A modern approach to therapy for cyclic mastalgia in comorbid patients

Tazina T.V.

Academician I.P. Pavlov Ryazan State Medical University, Ministry of Health of the Russian Federation, Ryazan, Russian Federation
Benign breast dysplasia is one of the most common abnormalities in the female population, which occurs mainly in reproductive-aged women usually with a concomitant gynecological and endocrine disease. The most common complaint in this category of patients is breast pain on one or both sides, which occurs in the second phase of the menstrual cycle and generally disappears immediately during menstruation or in the first days after its onset. There may be also independently detectable breast lumps and nipple discharge. At the same time, women do not always go timely to an obstetrician/gynecologist who engages in the breast as part of the reproductive system, considering this to be the norm. To date, long-term, uncorrected mastalgia is considered as an independent risk factor for breast cancer. In addition, some forms of mastopathy also have a high risk of malignant transformation, posing a threat to the patient's life. Therefore, in the context of the modern development of science and clinical practice, the mandatory criterion for high-quality health care for women is not only regular, age-appropriate screening for the breast, but also the absence of a neglectful attitude towards its benign disease.
Conclusion. Immediately initiated, pathogenetically justified treatment for benign breast disease, with the proven efficiency and influence on modifiable risk factors for hyperestrogenism that underlies the activation of proliferation processes of the ductal and intralobular epithelium of the breast, as well as an integrated approach to the patients, by taking into account gynecological and endocrine diseases, contribute not only to the elimination of complaints and the improvement of quality of life, but also are the basis for preventive medicine.

Keywords

benign breast dysplasia
estrogens
cyclic mastalgia
indolcarbinol
Indinol Forto

References

  1. Боксер О.Я., Григорьев К.И. Наука о боли: патофизиология и медико-психологические аспекты. Медицинская сестра. 2005; 8: 2-5. [Bokser O.Ya., Grigor'ev K.I. The science of pain: pathophysiology and medical and psychological aspects. Nurse/Medicinskaja sestra. 2005; 8: 2-5. (in Russian)].
  2. Borsook D., Youssef A.M., Simons L., Elman I., Eccleston C. When pain gets stuck: the evolution of pain chronification and treatment resistance. Pain. 2018; 159(12): 2421-36. https://dx.doi.org/10.1097/j.pain.0000000000001401.
  3. Письмо Министерства здравоохранения РФ от 7 ноября 2018 г. № 15-4/10/2-7235 «О направлении клинических рекомендаций (протокола лечения) "Доброкачественная дисплазия молочной железы"» [Letter of the Ministry of Health of the Russian Federation of November 7, 2018 No 15-4/10/2-7235 «On the direction of clinical recommendations (treatment protocol)" Benign breast dysplasia "». (in Russian)].
  4. Guray M., Sahin A.A. Benign breast diseases: classification, diagnosis, and management. Oncologist. 2006; 11(5): 435-49. https://dx.doi.org/10.1634/theoncologist.11-5-435.
  5. Андреева Е.Н., Рожкова Н.И., Соколова Д.А. Доброкачественные дисплазии молочных желез: патогенетический вектор лечения. Обзор исследований, клинические рекомендации: информационный бюллетень. М.: StatusPraesens; 2016. 24 с. [Andreeva E.N., Rozhkova N.I., Sokolova D.A. Benign breast dysplasia: a pathogenetic vector of treatment. Review of the research, clinical recommendations: Information bulletin. Moscow: Editorial Office of the Journal “StatusPraesens”; 2016. 24 p. (in Russian)].
  6. Degnim A.C., Dupont W.D., Radisky D.C., Vierkant R.A., Frank R.D., Frost M.H. et al. Extent of atypical hyperplasia stratifies breast cancer risk in 2 independent cohorts of women. Cancer. 2016; 122(19): 2971-8. https://dx.doi.org/10.1002/cncr.30153.
  7. Dyrstad S.W., Yan Y., Fowler A.M., Colditz G.A. Breast cancer risk associated with benign breast disease: systematic review and meta-analysis. Breast Cancer Res. Treat. 2015; 149(3): 569-75. https://dx.doi.org/10.1007/s10549-014-3254-6.
  8. Baer H.J., Schnitt S.J., Connolly J.L., Byrne C., Willett W.C., Rosner B., Colditz G.A. Early life factors and incidence of proliferative benign breast disease. Cancer Epidemiol. Biomarkers Prev. 2005; 14(12): 2889-97. https://dx.doi.org/10.1158/1055-9965.EPI-05-0525.
  9. Ritte R., Lukanova A., Tjønneland A., Olsen A., Overvad K., Mesrine S. Height, age at menarche and risk of hormone receptor-positive and -negative breast cancer: a cohort study. Int. J. Cancer. 2013; 132(11): 2619-29. https://dx.doi.org/10.1002/ijc.27913.
  10. Berkey C.S., Rosner В., Tamimi R.M., Willett W.C., Hickey M., Toriola A., Frazier A.L., Colditz G.A. Body size from birth through adolescence in relation to risk of benign breast disease in young women. Breast Cancer Res. Treat. 2017; 162(1): 139-49. https://dx.doi.org/10.1007/s10549-016-4084-5.
  11. Gunter M.J., Hoover D.R., Yu H., Wassertheil-Smoller S., Rohan T.E., Manson J. et al. Insulin, insulin-like growth factor-I, and risk of breast cancer in postmenopausal women. J. Natl. Cancer Inst. 2009; 101(1): 48-60. https://dx.doi.org/10.1093/jnci/djn415.
  12. Berkey C.S., Willett W.C., Frazier A.L., Rosner B., Tamimi R.M., Rockett H.R.H., Colditz G.A. Prospective study of adolescent alcohol consumption and risk of benign breast disease in young women. Pediatrics. 2010; 125(5): e1081-7. https://dx.doi.org/10.1542/peds.2009-2347.
  13. White A.J., DeRoo L.A., Weinberg C.R., Sandler D.P. Lifetime alcohol intake, binge dinking behaviors, and breast cancer risk. Am. J. Epidemiol. 2017; 186(5): 541-9. https://dx.doi.org/10.1093/aje/kwx118.
  14. Cui Y., Page D.L., Lane D.S., Rohan Т.Е. Menstrual and reproductive history, postmenopausal hormone use, and risk of benign proliferative epithelial disorders of the breast: a cohort study. Breast Cancer Res. Treat. 2009; 114(1): 113-20. https://dx.doi.org/10.1007/s10549-008-9973-9.
  15. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet. 1997; 350(9084): 1047-59. https://dx.doi.org/10.1016/S0140-6736(05)64043-3.
  16. Plu-Bureau G., Lê M.G., Sitruk-Ware R., Thalabard J.C. Cyclical mastalgia and breast cancer risk: results of a French cohort study. Cancer Epidemiol. Biomarkers Prev. 2006; 15(6): 1229-31. https://dx.doi.org/10.1158/1055-9965.EPI-05-0745.
  17. Приказ Министерства здравоохранения РФ от 20 октября 2020 г. № 1130н «Об утверждении Порядка оказания медицинской помощи по профилю "акушерство и гинекология"». [Order of the Ministry of Health of the Russian Federation of October 20, 2020 No 1130n «On approval of the Procedure for the provision of medical care in the profile of" obstetrics and gynecology "». (in Russian)].
  18. Высоцкая И.В. Современные возможности терапии фиброзно-кистозной болезни Опухоли женской репродуктивной системы. 2009; 1-2: 44-6. [Vysotskaya I.V. Modern possibilities of therapy for fibrocystic disease. Opuholi zhenskoj reproduktivnoj sistemy/Tumors of the female reproductive system. 2009; (1-2): 44-6. (in Russian)].
  19. Киселев В.И., Сметник В.П., Сутурина Л.В., Селиванов С.П., РудаковаЕ.Б., Рахматуллина И.Р., Андреева Е.Н., Фадеева Н.И., Хасанов Р.Ш., Кулагина Н.В., Рожкова Н.И., Артымук Н.В., Гависова А.А., Муйжнек Е.Л., Кузнецов И.Н., Друх В.М. Индолкарбинол (Индинол Форто) – метод мультитаргетной терапии при циклической мастодинии. Акушерство и гинекология. 2013; 7: 56-62. [Kiselev V.I., Smetnik V.P., Suturina L.V., Selivanov S.P., Rudakova E.B., Rakhmatullina I.R. et al. Indole carbinol (Indinol Forto) is a multitargeted therapy ortion for cyclic mastodynia. Akusherstvo i ginekologija/Obstetrics and gynecology. 2013; 7: 56-62. (in Russian)].
  20. Овсянникова Т.В. Доброкачественные заболевания молочных желез — антипролиферативная терапия. РМЖ. Мать и дитя. 2018; 1(1): 67-70. [Ovsjannikova T.V. Benign breast diseases – antiproliferative therapy. Breast cancer. Mother and child/RMZh Mat' i ditja. 2018; 1(1): 67-70. (in Russian)].
  21. Blüher M., Mantzoros C.S. From leptin to other adipokinesin health and disease: facts and expectations at the beginning of the 21st century. Metabolism. 2015; 64(1): 131-45. https://dx.doi.org/10.1016/j. metabol.2014.10.016.
  22. Радзинский В.Е. Факторы риска доброкачественных и злокачественных заболеваний молочных желез. В кн.: Радзинский В.Е., ред. Медицина молочной железы и гинекологические болезни. 2-е изд. М.; 2017: 225-64. [Radzinsky V.E. Risk factors for benign and malignant diseases of the mammary glands. In the book: Breast medicine and gynecological diseases. 2nd ed. М.; 2017: 225-64. (in Russian)].
  23. Трошина Е.А., Румянцев П.О., Алташина М.В., Плохая А.А. Влияние избыточной массы тела и ожирения на факторы риска развития рака молочной железы у женщин в постменопаузе. Ожирение и метаболизм. 2012; 3: 3-10. [Troshina E.A., Rumjancev P.O., Altashina M.V., Plohaja A.A. Impact of overweight and obesity on risk factors for breast cancer in postmenopausal women. Ozhirenie i metabolism/Obesity and metabolism. 2012; 3: 3-10. (in Russian)].
  24. Wang T.T.Y., Milner M.J., Milner J.A., Kim Y.S. Estrogen receptor a as a target for indole-3-carbinol. J. Nutr. Biochem. 2006; 17(10): 659-64. https://dx.doi.org/10.1016/j.jnutbio.2005.10.012.
  25. Bradlow H.L., Sepkovic D.W., Telang N.T., Osborne M.P. Multifunctional aspects of the action of indole-3-carbinol as an antitumor agent. Ann. N. Y. Acad. Sci. 1999; 889: 204-13. https://dx.doi.org/10.1111/j.1749-6632.1999.tb08736.x.
  26. Tin A.S., Park A.H., Sundar S.N., Firestone G.L. Tin Essential role of the cancer stem/progenitor cell marker nucleostemin for indole-3-carbinol anti-proliferative responsiveness in human breast cancer cells. BMC Biology. 2014; 12: 72. https://dx.doi.org/10.1186/s12915-014-0072-6.
  27. Obi N., Vrieling A., Heinz J., Chang-Claude J. Estrogen metabolite ratio: Is the 2-hydroxyestrone to 16 α -hydroxyestrone ratio predictive for breast cancer? Int. J. Women’s Health. 2011; 3: 37-51. https://dx.doi.org/10.2147/IJWH.S7595.
  28. Ткаченко Л.В., Свиридова Н.И., Складановская Т.В., Углова Н.Д., Костенко Т.И., Гриценко И.А. Современные возможности лечения масталгии на фоне мастопатии. Лекарственный вестник. 2018; 12(3): 71. [Tkachenko L.V., Sviridova N.I., Skladanovskaya T.V., Uglova N.D., Kostenko T.I., Gritsenko I.A. Modern possibilities for the treatment of mastalgia against the background of mastopathy. Medicinal Herald/Lekarstvennyj vestnik. 2018; 12(3):71. (in Russian)].
  29. Frasor J., Danes J.M., Komm B., Chang K.C.N., Lyttle C.R., Katzenellenbogen B.S. Profiling of estrogen up- and down-regulated gene expression in human breast cancers cells:insights into gene networks and pahtways underlying estrogenic control of proliferation and cell phenotype. Endocrinology. 2003; 144(10): 4562-74. https://dx.doi.org/10.1210/en.2003-0567.
  30. Берштейн Л.М. Гормональный канцерогенез. Санкт-Петербург: Наука; 2000. 199с. [Bershtein L.M. Hormonal carcinogenesis. St. Petersburg: Science; 2000.199 p. (in Russian)].
  31. Rosner В., Colditz G.A., Willett W.C. Reproductive risk factors in a prospective study of breast cancer: the Nurses′ Health Study. Am. J. Epidemiol. 1994; 139(8): 819-35. https://dx.doi.org/10.1093/oxfordjournals.aje.a117079.
  32. Радзинский В.Е., ред. Молочные железы и гинекологические болезни. М.; 2010. 304 с. [Radzinsky V.E., ed. Breasts and gynecological diseases. M.; 2010. 304 p. (in Russian)].
  33. Киселев В.И., Солодкий В.А., Ашрафян Л.А. РМЖ: практический курс включения генов. Эпигенетическое регулирование маммарного канцерогенеза и возможности его фармакологической коррекции. Status Praesens. Гинекология, акушерство, бесплодный брак. 2014; 4: 35-43. [Kiselev V.I., Solodkiy V.A., Ashrafyan L.A. Breast Cancer: A Practical Course in Gene Turn-On. Epigenetic regulation of mammary carcinogenesis and the possibility of its pharmacological correction. Status Praesens. Gynecology, obstetrics, sterile marriage/Status Praesens. Ginekologija, akusherstvo, besplodnyj brak. 2014; 4: 35-43. (in Russian)].
  34. Есенеева Ф.М., Киселев В.И., Салимова Л.Я. Эпигенетика и эпигенетические абберации при миоме матки. Вестник РУДН. Серия: Медицина. 2016; 2; 160-70. [Eseneeva F.M., Kiselev V.I., Salimova L.Ya. Epigenetics and epigenetic aberrations in uterine myoma. Vestnik RUDN. Serija: Medicina/RUDN Bulletin. Series: Medicine. 2016; 2: 160-70. (in Russian)].
  35. Giudice L., Kao L. Endometriosis. Lancet. 2004; 364(9447): 1789-99. https://dx.doi.org/10.1016/S0140-6736(04)17403-5.

Received 11.05.2021

Accepted 17.05.2021

About the Authors

Tatyana V. Tazina, Cand. Med. Sci, Assistant Professor of the Department of Surgery, Obstetrics and Gynecology, Faculty of Additional Supplementary Professional Education, I.P. Pavlov Ryazan State Medical University, Ministry of Health of Russia. Tel.: +7(910)644-85-28. E-mail: tazina@inbox.ru. ORCID: 0000-0003-1029-0390, Researcher ID: D-7640-2018, SPIN: 7059-9793. 9 Vysokovoltnaya str., Ryazan, 390026, Russian Federation.

For citation: Tazina T.V. A modern approach to therapy for cyclic mastalgia in comorbid patients.
Akusherstvo i Ginekologiya/ Obstetrics and Gynecology. 2021; 5: 158-164 (in Russian)
https://dx.doi.org/10.18565/aig.2021.5.158-164

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