Predisposing Factors for Granulomatous Lobular Mastitis: A Case-Control Study

Yifei Zeng; Dongxiao Zhang; Wenjie Zhao; Na Fu; Qiao Huang; Shuqi Li; Chang Gao; Jiale Yu

doi:10.2147/IJWH.S414054

Predisposing Factors for Granulomatous Lobular Mastitis: A Case-Control Study

Int J Womens Health. 2023 Jul 18:15:1063-1075. doi: 10.2147/IJWH.S414054. eCollection 2023.

Authors

Yifei Zeng^{1

2}, Dongxiao Zhang¹, Wenjie Zhao¹, Na Fu¹, Qiao Huang¹, Shuqi Li², Chang Gao², Jiale Yu²

Affiliations

¹ Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People's Republic of China.
² Graduate School, Beijing University of Chinese Medicine, Beijing, People's Republic of China.

Abstract

Background: Despite the rising incidence rate of granulomatous lobular mastitis (GLM), uncertainties persist about its etiologic and predisposing factors to guide clinical treatment and early prevention. The objective of this study is to explore the predisposing factors for GLM.

Patients and methods: This case-control study was conducted from 2018 to 2021 at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. Patients with GLM (cases) were matched with healthy examinees (controls) in a 1:1 ratio according to gender and living area. We analyzed their demographic features and investigated 75 factors that may be relevant to GLM using a standard questionnaire. Univariate and multivariable binary conditional logistic regression analyses were used to compare the differences between the two groups and evaluate the predisposing factors that may induce GLM.

Results: There were 594 female GLM patients and 594 matched controls included in the study. The average age of the cases was 32.78 years (mainly 20 to 40). The incidence was high within five years after childbirth, and lesions were mainly in the unilateral breast. Univariate and multivariable conditional logistic regression analyses obtained six relevant factors and six high-risk factors. The six relevant factors included age, marriage, emotional abnormality, high prolactin, psychiatric drug intake, and sex hormone intake. Additionally, the independent high-risk factors for GLM included gestation, nipple invagination, blunt trauma, non-iatrogenic massage, lactation disorder, and nipple discharge (odds ratio (OR)=17.378, 8.518, 4.887, 3.116, 2.522, 1.685, P<0.05). Menopause was an independent protective factor (OR=0.249, P<0.05).

Conclusion: The factors that increase milk and secretion production in the mammary duct are the main risk factors of GLM, especially when the nipples are invaginated. These factors can obstruct the duct and induce inflammation. Additionally, hormonal disorders, extrinsic trauma, and emotional abnormalities can accelerate the occurrence of GLM.

Keywords: GLM; case-control study; etiology; granulomatous lobular mastitis; predisposing factor; risk factor.

Grants and funding

This study was supported by the Beijing Ten Million Talent Plan Project (no. 2019A31); Gansu Provincial Science and Technology Program Subsidized Projects (21JRIRG303); Research and Transformation of Clinical Diagnosis and Treatment Technology in Beijing (Z211100002921020); Young Doctor Scholar Project (2022).