viernes, 2 de noviembre de 2018

Treatment and Prognosis for Diabetic Mastopathy

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By Susha Cheriyedath, M.Sc.Reviewed by Yolanda Smith, B.Pharm.

Diabetic mastopathy (DMP) is a breast-related complication seen in type 1 or 2 insulin-dependent diabetes mellitus. This condition manifests as hard, fibrous masses in one breast or both breasts. These masses are non-cancerous and irregular in shape. Interestingly, DMP has also been reported in men.

Clinical findings are mostly inconclusive in the case of DMP. The masses seen in this condition are large and painless and not easily differentiated from the ones seen in breast cancer. DMP masses are commonly present in both breasts, especially during the end stage of the disease. It is also usually accompanied by other complications of diabetes mellitus. A high blood glucose level that remains high has been suggested as a possible cause of the condition. However, the research to back this claim is not currently sufficient to support the suggestion.

Prognosis for Diabetic Mastopathy

DMP is not a malignant or pre-malignant condition that leads to a terminal illness. It is considered as a self-limited condition which does not necessitate treatment, though the disease can recur. To date, no malignant transformation of DMP lumps have been reported.

DMP is usually discovered by the patients themselves. They may describe it as an irregular and painless lump and inform their family physician, who will initiate the screening procedures for breast cancer. This includes mammograms and breast ultrasound studies, although the findings are usually inconclusive, and a biopsy needs to be performed to confirm the findings and rule out breast cancer. Core biopsy is highly recommended by doctors because the lesions and lumps can increase in size and number over time and this kind of biopsy is guided by ultrasound and removes tissue from the core part of the masses. Histological analysis is a crucial method that helps differentiate DMP from breast carcinoma.

Management and Treatment

Once DMP diagnosis is confirmed, the masses are usually left undisturbed. In the case of younger women, ultrasound examinations at regular intervals (usually once a year) are recommended. For older patients, yearly clinical examinations, mammogram, and ultrasound are recommended. As the patient ages, the size and number mastopathy masses can increase and all new lesions need to be investigated by fine needle or core biopsies to make sure they are benign lesions and not malignant.

Although surgical removal of diabetic mastopathy lumps is an option, it is something that needs to be decided between the patient and physician. The rate of regrowth of lesions post surgical removal is about 32%, and usually happens within 5 years of the surgery. Although there is no evidence to suggest that the lumps in the breast go away without treatment, no evidence supports the development of the lesions into breast carcinoma either, so if surgery can be avoided that will be the best.

Regardless, all DMP patients need to be advised about the possible complications of the condition and should be taught to self-examine their breasts. They should be advised to consult their doctor if they notice any changes in number or size of the lumps in their breast. Patients should have new lumps investigated by their physician as soon as they find any new lesions.