Diseases of the mammary glands: causes, symptoms, diagnosis, treatment

Mammary glands are part of the female reproductive system, breast tissue - targets for steroid hormones ovaries, prolactin, placental hormones and hormones mediated by other endocrine glands of the body.

According to the established tradition, oncologists are engaged in diagnostics and therapy of diseases of the breast. However, in recent years, obstetrician-gynecologists have begun to engage in a deeper problem of benign breast diseases.

Risk factors for the development of breast diseases

Currently, conditions are identified that contribute to the emergence and development of diseases of the mammary glands, which makes it possible to allocate a contingent of women with an increased risk of the disease.

Since benign diseases and breast cancer have much in common in etiological factors and pathogenetic mechanisms, the risk factors for their development are largely identical.

Of paramount importance is the hereditary factor - the presence of benign and malignant diseases in maternal relatives.

One of the most frequent adverse factors is chronic salpingo-oophoritis, as the development of sex hormones is disrupted as a result of inflammation.

Most patients with various forms of mastopathy are diagnosed with thyroid gland pathology. Hypofunction of the thyroid gland increases the risk of mastopathy by 3.8 times.

An important cause contributing to the occurrence of mastopathy are various diseases of the liver, bile duct and gallbladder. The liver plays a big role in the metabolism of excess endogenous estrogens. With her diseases, this ability is reduced and even lost, as a result of which the content of hormones increases.

Of the other risk factors, obesity may play a role, especially when combined with diabetes and hypertension. It is known that in the presence of the entire triad, the risk of mastopathy, as well as breast cancer, triples.

Another risk factor for the development of dyshormonal changes in the mammary glands is iodine deficiency, which contributes to disorders in the hypothalamus-breast system.

The greater risk of contracting a woman is exposed to stress, neurosis, depression, so chronic stress is one of the factors causing mastopathy.

Violations of the hormonal status of the female body are also caused by an irregular sexual life, which can contribute to the development of pathological processes in the mammary gland.

Indirect risk factors include addiction to alcohol and smoking.

The risk of developing mammary gland diseases can increase the effect of ionizing radiation.

Serious consequences for the development of breast diseases can have her injuries and micro-injuries.

Artificial termination of pregnancy significantly increases the risk of developing mammary pathology. After abortion proliferative processes in the mammary glands stop and the tissue undergoes reverse development. These regressive changes occur unevenly, so the structure of the glands can acquire a pathological character.

The risk of mastopathy and breast cancer is increased due to such unfavorable factors as absence of pregnancy or late first pregnancy, absence of breastfeeding.

Women who gave birth to two children under 25 years. Have a three times less risk of developing breast diseases compared with having only one child. Age is also an important risk factor for cancer: the incidence of breast cancer rises with age and reaches, according to some authors. To 75 years to 30%.

The association of an increased risk of the disease with the early onset of menstruation and their late termination was found.

Factors that have a protective effect include early births (20-25 years), breastfeeding, the number of births (more than two) with full lactation.

Often, causal factors are in interconnection, forming a common unfavorable background. The complexity of assessing the totality of causative factors dictates the need for a regular comprehensive examination (breast self-examination, mammography, mammologic consultation) for each woman.

Diagnosis of breast diseases

Clinical examination

The examination begins with an analysis of the anamnesis. Great importance in understanding the causes of the occurrence of diseases of the mammary glands has data on the risk factors for their occurrence.

Further clarify the complaints, the time of their appearance, the connection with the menstrual cycle, the presence of secretions from the nipples, their color, consistency, duration and constancy.

Objective examination includes examination and manual examination, in which the degree of gland formation, shape, size, skin condition, nipple are determined.

Surface and deep palpation of glands and lymph nodes is performed; reveals the presence of seals and their nature. Particular attention is paid to the existing nodal formations.

Palpation is performed in the vertical and horizontal position of the subject. Palpation allows you to determine the location of the tumor, its size, boundaries, consistency, relationships with the underlying tissues. It is first carried out by lightly touching the pads of 2, 3, 4 fingers laid flat on the palpable mammary gland. Then go to a deeper palpation, but it should be painless. Palpation of the mammary gland in a horizontal position can greatly facilitate the diagnosis of minimal tumors, as well as their difference from dyshormonal hyperplasia. In this position, the entire mammary gland becomes softer that allows you to identify small areas of compaction in it. In addition, with the horizontal position of the examined woman, the areas of dyshormonal hyperplasia become softer to the touch or are not detected at all, while the tumor node does not change its consistency in comparison with the standing study.

A scale for assessing changes in the mammary gland

Cipher	Characteristics of the palpable areas	Clinical Findings
3	In one or both mammary glands, localized compaction sites are clearly defined against the background of diffuse	Localized fibroadenomatosis in the background of diffuse
2	In one or both uterine glands, compacted areas without clear contours are defined on the background of diffuse fibro-adenomatosis	Localized fibroadenomatosis in the background of diffuse
1	In one or both mammary glands fine-grained compaction sites of a diffuse character are determined	Diffuse cystic or fibrous fibroadenomatosis
0	Palpator gland structure is uniform	Absence of physical signs of pathological process

An objective assessment of the gland condition is made up of examination and palpation data, as well as mammography, ultrasound and other special studies of breast tissue.

Laboratory and instrumental methods of research of diseases of mammary glands

Laboratory methods

An obligatory component in the complex examination of patients with breast diseases is the determination of the individual hormonal status of the woman; in the first place, the level of prolactin and estrogen.

For examination to determine the probability of development of pathological processes in the mammary glands, over the past two decades, the definition of tumor markers has been proposed. Data from the literature indicate an increased level of tumor markers in groups of women with severe diffuse forms of mastopathy. Determining the role of markers in predicting the occurrence of breast pathology is more rational to conduct in patients who have genetic or anamnestic predispositions to a malignant process or proliferative forms of mastopathy.

Such markers as cancer-embryonic antigen (CEA), high-molecular antigens CA-125 and CA19-9, mucin-like cancer-associated antigen (MRA), allow monitoring the effectiveness of the treatment.

Beam methods

Mammography. The accuracy of mammography diagnostics ranges between 75-95%. A high percentage of false negative results is due to the fact that in young women, especially during lactation, knots and tumors are difficult to distinguish on a dense background of the gland. On this basis it is considered inexpedient to perform mammogram in women younger than 30 years. Great difficulty is the detection of a tumor against the background of mastopathy. Under these conditions, the tumor node is found in no more than 50% of cases. The minimum tumor size detected in mammography is 0.5-1.0 cm.

The conduct of this study is appropriate on the 5-12th day of the menstrual cycle.

X-ray mammography should be performed in women older than 35 years, in cases when the tumor is not clearly palpable; with the localization of education directly behind the nipple; with developed premammary fatty tissue; expressed involutive changes in breast tissue; as a screening method of investigation (Figure 15.2).

Currently, women over 40 years are recommended to perform mammography every 2 years, after 50 years - every year. When local seals are detected, which are determined palpation, mammography is performed at women of any age.

Pneumocamma is used to improve the contouring of the node located deep in the breast tissue, as well as tumors located on the periphery of the gland (at the edge of the sternum, in the projection of the subclavian and axillary processes), obtaining an x-ray image of which is difficult. X-ray examination is carried out after the introduction through several needles, located in different quadrants of the mammary glands, 200-500 ml of nitrous oxide.

Pneumocystography is an additional differential diagnostic method for cystic forms of fibroadenomatosis and cystadenopapillomas. After puncturing the cyst and evacuating its contents into the cavity, 10 ml of air is introduced. The X-ray picture allows to trace the structure of the cyst walls, the relief of its internal surface.

Ductography or galactography is a method used to diagnose non-palpable ductal tumors. The informativeness of this method is 80-90%.

Electroentgenography (xerography) is an informative method, but its drawback is a high dose of radiation, exceeding in 3 times the dose for usual mammography.

Echography. Preference to this method of diagnosis should be given: when examining patients under the age of 30, with localization of the lesion in mammography areas difficult to access for mammography (subcutaneous procession, submammary fold, retromammary space, axillary process), differential diagnosis of solid and cavity formations, puncture biopsy. The informativeness of the method is 87-98%.

Mammography and ultrasound are complementary methods.

CT scan. Highly informative method of examination of patients with obscure data of conventional tomography and "dense" mammary glands. Computer tomography can detect tumors up to 2 mm, evaluate their distribution, and also conduct differential diagnosis of mastopathy and malignant neoplasms.

Magnetic resonance imaging (MRI). The harmlessness of the procedure combined with the good execution of sections of arbitrary direction allows us to consider that it will become one of the leading techniques. However, such an early sign of cancer, like microcalcifications, is not visible with MTP.

Transillumination (diaphanoscopy). The method is based on evaluating the structures of the mammary gland in transmitted light. The study is conducted in a darkened room. The light source is placed under the mammary gland and the structure of the organ is visually examined. In modern devices for diaphanoscopy, a television camera and a monitor are used to enhance the contrast of the image. To the undoubted merits of the method of diaphanoscopy is non-invasiveness, the absence of ionizing radiation, economy, simplicity of research. However, the method is not sensitive enough. Its further development is expected due to the computer evaluation of the results and the use of lasers with low energy of radiation.

Histological methods

Puncture biopsy - the introduction of a needle into the thickness of the seal and the aspiration of tissue particles through it. In 80-85% of cases, cytological examination of punctata gives an opportunity to diagnose. With disgormonalnyh hyperplasia, puncture biopsy allows to establish the degree of proliferation and atypia of the epithelium, to reveal the presence of a cystic cavity.

Excisional biopsy consists in excision of the revealed compaction together with a site of surrounding tissues. If benign changes in the mammary gland are detected, the implementation of such an intervention is therapeutic and preventive.

Trepanobiopsy is performed with the help of special needles, which make it possible to obtain a column of tissue sufficient for histological examination. Trepanobiopsy, possibly, increases the risk of dissemination of the tumor process. Therefore, it should be performed immediately before the beginning of the antitumor treatment, and not as a routine study conducted by all patients with a palpable tumor. The informativeness of this method in breast cancer is about 95%.

Cytological examination of the discharge from the nipple allows the detection of malignant cells in intraductive tumors.

Of the listed methods of practical importance to date have: x-ray mammography, ultrasound of the mammary glands, puncture and excision biopsy, cytological examination of the discharge from the nipple. The rest of the methods are rarely used in everyday practice.

[1], [2], [3], [4], [5], [6]