Application possibilities of biguanides for fibrocystic breast disease in women of reproductive age

Abstract

Hypothesis/aims of study. The ongoing global problem of health care and medical science is an associated increase in the frequency of endocrine and metabolic diseases and cancer, including in women of childbearing age. Thus, the frequency of diabetes in the population has been growing rapidly for many years. Similar trends were observed in the dynamics of the frequency of cancer pathology, especially of breast cancer, which is one of the leading places in the structure of the cancer incidence in the female population. It is known that diabetes and related insulin resistance have a very negative effect on the female reproductive function, leading to hyperplastic processes of the mammary glands. The least studied problem so far is understanding the mechanisms of development, timely diagnosis, prevention, and treatment of fibrocystic mastopathy, the proliferative forms of which underlie malignant tumors, while its atypical variations are regarded as a precancerous condition. It is likely that the pathogenesis of hyperplastic processes in the mammary gland and the risk of neoplastic transformation in disorders of carbohydrate metabolism may have special factors. The actual problem is the development of a method for pathogenetically substantiated correction of fibrocystic breast disease. This is essential for the development of pharmacological strategies for secondary prevention of breast cancer and, in this regard, it is of great interest to study application possibilities of biguanides. The purpose of the present study was to conduct a comparative assessment of the effectiveness of metformin therapy in fibrocystic mastopathy patients with and without insulin resistance.
 Study design, materials, and methods. The study involved 120 women, aged 18 to 40 years inclusive, with clinical and / or ultrasound signs of fibrocystic breast disease. According to the results of calculating HOMA index, patients were divided into two groups: the first group comprised 66 patients with insulin resistance (HOMA > 2.5) and the second group consisted of 54 patients with no insulin resistance (HOMA < 2.5). Assessment of mastalgia was performed using the Visual Analogue Scale. Breast ultrasound examination was performed on days 5 to 7 of the menstrual cycle. For the purpose of quantitative image analysis of the breast parenchyma, the following parameters were evaluated: a) thickness of the parenchyma (fibroglandular zone); b) diameter of the milk ducts; c) echogenicity. All patients received metformin at a dose of 1500 mg per day. Dynamic control of the clinical picture of the disease, as well as of mammographic breast parenchymal pattern, was performed after 3 and 6 months from the start of therapy.
 Results and conclusion. After 6 months of therapy, there was a decrease in the frequency of mastalgia, and significant changes in breast ultrasound picture were observed. The data obtained on the positive effect of metformin on clinical mastitis and structural changes in the mammary parenchyma in patients with mastopathy allow considering such an approach as a promising therapeutic strategy in this pathological association.

Metformin in the management of fibrocystic breast disease: a placebo-controlled randomized clinical trial

“…We also found two studies that evaluated the effect of MF on FCD disorder in insulin-resistive and non-insulin-resistive patients that showed the positive effect of MF in the management of FCD in these patients [ 29 , 30 ].…”

Effects of oral N-acetyl cysteine on pain and plasma biochemical parameters in fibrocystic breast disorder: A randomized controlled trial

“…Regarding benign nature of FCC in association with its slow growth, close observation of the lesion beside therapy of symptoms is considered as the first line of treatment. To date, various herbal and synthetic medications like evening primrose oil; vitagnus; vitamins including D, E, and B; probiotics; metformin; and antioxidant agents have been introduced for prevention of symptoms in FCC, although there is no general consensus on any [ 1 , 6 , [9] , [10] , [11] , [12] ].…”

“…Therefore, identifying suitable medication with sufficient potency to control such pain could be interesting and helpful to recover patients. Based on previous studies that have demonstrated NAC could act as sulfhydryl group donor, restore glutathione, scavenge free radical, and also regulate production of sex hormones including estrogen and progesterone, we hypothesized that NAC could positively change oxidative stress reactions leading to inflammation and following FCC formation [ [8] , [9] , [10] , [11] , [12] ]. According to this hypothesis, this study aims to investigate possible effects of NAC on pain and biochemical parameters related to FCC.…”