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[IP] Diabetic Mastopathy

This is from an article in Diabetes Forecast

Denise Guerin
type 1 47 years
Minimed 507  3+years


Painless, Lumpy Breasts
You find a lump in your breast, and fear washes over you. But don't panic
yet. It might just be diabetic mastopathy--a little-known problem associated
with diabetes.

"Women with diabetes and their doctors need to know about this problem--and
that it does not appear to increase breast cancer risk--to help ease anxiety
when nodules arise," explained Timothy O'Brien, MD, a senior associate
consultant in endocrinology at the Mayo Clinic, who took part in a new study
of this condition. "Nonetheless, every nodule must be fully evaluated, often
with a biopsy, to make sure it is not malignant."

A woman with diabetic mastopathy has painless lumps in dense breast tissue,
and the tissue has immune cells in it, suggesting an autoimmune disorder.
The problem is most apt to occur in women in their late 30s who have type 1
diabetes (which is an autoimmune disease), whose blood glucose levels have
not been well controlled, and who also have diabetic retinopathy. Most
gynecologists, internists, and endocrinologists appear to be unaware of
diabetic mastopathy. The density of breast tissue in these women makes
interpretation of mammograms and ultrasonograms more difficult, and biopsies
are often done.

The researchers reviewed patient records of 16 women found to have the
disorder. All had type 1 diabetes. The women averaged 39 years of age and
had had diabetes for an average of nearly 27 years. Their average
glycohemoglobin was 11.7 percent (normal on this scale is under 7 percent),
and 94 percent had diabetic retinopathy.

"The usual presentation is a woman who has lumpy breasts but, with time, one
lump--called a nodule--stands out as more significant and can be felt by an
examining physician," explains Yogish C. Kudva, MD, an endocrinology fellow
at Mayo who presented the study at the American Diabetes Association
meeting. "They have dense breast tissue that is infiltrated with...immune
cells whose presence suggests that it is an autoimmune condition."

The presence of such a dominant nodule led to biopsy in 88 percent of the
women studied; indeed, 38 percent had more than one biopsy, with one woman
having had five such diagnostic procedures over a number of years as new
nodules developed.

"These women were followed for an average of seven years, and none developed
breast cancer," said O'Brien. "So the condition does not appear to be a risk
factor for breast cancer." While this knowledge can help ease women's
anxiety during the diagnostic process, O'Brien emphasized that one can never
assume that a lump will be benign. A full evaluation remains essential.

Thomas B. Crotty, MD, a senior associate consultant in pathology at Mayo,
explained that the pathologic findings differ from those in nondiabetic
women who have lumpy breasts. There is dense fibrosis, like scarring, and
immune cells in the tissue.

The researchers suggested that future studies should seek to better
understand the disorder and develop improved imaging techniques to diagnose
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