В статье представлен обзор литературных данных факторов риска фиброзно-кистозной болезни (ФКБ), рассмотрены роль и место отдельных факторов риска, таких как маммографическая плотность и циклическая масталгия. Произведена оценка значимых клинических симптомов как фактора риска рака молочной железы (РМЖ). Рассмотрены современные возможности диагностики ФКБ. Приведены современные рекомендации по лечебной тактике. Описаны патогенетическое лечение ФКБ, направленное на профилактику РМЖ, применение лекарственного препарата Прожестожель® для лечения ФКБ и профилактики РМЖ. Ключевые слова: фиброзно-кистозная болезнь, доброкачественная дисплазия молочной железы, рак молочной железы, факторы риска, маммографическая плотность, пролиферация эпителия, клеточная атипия, прогестерон, Прожестожель, профилактика рака молочной железы
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The article describes the review of literature risk factors for fibrocystic disease (FCD), the role and place of individual risk factors such as mammographic density and cyclic mastalgia. The evaluation of significant clinical symptoms as a risk factor for breast cancer (BC) was made. The modern possibilities of diagnostics of FCD are considered. The modern recommendations on medical tactics are given. The pathogenetic treatment of FCD aimed at preventing breast cancer is described; The use of a Progestogel® drug for the treatment of FCD and breast cancer prophylaxis. Key words: fibrocystic disease, benign breast disease, breast cancer, risk factors, mammographic density, epithelial proliferation, cellular atypia, progesterone, Progestogel, prevention of breast cancer.
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1. Kaprin A.D., Stalinskii V.V., Petrova G.V. Zlokachestvennye novoobrazovaniia v Rossii v 2015 godu (zabolevaemost' i smertnost'). M.: MNIOI im. P.A.Gertsena. Filial FGBU «NMIRTs» Minzdrava Rossii, 2017; s. 250. [in Russian]
2. Ferlay J, Soerjomataram I, Dikshit R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: 359–86. doi:10.1002/ijc.29210
3. Rozhkova N.I., Meskikh E.V., Burdina L.M. i dr. Le- karstvennaia patogeneticheskaia korrektsiia dobrokachestvennykh zabolevanii molochnoi zhelezy. Opukholi zhenskoi reproduktivnoi si- stemy. 2008; 2: 48–54. [in Russian]
4. NCCN – Evidence-Based Cancer Guidelines. https://www.nccn.org/
5. Senkus E, Kyriakides S, Ohno S et al. Primary Breast Cancer: ESMO Clin Pract Guidelines Ann Oncol 2015; 26 (5): 8–30. DOI: https://doi.org/10.1093/annonc/mdv298.
6. WHO, corp-author. Breast cancer: Prevention and control. http://www.who.int/cancer/detection/breastcancer/en/index1.html
7. Vasil'ev D.A., Zaitsev A.N., Bershtein L.M. Mammograficheskaia plotnost' molochnykh zhelez i opredeliaiushchie ee faktory v svete povyshennogo onkologicheskogo riska. Opukholi zhenskoi reproduktivnoi sistemy. 2011; 3: 15–22. DOI: 10.17650/1994-4098-2011-0-3-15-22. [in Russian]
8. Pettersson A, Graff RE, Ursin G et al. Mammographic density phenotypes and risk of dreast cancer: a meta‐analysis. J Natl Cancer Inst 2014; 106 (5); pii: dju078.
9. Li T, Sun L, Miller N et al. The association of measured breast tissue characteristics with mammographic density and other risk factors for breast cancer. Cancer Epidemiol Biomark Prev 2005; 14 (2): 343–9.
10. Bespalov V.G., Travina M.L. Fibrozno-kistoznaia bolezn' i risk raka molochnoi zhelezy (obzor literatury). Opukholi zhenskoi reproduktivnoi sistemy. 2015; 11 (4): 58–70. DOI: 10.17650/1994-4098-2015-11-4-58-70. [in Russian]
11. Santen RJ. Benign Breast Disease in Women. Source Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc., 2000–2017.
12. Tice JA, Miglioretti DL, Li CS et al. Breast density and benign breast disease: risk assessment to identify women at high risk of breast cancer. J Clin Oncol 2015; 33 (28): 3137–43.
13. Boyd NF, Jensen HM, Cooke G et al. Mammographic densities and the prevalence and incidence of histological types of benign breast disease. Reference Pathologists of the Canadian National Breast Screening Study. Eur J Cancer Prev 2000; 9 (1): 15–24.
14. Mezhdunarodnaia statisticheskaia klassifikatsiia boleznei i problem, sviazannykh so zdorov'em (10-i peresmotr). Vsemirnaia organizatsiia zdravookhraneniia. M., 1998. [in Russian]
15. Prikaz №572-n ot 12.11.2012. M., 2014; s. 18–9. [in Russian]
16. Ader DN, Browne MW. Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Am J Obstet Gynecol 1997; 177 (1): 126–32.
17. Goodwin PJ, Miller A, Del Giudice ME, Ritchie K. Breast health and associated premenstrual symptoms in women with severe cyclic mastopathy. Am J Obstet Gynecol 1997; 176 (5): 998–1005.
18. Griffith CD, Dowle CS, Hinton CP, Blamey RW. The breast pain clinic: a rational approach to classification and treatment of breast pain. Postgrad Med J 1987; 63 (741): 547–9.
19. Leinster SJ, Whitehouse GH, Walsh PV. Cyclical mastalgia: clinical and mammographic observations in a screened population. Br J Surg 1987; 74 (3): 220–2.
20. Maddox PR, Harrison BJ, Mansel RE, Hughes LE. Non-cyclical mastalgia: an improved classification and treatment. Br J Surg 1989; 76 (9): 901–4.
21. Mansel RE. ABC of breast diseases. Breast pain. BMJ 1994; 309 (6958): 866–8.
22. Olawaiye A, Withiam-Leitch M, Danakas G, Kahn K. Mastalgia: a review of management. J Reprod Med 2005; 50 (12): 933–9.
23. Barton MB, Elmore JG, Fletcher SW. Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med 1999; 130 (8): 651–7.
24. Fentiman IS, Hamed H. Assessment of breast problems. Int J Clin Pract 2001; 55 (7): 458–60.
25. Preece PE, Mansel RE, Bolton PM et al. Clinical syndromes of mastalgia. Lancet 1976; 2 (7987): 670–3.
26. Vaidyanathan L, Barnard K, Elnicki DM. Benign breast disease: when to treat, when to reassure, when to refer. Cleve Clin J Med 2002; 69 (5): 425–32.
27. Ashrafian L.A., Babaeva N.A., Antonova I.B. i dr. Uroven' balansa estrogennykh metabolitov pri rake molochnoi zhelezy i puti ego korrektsii. Opukholi zhenskoi reproduktivnoi sistemy. 2015; 11 (3): 22–9. DOI: 10.17650/1994-4098-2015-11-3-22-29. [in Russian]
28. Smetnik V.P., Konovalova V.N. Molochnaia zheleza kak svoeobraznyi intrakrinnyi organ. Vestn. reproduktivnogo zdorov'ia. 2009; 1: 39–44. [in Russian]
29. Kogan I.Iu., Miasnikova M.O. Diagnostika i lechenie mastopatii. SPb., 2010. [in Russian]
30. Mansel RE, Webster DJ, Sweetland HM. Breast pain and nodularity. In: Benign disorders and diseases of the breast. Elsevier 2009; p. 107–39.
31. Burdina L.M. Diagnostika i lechenie dobrokachestvennykh patologicheskikh izmenenii molochnykh zhelez. Terapevt. arkhiv. 1998; 10 (70): 37–41. [in Russian]
32. Burdina L.M. Lechenie zabolevanii molochnykh zhelez i soputstvuiushchikh narushenii menstrual'noi funktsii mastodinonom. Lechashchii vrach. 1999; 8: 13–6. [in Russian]
33. Klimberg SV. Etiology and management of breast pain. In: Bland KI, Copeland EM, eds. The breast: comprehensive management of benign and malignant diseases. 4th ed. Philadelphia, PA: Saunders Elsevier, 2009; p. 87–96, 123–8.
34. Kullberg C, Selander J, Albin M. Female white-collar workers remain at higher risk of breast cancer after adjustments for individual risk factors related to reproduction and lifestyle. Occup Environ Med 2017; 4. pii: oemed-2016-104043. DOI: 10.1136/oemed-2016-104043.
35. Davies EL, Gateley CA, Miers M, Mansel RE. The long-term course of mastalgia. J R Soc Med 1998; 91 (9): 462–4.
36. Wisbey JR, Kumar S, Mansel RE et al. Natural history of breast pain. Lancet 1983; 2 (8351): 672–4.
37. Onstad M, Stuckey A. Benign breast disorders. Obstet Gynecol Clin North Am 2013; 40 (3): 459–73.
38. Ader DN, Shriver CD, Browne MW. Cyclical mastalgia: premenstrual syndrome or recurrent pain disorder? J Psychosom Obstet Gynaecol 1999; 20 (4): 198–202.
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Авторы
А.Э.Протасова*1,2, Е.Н.Вандеева1
1. ФГБУ «Северо-Западный федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2;
2. ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
*protasova1966@yandex.ru
________________________________________________
A.E.Protasova*1,2, E.N.Vandeeva1
1. V.A.Almazov North-West Federal Medical Research Center of the Ministry of Health of the Russian Federation. 197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2;
2. I.I.Mechnikov State Northwestern Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation, Saint Petersburg, ul. Kirochnaia, d. 41
*protasova1966@yandex.ru