dangerous, but is a constant source of problem to some women. In this case report, we present a female suffering from mammary dysplasia (MD). She was initially treated with conventional medicine but received no benefit, so shifted to Traditional Chinese medicine (TCM). Here, acupuncture, herbal remedies, and specific instructions for a dietary regimen and bra usage were given. We found that by utilizing this holistic approach to treat the root cause, rather than the symptoms, breast pain was eliminated, cystic lumps and related densities were diminished, and cancer progression was thwarted by pursuing healthy lifestyle modification and paying more attention to diet and exercise. Ultimately, this resulted in a better quality of life and suggests that TCM can be employed successfully to treat MD when conventional medicine has failed.

Visualization of the shear wave on gray-scale ultrasound: experience with a complex breast cyst

Shear wave elastography (SWE) is the newer of the two methods of measuring tissue stiffness using ultrasound. We present the case of a 39-year-old patient with fibrocystic breast disease who presented with a left painful breast lump. The patient underwent a breast ultrasound that depicted a complicated cyst with a “pseudo-solid” content. When the SWE mode was turned on, the ultrasound share wave was observed on the gray-scale image, as surface undulations of the “pseudo-solid” component. To the best of our knowledge, this is the first report of the share wave visualization on a gray-scale image. The impact on patient management is discussed.

Experience in treating breast pathology in outpatient practice

Introduction. According to epidemiological researches, such mammary gland disease as fibrocystic breast disease takes the leading place in the structure of pre-tumor diseases in women. Pathological cell proliferation is the common starting point for pathogenesis of both mastopathy and breast cancer. Patients with fibrocystic breast disease complain of pain unrelated to the menstrual cycle in the area of the mammary glands, swelling of breast tissue, nipple discharge. An important problem is the effective treatment of mastitis and lactostasis, during and after which the possibility of breastfeeding was maintained. Mastitis is a formidable complication of the postpartum period and the cause of lactation failure. For a long time, all patients with infectious mastitis underwent surgical treatment of the area of infection with subsequent drainage. As a rule, with the prescription of broad spectrum antibiotic drugs. Often, against the background of such stress for the body the ability to breastfeed dies down. Timely diagnosis and adequate treatment of mastitis and lactostasis help to preserve breastfeeding and improve the health of mother and child. Treatment of mastitis and lactostasis, fibrocystic breast disease is a complex problem of modern mammology.Aim. This paper presents a pathogenetic approach to the treatment of fibrocystic breast disease from the point of view of evidence-based medicine using micronized progesterone. In order to avoid surgical interventions on the mammary glands and to preserve the maximum possible period of breastfeeding, we studied and proposed the method of mini-invasive and evidence-based approach to the treatment and prophylaxis of mastitis and lactostasis using a drug containing the strain L. Fermentum CECT5716.Materials and methods. 13 patients with mastitis symptoms were included in the study. The main complaint of all patients who applied was lactostasis (100%). According to breast ultrasound, most patients were diagnosed with infiltrative mastitis – 8 (61.5%), serous mastitis – 4 (30.7%). Only one patient was diagnosed with purulent mastitis (7.7%). After prescription of treatment for mastitis and lactostasis after 21 days of clinical and radiological mammary gland image in 10 cases (77%) without pathology, duct ectasia was found in three women, which is the physiological norm in breastfeeding. All breastfeeding women have recovered normal lactation without symptoms of lactostasis. Almost all patients according to pain VAS noted not exceeding 1 point (mean was 1 ± 0.7). In most cases, the punctate cytogram corresponded to acute inflammation and purulent inflammation, 7 (53.9%) and 6 (46.1%). Results of a bacteriological study: Staphylococcus aureus – 11 (84.6%). Three patients had mixed microflora, Staphylococcus aureus/Staphylococcus epidermidis and Staphylococcus aureus/Staphylococcus saprophyticus, 2 (15.3%) and 1 (7.7%), respectively. One patient was diagnosed with Enterococcus faecalis. These data affected the choice of therapy. All patients were prescribed therapy with a drug containing the strain of L. Fermentum CECT5716 one capsule per day for 28 days, with subsequent assessment of the therapeutic effect on the 10th, 21st days.Results. After treatment on the 10th day of control examination all the patients had galactorrhea cytogram without morphological signs of inflammation. According to the data of the bacteriological study of cultures, complete elimination of pathogenic microflora was revealed in most cases – 8 (61,5%), in 5 patients there were titers of less than 104 CFU/ml, which was the norm indicator. Clinical examples of treatment are given.Conclusions. Our experience in treating such patients with a drug containing the strain L. Fermentum CECT5716 can successfully replace the standard of medical care for the treatment of mastitis and lactostasis. However, a combination with antibiotic therapy can be used for high bacterial load and mixed microflora. In all cases (100%) on the 10th day after the start of therapy all symptoms and clinical and radiological signs of lactostasis and mastitis were cured.