Pathogenetic therapy of benign breast dysplasia

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Objective: To evaluate mammographic breast density and determine the relationship of breast density in terms of synergy of radiation diagnostics and long-term pathogenetic therapy (6 months) with indolcarbinol medication in patients with benign breast dysplasia and mastodynia.

Materials and methods: The study included the results of the retrospective analysis of the data obtained from 2500 patients aged 20 to 59 years diagnosed with benign breast dysplasia. All the patients were examined and treated at the Russian Scientific Center of Roentgen Radiology, Moscow from 2021 to 2024. The evaluation of the patients’ condition included clinical examination, pain assessment using visual analog scale and instrumental studies (mammography, color Doppler ultrasonography and elastography, MRI with contrast agents) depending on the age and indications for the study. The results of instrumental examinations were evaluated according to the Breast Imaging-Reporting and Data System (BI-RADS) classification on a scale from 1 to 5, including tissue density assessment by the ACR classification (for mammography). The evaluation of the hormonal status and the concomitant diseases of the organs of the female reproductive system was carried out by a gynecologist. The results of the study showed that there were 250 patients with high tissue density, mastalgia and concomitant diseases of the reproductive organs; they were recommended therapy with indolcarbinol (Indinol Forto medication), namely one capsule twice a day for six months.

Results: Mastodynia/mastalgia disappeared in 140/250 (56%) women after six months of taking Indinol Forto. The condition stabilized (mastalgia and mastodynia were absent) in 198/250 (79.2%) patients one year after treatment. There was a one-point decrease in BI-RADS category 6 months after treatment with Indinol Forto in 18% of cases (change of category 3 BI-RADS to category 2 BI-RADS in 7.2% of cases, and category 2 BI-RADS to category 1 BI-RADS in 10.8% of cases); the assessment of tissue density type using the ACR classification showed changes after treatment from type D to type C, and from type C to type B in 25% of cases.

Conclusion: Indinol Forto is an effective medication for the treatment of benign breast dysplasia and can be recommended as a first-line treatment for cyclic mastalgia.

Full Text

Restricted Access

About the authors

Elena V. Meskikh

Russian Scientific Center of Roentgen Radiology, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Author for correspondence.
Email: meskihelena@rambler.ru

Dr. Med. Sci., Professor of the Department of X-ray Radiology; doctor of the highest category, Chief Researcher at X-ray Radiological Laboratory

Russian Federation, Moscow; Moscow

Lev A. Ashrafyan

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: levaa2004@yahoo.com
ORCID iD: 0000-0001-6396-4948

Academician of the Russian Academy of Sciences, Professor, Dr. Med. Sci., Head of the Institute of Oncogynecology and Mammology

Russian Federation, Moscow

References

  1. Acciavatti R.J., Lee S.H., Reig B., Moy L., Conant E.F., Kontos D. et al. Beyond breast density: risk measures for breast cancer in multiple imaging modalities. Radiology. 2023; 306(3): e222575. https://dx.doi.org/10.1148/radiol.222575.
  2. Kim E., Lewin A.A. Breast density: where are we now? Radiol. Clin. North Am. 2024; 62(4): 593-605. https://dx.doi.org/10.1016/j.rcl.2023.12.007.
  3. Gordon P.B. Breast density and risk of interval cancers. Can. Assoc. Radiol. J. 2022; 73(1): 19-20. https://dx.doi.org/10.1177/08465371211030573.
  4. Edmonds C.E., O'Brien S.R., Conant E.F. Mammographic breast density: current assessment methods, clinical implications, and future directions. Semin. Ultrasound CT MR. 2023; 44(1): 35-45. https://dx.doi.org/10.1053/ j.sult.2022.11.001.
  5. Bissell M.C.S., Kerlikowske K., Sprague B.L., Tice J.A., Gard C.C., Tossas K.Y. et al.; Breast Cancer Surveillance Consortium. Breast cancer population attributable risk proportions associated with body mass index and breast density by race/ethnicity and menopausal status. Cancer Epidemiol. Biomarkers Prev. 2020; 29(10): 2048-56. https://dx.doi.org/10.1158/1055-9965.EPI-20-0358.
  6. Wolfe J.N., Saftlas A.F., Salane M. Mammographic parenchymal patterns and quantitative evaluation of mammographic densities: a case-control study. AJR Am. J. Roentgenol. 1987; 148(6): 1087-92. https://dx.doi.org/10.2214/ajr.148.6.1087.
  7. Boyd N.F., Byng J.W., Jong R.A., Fishell E.K., Little L.E., Miller A.B. et al. Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. J. Natl. Cancer Inst. 1995; 87(9): 670-5. https://dx.doi.org/10.1093/jnci/87.9.670.
  8. Bodewes F.T.H., van Asselt A.A., Dorrius M.D., Greuter M.J.W., de Bock G.H. Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis. Breast. 2022; 66: 62-8. https://dx.doi.org/10.1016/ j.breast.2022.09.007.
  9. Kataoka M. Mammographic density for personalized breast cancer risk. Radiology. 2023; 306(2): e222129. https://dx.doi.org/10.1148/radiol.222129.
  10. Seely J.M., Peddle S.E., Yang H., Chiarelli A.M., McCallum M., Narasimhan G. et al. Breast density and risk of interval cancers: the effect of annual versus biennial screening mammography policies in Canada. Can. Assoc. Radiol. J. 2022; 73(1): 90-100. https://dx.doi.org/10.1177/08465371211027958.
  11. Astley S.M., Harkness E.F., Sergeant J.C., Warwick J., Stavrinos P., Warren R. et al. A comparison of five methods of measuring mammographic density: a case-control study. Breast Cancer Res. 2018; 20(1): 10. https://dx.doi.org/10.1186/s13058-018-0932-z.
  12. Mann R.M., Athanasiou A., Baltzer P.A.T., Camps-Herrero J., Clauser P., Fallenberg E.M. et al.; European Society of Breast Imaging (EUSOBI). Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur. Radiol. 2022; 32(6): 4036-45. https://dx.doi.org/10.1007/s00330-022-08617-6.
  13. O'Driscoll J., Burke A., Mooney T., Phelan N., Baldelli P., Smith A. et al. A scoping review of programme specific mammographic breast density related guidelines and practices within breast screening programmes. Eur. J. Radiol. Open. 2023; 11: 100510. https://dx.doi.org/10.1016/j.ejro.2023.100510.
  14. Magny S.J., Shikhman R., Keppke A.L. Breast imaging reporting and data system. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.
  15. Yeh E.D. Invited commentary: Update on mammographic breast density and supplemental screening for breast cancer. Radiographics. 2023; 43(10): e230183. https://dx.doi.org/10.1148/rg.230183.
  16. Kim S., Tran T.X.M., Song H., Ryu S., Chang Y., Park B. Mammographic breast density, benign breast disease, and subsequent breast cancer risk in 3.9 million Korean women. Radiology. 2022; 304(3): 534-41. https://dx.doi.org/10.1148/ radiol.212727.
  17. Alomaim W., O'Leary D., Ryan J., Rainford L., Evanoff M. et al. Subjective versus quantitative methods of assessing breast density. Diagnostics (Basel). 2020; 10(5): 331. https://dx.doi.org/10.3390/diagnostics10050331.
  18. Ашрафян Л.А., Рожкова Н.И., Прокопенко С.П., Меских Е.В., Артымук Н.В., Белоцерковцева Л.Д., Долгушина В.Ф., Коротких Н.В., Кузнецова Л.В., Кукарская И.И., Кононенко Т.С., Марочко Т.Ю., Соколов К.А., Вербицкая Ю.С. Влияние препарата индолкарбинола на течение циклической масталгии на фоне доброкачественной дисплазии молочной железы в условиях рутинной клинической практики (исследование «АФРОДИТА»). Акушерство и гинекология. 2024; 2: 134-42. [Ashrafyan L.A., Rozhkova N.I., Prokopenko S.P., Meskikh E.V., Artymuk N.V., Belotserkovtseva L.D., Dolgushina V.F., Korotkikh N.V., Kuznetsova L.V., Kukarskaya I.I., Kononenko T.S., Marochko T.Yu., Sokolov K.A., Verbitskaya Yu.S. The effect of the indolcarbinol on cyclic mastalgia in benign mammary dysplasia in routine clinical practice (“APHRODITE” study). Obstetrics and Gynecology. 2024; (2): 134-42. (in Russian)]. https://dx.doi.org/10.18565/aig.2024.35.
  19. Кравченко Е.Н., Набока М.В. Лечение диффузных доброкачественных заболеваний молочной железы. Акушерство и гинекология. 2023; 2: 140-5. [Kravchenko E.N., Naboka M.V. Treatment for diffuse benign breast diseases. Akusherstvo Obstetrics and Gynecology. 2023; (2): 140-5. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.25.
  20. Plu-Bureau G., Thalabard J.C., Sitruk-Ware R., Asselain B., Mauvais-Jarvis P. Cyclical mastalgia as a marker of breast cancer susceptibility: results of a case-control study among French women. Br. J. Cancer. 1992; 65(6): 945-9. https://dx.doi.org/10.1038/bjc.1992.198.
  21. Киселев В.И., Сметник В.П., Сутурина Л.В., Селиванов С.П., Рудакова Е.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 – 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., Andreyeva E.N., Fadeyeva N.I., Khasanov R.Sh., Kulagina N.V., Rozhkova N.I., Artymuk N.V., Gavisova A.A., Muizhnek E.L., Kuznetsov I.N., Drukh V.M. Indole carbinol (Indinol Forto) is a multitargeted therapy option for cyclic mastodynia. Obstetrics and Gynecology. 2013; (7): 56-62. (in Russian)].
  22. Инструкция по медицинскому применению лекарственного препарата Индинол Форто®. РУ № ЛП 002010. [Instructions for the medical use of the medicinal product Indinol Forto®. RU Nо. LP 002010. (in Russian)].
  23. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Доброкачественная дисплазия молочной железы. 2024. [Ministry of Health of the Russian Federation. Clinical guidelines. Benign breast dysplasia. 2024. (in Russian)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Assessment of density according to the ACR scale (the percentage of fibroglandular tissue to fat is given in brackets)

Download (195KB)
Indexing metadata
3. Fig. 2. Density by ACR (mammography)

Download (148KB)
Indexing metadata
4. Fig.3. Evaluation of instrumental methods according to B-IRADS

Download (204KB)
Indexing metadata
5. Fig. 4. Clinical example of hereditary breast cancer in patient K., born in 1987. Mammograms of the mammary glands: against the background of glandular tissue (high radiographic density) in the left mammary gland on the border of the lower quadrants, an area of ​​local strand reorganization of the structure measuring 12x10 mm is determined. Ultrasound examination of the mammary glands (B-mode and elastography): in the left mammary gland on the border of the lower quadrants, an irregularly shaped formation measuring 8x4 mm is determined, vertically oriented, with unclear outlines. Histological examination: infiltrating ductal carcinoma G3; immunohistochemical examination: luminal type B HER 2 negative BRCA1+

Download (175KB)
Indexing metadata
6. Fig. 5. Assessment of pain syndrome before and after treatment

Download (157KB)
Indexing metadata
7. Fig. 6. B-IRADS score before and after treatment

Download (67KB)
Indexing metadata
8. Fig. 7. Changes in tissue density on mammograms according to ACR before and after treatment

Download (70KB)
Indexing metadata
9. Fig. 8. Clinical example of the effect of long-term pathogenetic therapy with Indinol Forte on changes in tissue density in patient K., born in 1985, with a diagnosis of: Fibrocystic mastopathy (N60.1), B-IRADS 2, with severe mastalgia

Download (203KB)
Indexing metadata

Copyright (c) 2024 Bionika Media