Association between polycystic ovary and fibrocystic breast disease

The effect of polycystic ovarian syndrome on fibrocystic breast changes in postmenopausal women

Background

Fibrocystic breast changes (FCCs) are benign lesions thought to be caused by an increased estrogen-to-progesterone ratio. One of the most common endocrinopathies that increases this ratio is polycystic ovarian syndrome (PCOS). Although nonproliferative FCCs do not increase the risk of breast cancer, they can make mammographic detection of malignancy in postmenopausal women more difficult. The aim of this study was to investigate the effects of PCOS on the development of postmenopausal FCCs.

Methods

This retrospective cohort study used the TriNetX research network to identify two cohorts of postmenopausal women (Z78.0) older than 45, without a prior diagnosis of FCCs (N60.1) or hormone replacement therapy (Z79.890). One cohort included a diagnosis of PCOS (E28.2). The cohorts were balanced for age, race, ethnicity, and hormonally relevant comorbidities. The cohorts were then evaluated for the development of FCCs after menopause.

Results

Postmenopausal patients with PCOS were 52% more likely to develop FCCs than those without PCOS (2.2% vs. 1.4%, relative risk 1.52, 95% confidence interval 1.05, 2.22, P = 0.03).

Conclusion

Postmenopausal women with PCOS have a higher risk of developing FCCs. Further studies are needed to improve the differentiation of benign FCCs from malignant lesions on imaging for postmenopausal women with PCOS who develop FCCs.

Association of polycystic ovary syndrome with mammographic density in Turkish women: a population-based case-control study

OBJECTIVE

The objective of this study was to investigate the breast densities and Breast Imaging-Reporting and Data System scores of patients with polycystic ovary syndrome and normoovulatory women and to determine whether these patients constitute a high-risk population for breast cancer.

METHODS

This retrospective case-control study was conducted at our institution between January 2022 and December 2022, involving patients diagnosed with polycystic ovary syndrome. Menstrual periods, hyperandrogenemic findings, and ultrasound reports of the patients were retrieved from our hospital's database. Patients who met at least two of the Rotterdam criteria were included in the polycystic ovary syndrome group. A total of 70 premenopausal patients over the age of 40 years, diagnosed with polycystic ovary syndrome, and 70 normoovulatory women, matched for age and body mass index, were included in the study. The two groups were compared regarding age at menarche, menstrual pattern, gravida, parity, levels of follicle-stimulating hormone, luteinizing hormone, and estradiol, endometrial thickness, breast density category, and Breast Imaging-Reporting and Data System classifications.

RESULTS

Patients in the polycystic ovary syndrome group had a higher age at menarche (12.7 vs. 12.3, p=0.006). There was no difference between the gonadotropin levels in both groups. However, the estradiol level was higher in the polycystic ovary syndrome group (p<0.001). There was no statistically significant difference between the two groups in terms of breast density and Breast Imaging-Reporting and Data System scores (p=0.319 and p=0.650, respectively).

CONCLUSION

Although we can conclude that the risk of breast malignancy is not increased in patients with polycystic ovary syndrome, the impact of the complex hormonal status of polycystic ovary syndrome on breast cancer remains unclear in the literature.

The association of fibrocystic breast disease with endometrial histopathological results in abnormal uterine bleeding

Background/Aim: Fibrocystic breast disease (FBD) is the most frequent benign breast disease. Increased estrogen and decreased progesterone concentrations are thought to be involved in the pathogenesis of FBD. But there is insufficient data on benign breast disease and endometrial pathology. This study evaluates the association between FBD and endometrial pathology in women complaining of abnormal uterine bleeding. Methods: This study was designed as a retrospective case-control study. The medical records of women who had endometrial sampling for abnormal uterine bleeding between 2018 and 2020 were evaluated. Patients with FBD were included in the study group, while the first patients who had endometrial sampling after patients with FBD and without breast disease were recruited as the control group. Demographic, laboratory data, and endometrial histopathological results were obtained from hospital records and compared between the groups. Results: In total, 250 women (106 women with FBD and 144 without breast disease) were recruited for the study. There was no statistically significant difference in mean age, gravidity, parity, and BMI between FBD and control groups. Endometrial hyperplasia without atypia (19.8% versus 10.5%, respectively, P = 0.037) and endometrial polyp (12.2% versus 4.8%, respectively, P = 0.033) were found to be significantly increased in patients with FBD than women without the disease. There was no statistically significant difference in terms of other histopathological results between the groups. Conclusion: Evaluation of the endometrium for abnormal uterine bleeding is essential for early diagnosis and treatment of endometrial pathology, especially for endometrial cancer. In this study, we found that women with FBD have an increased risk for endometrial hyperplasia and endometrial polyp. As endometrial hyperplasia is a precursor lesion for endometrial cancer, clinicians should pay attention to and investigate menstrual bleeding abnormalities of women with FBD and should not delay the evaluation of the endometrium.

The effect of the polycystic ovary syndrome and hypothyroidism on the risk of fibrocystic breast changes: a meta-analysis

This meta-analysis aimed to determine the pooled association between polycystic ovary syndrome (PCOS), hypothyroidism, and fibrocystic breast changes. We searched important databases, including PubMed (Medline), Scopus, Web of Science, and Embase to retrieve all relevant studies published from 1990 to April 2021. The bias risk of selected articles was assessed based on the JBI checklist. Our search strategy yielded a total of 487 articles from the international databases. After screening their full-texts, 6 articles met the inclusion criteria and were considered for meta-analysis. The effect of PCOS on the incidence of fibrocystic breast changes was 2.49 (95% CI 1.85–3.34). Also, the effect of hypothyroidism on the incidence of fibrocystic breast changes was 1.90 (95% CI 0.92–3.93). The results showed that women with PCOS were at higher risks to develop fibrocystic breast changes.

Polycystic Ovary Syndrome and Fibrocystic Breast Disease: An Updated Review

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. There is no clear association between PCOS and benign breast disease (BBD). The latter is a frequent benign disorder, affecting women between 20 and 50 years of age. To date, the classification remains controversial, and the risk of developing breast cancer that is associated with these changes is different depending on the histopathological findings. The most frequent changes are breast cysts, which are noted in up to 50% of patients older than 30 years of age. This up-to-date review presents the relationship between PCOS and BBD. In conclusion, there is no clear association between benign breast disease and PCOS. Further studies on a large population with prospectively collected data using updated PCOS criteria are necessary.

High prevalence of benign mammary tumors in a rat model of polycystic ovary syndrome during postmenopausal period

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in reproductive-age women. Significant associations between PCOS and benign breast diseases (BBD) and a possibly potential association between PCOS and breast cancer have been reported. The etiology of these events of mammary glands in PCOS remains unclear. Animal models that show BBD and breast cancer may contribute to further understanding about these diseases. We aimed to examine the spontaneous occurrence of mammary tumors, their prevalence, and type in our rat model of PCOS. Prenatal androgen-induced PCOS rats and controls were examined in later life. Benign mammary tumors were observed in 75% and 33.33% of PCOS rats and controls during the postmenopausal period, respectively (p = .0158). Mammary tumors were non-invasive, margins of excision were normal and tumors were freely movable, in both groups. After microscopic evaluations of tumors, proliferative breast lesions and adenomas with a tubular growth pattern were observed in both groups. However, in PCOS rats, of benign tumors two had a mixed pattern of fibroadenoma/fibroma and cysts. High prevalence of benign mammary tumors was observed in our rat model of PCOS during the postmenopausal period, possibly due to hormonal imbalances during their reproductive lifespan; this model may contribute to current data available regarding the events of mammary glands in PCOS.

Is hyperandrogenemia protective for fibrocystic breast disease in PCOS?

The aim of this study is to evaluate the fibrocystic breast disease rates and its association with different clinical, endocrine and metabolic parameters between main polycystic ovary syndrome (PCOS) phenotypes. One hundred thirty two consecutive women were included in the study. Body mass index, serum follicle-stimulating hormone, luteinizing hormone (LH), progesterone, estradiol, testosterone, dehydroepiandrosterone sulphate, fasting glucose, low density lipoprotein (LDL-C), total cholesterol, high density lipoprotein, insulin, insulin sensitivity and fibrocystic breast disease rates were compared among different phenotypes of PCOS. Group 1: Polycystic ovaries (PCO)-anovulation (n = 32), Group 2: Hyperandrogenemia (HA)-anovulation (n = 28), Group 3: HA-PCO (n = 29), Group 4: HA-PCO-anovulation (n = 43). There were statistically significant differences between the different phenotype groups in terms of waist-hip ratio (p = 0.006), serum LDL-C (p = 0.008), LH (p = 0.002), estradiol (p = 0.022), fasting glucose (p = 0.001), progesterone (p = 0.007), free testosterone levels (p < 0.001) and Ferriman-Gallwey (FG) scores (p < 0.001). Different phenotype groups had significantly different fibrocystic breast disease rates. (p = 0.016). Higher free testosterone >3 pg/dl was protective for fibrocystic disease (RR = 0.316, 95:% CI 0.109-0.912, p = 0.033). Higher FG scores were more protective for fibrocystic disease (RR = 0.005, 95:% CI 0.001-0.042, p < 0.001). Group 3 ovulatory PCOS patients with PCO and hyperandrogenemia phenotype had lower risk to develop fibrocystic disease, while higher rates were observed in group 1 anovulatory-normoandrogenemic PCOS patients. Hyperandrogenemia is protective for fibrocystic diseases in PCOS.

[Polycystic ovary syndrome associated neoplasms]

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women on reproductive age. PCOS is characterized by the presence of anovulation, infertility and hyperandrogenism and is associated with obesity and insulin resistance. A major risk for neoplasms of the reproductive tract, like endometrial, breast and ovary cancer seems to be related to PCOS. While several studies have shown an increased risk for endometrial hyperplasia and cancer in PCOS patients, the variability of the selection criteria for PCOS has been recognized as a potential bias for these data. PCOS women also present clinical characteristics that are related to risk factors for breast cancer and some epidemiological evidences have been described on this issue. However, until now, a clear association between the presence of PCOS and breast carcinoma has yet not been found. Finally, high local steroid and growth factor concentrations are considered risk factors for ovary carcinoma, and are frequently observed in PCOS women. In turn, few studies have addressed the possibility of a link between PCOS and ovarian cancer and the results are conflicting but suggest that this association is unlikely.

The prevalence of benign breast disease in women with polycystic ovary syndrome: a review of a 12-year follow-up

A cross-sectional study of benign breast disease (BBD) was conducted to determine the actual prevalence and follow-up importance of BBD among women with polycystic ovary syndrome (PCOS) in conjunction with an ongoing prospective cohort study. The present study involved a subset of the original group of 244 women with a diagnosis of PCOS and 244 control women matched by age and race. A total of 240 women (116 cases and 124 controls) were included in the present analysis. The majority of women in each group were Caucasians (93 and 96%, respectively). The median age was 46 years in the cases and 47 years in the controls. Screening mammography begins at the age of 40 and has been carried out in 69% of cases and 66% of controls since the study began. Family history of breast disease was observed in 27 cases of both the groups (p > 0.05). Neither fibrocystic breast disease, lump thickening, calcification, fibroadenoma, pain, redness, discharge nor hyperplasia showed a significantly higher prevalence rate in cases than in controls. Eleven (9%) women with PCOS and 21 (17%) controls underwent diagnostic or curative surgery (relative risk: 0.56). These results, in contrast to the previously published literature, do not allow us to conclude that there is a higher risk for BBD among women with PCOS, and the proportion of women with a positive family history of breast cancer was significantly greater in women with PCOS compared with controls. Our observation is that having PCOS does not appear to affect surgeons' decisions to remove BBD.

Diameter of mammary terminal ducts as an additional tool in evaluation of women with polycystic ovarium disease

OBJECTIVE

Aim of this study was to show the change of diameter of mammary ducts in relation to polycystic ovaries disease.

DESIGN

Women who took part were divided into two groups- the first with polycystic ovaries disease and another second group with no such disease.

METHOD

To both groups a series of laboratory, clinical and ultrasound (u/s) exams were used to diagnose polycystic ovaries disease. Furthermore u/s measurement of mammary ducts was used to define the diameter.

RESULTS

In women with polycystic ovaries disease u/s showed an increase in diameter of mammary ducts whereas in the second group we didn't observe such finding.

CONCLUSION

Our study showed that there seems to be a strong relation between the increased diameter of the main terminal lactiferous ducts- the polycystic configuration of the ovaries and the hormonal levels.