ACRT Journal

Introduction

Benign breast pathology is defined as a group of alterations in breast tissue which respond to hormonal mechanisms, external factors, such as lifestyle, nutritional habits, interacting with each other and that constitute a heterogeneous group of lesions that include developmental abnormalities, inflammatory lesions, epithelial and stromal proliferations, which have an association for the development of breast cancer, which include: palpable mass, mastalgia, nodularity, and cysts [1-3].

The importance of a deep understanding and knowledge about benign breast pathology is of great importance since it generates relief of attributable symptoms when this is possible, they can be identified in a timely manner and in turn know the patient’s history that may predispose her to a significant risk of cancer; as well as the distinction of benign from malignant pathology in a timely manner [4].

As for malignant breast pathology, breast cancer is the main exponent and is defined as the abnormal and disordered growth of cells of the epithelium of the breast ducts or lobules, which has the ability to spread. According to the World Health Organization (WHO), breast cancer is the most common neoplasm in women worldwide, representing 16% of all female cancers, which is why it is important to highlight its study, prevalence and prevention.

Mammography, as a screening method, plays an important role in the early detection of breast pathology, however, there are points of controversy that include the absence of consensus regarding the age at which it should be started, the appropriate interval between two screenings, the age at which it should be suspended, and the value of the method as screening in young women at high risk for cancer development [5]. The BI-RADS (Breast Imaging-Reporting and Data System) system is being used in health units and consists of seven stages (0-6), which are described as:

BI-RADS 0: Inconclusive due to incomplete reading.

BI-RADS 1: Normal breast.

BI-RADS 2: Benign (probability of cancer similar to the general population).

BI-RADS 3: Probably benign findings. (<2% risk of malignancy).

BI-RADS 4: Probably malignant (positive predictive value for cancer between 29-34% to 70%).

BI-RADS 5: Highly suggestive of malignancy (PPV for cancer greater than 70%).

BI-RADS 6- Malignancy confirmed histologically, but before starting definitive treatment.

Mammography should be annual in asymptomatic women from 40 years of age to 69 years of age, since this measure has been shown to reduce mortality and is applied worldwide [3].

Women with dense breasts according to the BI-RADS classification had an increased risk of breast cancer, increasing the risk and odds ratio of breast cancer among women with dense breast (heterogeneous and extremely dense breast) was 1.9 (95% confidence interval, 1.3-2.8) compared to women with fatty breasts. followed by factors such as body mass index, age at menarche, age at menopause, age at first delivery, number of live births, use of oral contraceptives, family history of breast cancer, previous breast procedures and use of hormone replacement therapy, considered as factors that are related to the presence of benign and malignant breast pathology [6-10].

A history of benign breast diseases can be developed by several risk factors which can be non-modifiable or modifiable, among the non-modifiable can be included menarche and genetic factors such as age, race, family history of breast cancer and personal history of benign breast diseases, while among the modifiable risk factors we have diet, smoking, alcohol consumption, sedentary lifestyle, overweight or obesity, non-breastfeeding [11, 12].

Our objective is to determine the risk factors associated with benign and malignant breast pathology, from 40 to 69 years of age, since in our country breast cancer is an important public health problem, due to the constant increase in incidence and mortality values.

Materials and Methods

A comparative, observational, cross-sectional, ambispective study was carried out in the Family Medicine Unit (UMF) 55. A total of 326 women aged 40 to 69 years who underwent mammography in the last 2 years and who had a mammogram interpretation report were included, the associated factors that were studied are: intake of oral contraceptives, alcohol consumption, smoking, sedentary lifestyle, breastfeeding and obesity. For the bivariate analysis for the variables smoking, alcohol consumption, exercise, use of oral hormones (dichotomous) compared to the presence of breast pathology (dichotomous), the chi-square test was used, while for nutritional status (ordinal) the Mann-Whitney U test was used. Statistical significance was defined with a value of p≤0.05.

Results

Information from 326 women whose median age was 53 years was analyzed, with an interquartile range of 25, 75 (IQR 25.75) of 52.15 and 53.77 years, respectively.

Within the anthropometric measurements, it was observed that the median weight of the patients is 70.3 kg with an IQR of 25, 75 of

70.00, 73.08 kg respectively, with respect to height the median is

1.53 meters with an IQR of 25 of 1.52 meters and an IQR of 75 of 1.54 meters, on the other hand the median body mass index (BMI) is 29.53 with an IQR of 25, 75 of 29.72, 30.92 kg/m2 respectively.

In nutritional status, it was found that 46.3% (151) of the participants were in the obesity group, while 40.2% (131) were overweight and only 13.5% (44) were of normal weight.

Regarding the presence of breast pathology, it was observed that 17.5% (57) of the participants were present with breast pathology compared to 82.5% (269) of patients who were without the presence of breast pathology (Figure 1, Table 1).

Figure 1: Diagram of sectors with the presence of breast pathology in women aged 40 to 69 years.

Table 1: Sociodemographic characteristics of women aged 40 to 69 years.

According to the risk factors, it was observed that 26.1% (85) of the participating women reported smoking, while 73.9% (241) did not smoke (Figure 2), on the other hand, 18.7% (61) reported consuming alcohol and 81.3% (265) did not consume alcohol, with respect to breastfeeding was practiced by 72.4% (236). Moreover, 27.6% (90) did not breastfeed, in contrast to the patients who perform physical exercise, 33.1% (108) reported physical exercise and 66.9% (218) did not, on the other hand, the use of hormonal methods was observed that 21.2% (69) reported using hormonal methods and 78.8% (257) did not use it.

Figure 2: Distribution of smoking consumption with the presence of breast pathology.

The BIRADS classification showed a higher frequency of the BIRADS 2 group with 71.5% (233) of the cases, followed by BIRADS 1 with 10.7% (35) and BIRADS 0 with 8.6% (28) of the cases, i.e., 90.8% of the participants were classified in BIRADS 0, 1 and 2, while the remaining 9.2% were classified in BIRADS 3, 4 or 5.

Next, the comparative analysis of the sociodemographic variables by smoking habit was carried out, observing that 85 women (26.1) smoked compared to 241 women (73.9) who did not report this habit. The age of the women was analyzed, observing that there was no difference in the median age, the median age reported was 53 years, with a IQR of 25.75 for women with smoking between 47 and 58 years, while women without smoking registered an IQR of 25.75 for women aged 47 to 59 years (p=0.965).

With respect to weight, it is observed that the difference between patients with smoking is 1 kg compared to patients without smoking, reporting a median weight of 71 kg with an IQR 25.75 of 63.40.79.25 and an IQR 25.75 of 64.40.79 for those who do not smoke (0.895).

The height of the women was analyzed, observing that there was no difference in the medians of age, the median height reported was 1.53 meters, with a IQR of 25.75 for women with smoking of 1.50 to 1.57 meters, while women without smoking registered an IQR of 25.75 from 1.49 to 1.57 years (p=0.507).

Regarding body mass index, there was a difference of 0.21 kg/ m2 compared to patients without smoking, reporting a median of 29.47 with a IQR 25.75 of 27.05, 32.66, and a median of 29.68 with a IQR 25.75 of 26.56, 33.27 for those who did not smoke (p=0.931).

Of the nutritional status groups with and without the presence of tobacco consumption; In the group of women with tobacco use, the most frequent nutritional status was obesity with 27.2% (41), followed by the normal group and the nutritional status of overweight with 31.8% and 22.9%, respectively, with overweight being the most frequent in patients without smoking in 77.1% (101) and in a lesser proportion in obesity and normal nutritional status in 72.8% and 68.2% respectively (p=0.990).

Regarding alcohol consumption, the percentage of women who did consume alcohol within the group of women with smoking was 60.7% (37), which is similar to the percentage of women without smoking, which was 39.3% (24) (p= <0.001).

It was observed that, within the group of women with breastfeeding and tobacco consumption, 25% (59) had it compared to women who were not breastfed and 75% (177) without tobacco consumption (p=0.475).

In terms of physical exercise, the percentage of women who did not exercise within the group of women with smoking is lower than the group of women without smoking at 75%. (p=0.966).

Regarding the use of hormonal methods, the percentage of patients who did use within the group of women with smoking was 22 (31.9), with a difference of 25 patients compared to those who did use hormonal methods and smoked, in contrast to those who did not use hormonal methods, with a difference of 131 patients who did not smoke, 194 (75.5) (p=0.216).

Finally, in the cross-referencing of the BIRADS classification with the presence of breast pathology, it was observed that while in the group of women with smoking the most frequent BIRADS classification was BIRADS 2 with 25.3% (59), in the group of women without smoking this percentage was 74.7% (174). No statistically significant association was found between the BIRADS classification and tobacco consumption (p=0.172) (Table 2).

Table 2: Comparison of the sociodemographic characteristics of women aged 40 to 69 years by the presence of smoking.

Bivariate analysis of the presence of pathology and without the presence of pathology was performed with the different risk factors, with a frequency of 61 patients who present a lower presence of breast pathology with the use of oral hormonal methods compared to those who do not use them, with a total of 208 patients p of 0.147, being statistically not significant (Table 3).

Table 3: Analysis of the factors associated with smoking in women aged 40 to 69 years associated with benign and malignant breast pathology.

Discussion

The present research aimed to identify the risk factors associated with benign and malignant breast pathology in women aged 40 to 69 years at the Family Medicine Unit 55 (FMU 55). The results obtained provide a detailed overview of the demographic and health characteristics of the population studied, allowing comparison with the existing literature.

In terms of demographic characteristics, the median age of 53 years reflects a predominantly postmenopausal female. This finding is consistent with previous studies that suggest an increase in the incidence of breast pathology with age. The prevalence of obesity of 46.3% in our sample is also consistent with the global trend of increasing obesity and its association with an increased risk of breast cancer.

Smoking, reported by 26.1% of the participants, emerged as a factor of interest. Although the literature supports the association between smoking and breast cancer, it should be noted that the relationship between these two factors is complex and may depend on other elements, such as the duration of smoking and the amount of tobacco consumed. In our comparison by smoking, it was found that demographic and health variables, such as age, weight, height, and BMI, did not differ significantly between smokers and non-smokers, which is consistent with some studies that do not find a direct association between these variables and smoking.