Predisposing Factors for Idiopathic Granulomatous Mastitis: A Large Prospective Multicentric Study
-
Sadaf Alipour
,
Maryam Tabatabaeian
,
Parisa Aziminezhadan
,
Azin Saberi
,
Maryam Daneshpazhooh
,
Ramesh Omranipour
,
Paniz Famil-Amir
,
Najmeh Ahmadi
,
Maryam Sarkardeh
,
Nahid Nafissi
,
Azita Mazinani
,
Azadeh Joulaee
,
Shahla Astaraki
,
Zohreh Zahernia-Shahrbabaki
,
Reihane Tahery-Mehr
,
Maryam Gharini-Ahmadi
,
Behnaz Khajeh-Ali-Beiki
,
Marzieh Orouji
,
Bita Eslami
Abstract
Background: Idiopathic granulomatous mastitis (IGM) is a chronic breast disease with unknown pathophysiological and clinical aspects. Therefore, we designed this multi-center prospective case-control study to explore and clarify the risk factors with an acceptable sample size.
Methods: From March 2021 to December 2023, five hundred-four women with a histologically proven IGM were entered into the IGM group and 504 women with healthy breasts were included in the control group across nine centers. Participants' information was obtained by trained staff. Multivariate binary logistic regression was used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for the associations between variables and IGM.
Results: The mean age of all participants was 34.92 ± 7.12 yr. The previous history of diseases as a whole, was significantly higher in the IGM group (33.1%) compared with the control group (26.6%). Logistic regression showed that previous lactation (OR= 7.51, 95% CI= 2.37-23.77) and a positive history of diabetes (OR = 4.23, 95% CI= 1.32-13.51) had a positive association with IGM, while OCP use (OR = 0.70, 95% CI= 0.52-0.93) was associated with IGM reversely.
Conclusion: The history of breastfeeding and not its duration is associated with a 7-fold increase in the rate of IGM. Furthermore, previous history of diabetes is a risk factor, while OCP use is a protective factor against IGM. We are designing another study to further investigate the relationship between breastfeeding, milk stasis, and IGM, based on our findings.
1. Kessler E, Wolloch Y (1972). Granuloma-tous mastitis: a lesion clinically simulat-ing carcinoma. Am J Clin Pathol, 58(6):642-646.
2. Metanat S, Jobaneh YS, Noori M, et al (2022). Global distribution of idiopathic granulomatous mastitis: a scoping re-view: IGM global distribution. Arch Breast Cancer, 9(3-SI):261-271.
3. Omranipour R, Mohammadi SF, Samimi P (2013). Idiopathic granulomatous lobular mastitis-report of 43 cases from iran; in-troducing a preliminary clinical practice guideline. Breast Care (Basel), 8(6):439-443.
4. Kaviani A, Vasigh M, Omranipour R et al (2019). Idiopathic granulomatous masti-tis: Looking for the most effective ther-apy with the least side effects according to the severity of the disease in 374 pa-tients in Iran. Breast J, 25(4):672-677.
5. Yin Y, Liu X, Meng Q, et al (2022). Idio-pathic granulomatous mastitis: etiology, clinical manifestation, diagnosis and treatment. J Invest Surg, 35(3):709-720.
6. Alipour S, Tabatabaeian M, Nafissi N, et al (2023). Idiopathic Granulomatous Masti-tis and History of Hypothyroidism: In-tervening Data of a Prospective Multi-center Trial and Meta-Analysis of the Existing Literature: IGM and Hypothy-roidism. Arch Breast Cancer, 10(1):38-47.
7. Capiro N, Naik P, Lo A, et al (2023). De-mographic and socioeconomic risk fac-tors for granulomatous mastitis in the United States: a case-control study. J Breast Imaging, 5(2):174-179.
8. Pak H, Maghsoudi LH, Soltanian A, et al (2021). Evaluation of clinical manifesta-tion and risk factors of idiopathic gran-ulomatous mastitis. Int J Surg Open, 35:100380.
9. Ramadan R, Koryem IM, Fayed H (2022). Idiopathic granulomatous mastitis: Risk factors and management. Breast Dis, 41(1):413-420.
10. Raam M. Etiological evaluation of idio-pathic granulomatous mastitis by a pro-spective case control study [Doctoral dissertation]. Christian Medical College, Vellore; 2018.
11. Al-Khaffaf B, Knox F, Bundred NJ (2008). Idiopathic granulomatous mastitis: a 25-year experience. J Am Coll Surg, 206(2):269-273.
12. Pereira FA, Mudgil AV, Macias ES, et al (2012). Idiopathic granulomatous lobular mastitis. Int J Dermatol, 51(2):142-151.
13. Barreto DS, Sedgwick EL, Nagi CS, et al (2018). Granulomatous mastitis: etiology, imaging, pathology, treatment, and clin-ical findings. Breast Cancer Res Treat, 171:527-534.
14. Boufettal H, Essodegui F, Noun M, et al (2012). Idiopathic granulomatous masti-tis: a report of twenty cases. Diagn Interv Imaging, 93(7-8):586-596.
15. Li J, McGregor HP (2017). Idiopathic gran-ulomatous mastitis associated with hy-perprolactinemia: a nonoperative ap-proach. Breast J, 23(6):742-744.
16. Nikolaev A, Blake CN, Carlson DL (2016). Association between hyperprolac-tinemia and granulomatous mastitis. Breast J, 22(2):224-231.
17. Prasad S, Jaiprakash P, Dave A, et al (2017). Idiopathic granulomatous mastitis: an institutional experience. Turk J Surg, 33(2):100-103.
18. Moris D, Damaskos C, Davakis S, et al (2017). Is idiopathic granulomatous mas-titis a surgical disease? The jury is still out. Ann Transl Med, 5(15):309.
19. Altintoprak F, Kivilcim T, Ozkan OV (2014). Aetiology of idiopathic granu-lomatous mastitis. World J Clin Cases, 2(12):852-858.
20. Jafari A, Rajabi A, Gholian-Aval M, et al (2021). National, regional, and global prevalence of cigarette smoking among women/females in the general popula-tion: a systematic review and meta-analysis. Environ Health Prev Med, 26(1):5.
21. Goldman M, Selke HM, Pardo I, et al (2009). Idiopathic granulomatous masti-tis in hispanic women-Indiana, 2006-2008. MMWR Morb Mortal Wkly Rep, 58(47):1317-1321.
22. Ong SS, Xu J, Sim CK, et al (2003). Profiling Microbial Communities in Idiopathic Granulomatous Mastitis. Int J Mol Sci, 24(2):1042.
23. Uysal E, Soran A, Sezgin E (2018), Granu-lomatous Mastitis Study Group. Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study? ANZ J Surg, 88(6):635-639.
24. Koksal H (2021). What are the new findings with regard to the mysterious disease id-iopathic granulomatous mastitis? Surg Today, 51:1158-1168.
25. Alikhassi A, Azizi F, Ensani F (2020). Imag-ing features of granulomatous mastitis in 36 patients with new sonographic signs. J Ultrasound, 23:61-68.
26. Yücesoy C, Aydın ZB, Fidan N, et al (2021). Radiologic Features of Idiopathic Granulomatous Mastitis and Emphasis on Analysis of Socioeconomic Status: Over 5 Years of Experience. Indian J Surg, 84(Suppl 3):779-785.
27. Davis J, Cocco D, Matz S, et al (2019). Re-evaluating if observation continues to be the best management of idiopathic granulomatous mastitis. Surgery, 166(6):1176-1180.
28. Basim P, Argun D, Argun F (2022). Risk fac-tors for idiopathic granulomatous masti-tis recurrence after patient-tailored treatment: Do we need an escalating treatment algorithm? Breast Care (Basel), 17(2):172-179.
29. Bademler S, Ucuncu MZ (2018). Our Ther-apeutic Approach to Idiopathic Granu-lomatous Mastitis. Anatol Clin J Med Sci, 23(2):88-92.
30. Patmano M, Akcan A, Oz AB, et al (2019). Comparison of surgery and surgery plus corticosteroid therapy in idiopathic granulomatous mastitis, prospective randomized study. Ann Med Res, 26(12):2984-2989.
2. Metanat S, Jobaneh YS, Noori M, et al (2022). Global distribution of idiopathic granulomatous mastitis: a scoping re-view: IGM global distribution. Arch Breast Cancer, 9(3-SI):261-271.
3. Omranipour R, Mohammadi SF, Samimi P (2013). Idiopathic granulomatous lobular mastitis-report of 43 cases from iran; in-troducing a preliminary clinical practice guideline. Breast Care (Basel), 8(6):439-443.
4. Kaviani A, Vasigh M, Omranipour R et al (2019). Idiopathic granulomatous masti-tis: Looking for the most effective ther-apy with the least side effects according to the severity of the disease in 374 pa-tients in Iran. Breast J, 25(4):672-677.
5. Yin Y, Liu X, Meng Q, et al (2022). Idio-pathic granulomatous mastitis: etiology, clinical manifestation, diagnosis and treatment. J Invest Surg, 35(3):709-720.
6. Alipour S, Tabatabaeian M, Nafissi N, et al (2023). Idiopathic Granulomatous Masti-tis and History of Hypothyroidism: In-tervening Data of a Prospective Multi-center Trial and Meta-Analysis of the Existing Literature: IGM and Hypothy-roidism. Arch Breast Cancer, 10(1):38-47.
7. Capiro N, Naik P, Lo A, et al (2023). De-mographic and socioeconomic risk fac-tors for granulomatous mastitis in the United States: a case-control study. J Breast Imaging, 5(2):174-179.
8. Pak H, Maghsoudi LH, Soltanian A, et al (2021). Evaluation of clinical manifesta-tion and risk factors of idiopathic gran-ulomatous mastitis. Int J Surg Open, 35:100380.
9. Ramadan R, Koryem IM, Fayed H (2022). Idiopathic granulomatous mastitis: Risk factors and management. Breast Dis, 41(1):413-420.
10. Raam M. Etiological evaluation of idio-pathic granulomatous mastitis by a pro-spective case control study [Doctoral dissertation]. Christian Medical College, Vellore; 2018.
11. Al-Khaffaf B, Knox F, Bundred NJ (2008). Idiopathic granulomatous mastitis: a 25-year experience. J Am Coll Surg, 206(2):269-273.
12. Pereira FA, Mudgil AV, Macias ES, et al (2012). Idiopathic granulomatous lobular mastitis. Int J Dermatol, 51(2):142-151.
13. Barreto DS, Sedgwick EL, Nagi CS, et al (2018). Granulomatous mastitis: etiology, imaging, pathology, treatment, and clin-ical findings. Breast Cancer Res Treat, 171:527-534.
14. Boufettal H, Essodegui F, Noun M, et al (2012). Idiopathic granulomatous masti-tis: a report of twenty cases. Diagn Interv Imaging, 93(7-8):586-596.
15. Li J, McGregor HP (2017). Idiopathic gran-ulomatous mastitis associated with hy-perprolactinemia: a nonoperative ap-proach. Breast J, 23(6):742-744.
16. Nikolaev A, Blake CN, Carlson DL (2016). Association between hyperprolac-tinemia and granulomatous mastitis. Breast J, 22(2):224-231.
17. Prasad S, Jaiprakash P, Dave A, et al (2017). Idiopathic granulomatous mastitis: an institutional experience. Turk J Surg, 33(2):100-103.
18. Moris D, Damaskos C, Davakis S, et al (2017). Is idiopathic granulomatous mas-titis a surgical disease? The jury is still out. Ann Transl Med, 5(15):309.
19. Altintoprak F, Kivilcim T, Ozkan OV (2014). Aetiology of idiopathic granu-lomatous mastitis. World J Clin Cases, 2(12):852-858.
20. Jafari A, Rajabi A, Gholian-Aval M, et al (2021). National, regional, and global prevalence of cigarette smoking among women/females in the general popula-tion: a systematic review and meta-analysis. Environ Health Prev Med, 26(1):5.
21. Goldman M, Selke HM, Pardo I, et al (2009). Idiopathic granulomatous masti-tis in hispanic women-Indiana, 2006-2008. MMWR Morb Mortal Wkly Rep, 58(47):1317-1321.
22. Ong SS, Xu J, Sim CK, et al (2003). Profiling Microbial Communities in Idiopathic Granulomatous Mastitis. Int J Mol Sci, 24(2):1042.
23. Uysal E, Soran A, Sezgin E (2018), Granu-lomatous Mastitis Study Group. Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study? ANZ J Surg, 88(6):635-639.
24. Koksal H (2021). What are the new findings with regard to the mysterious disease id-iopathic granulomatous mastitis? Surg Today, 51:1158-1168.
25. Alikhassi A, Azizi F, Ensani F (2020). Imag-ing features of granulomatous mastitis in 36 patients with new sonographic signs. J Ultrasound, 23:61-68.
26. Yücesoy C, Aydın ZB, Fidan N, et al (2021). Radiologic Features of Idiopathic Granulomatous Mastitis and Emphasis on Analysis of Socioeconomic Status: Over 5 Years of Experience. Indian J Surg, 84(Suppl 3):779-785.
27. Davis J, Cocco D, Matz S, et al (2019). Re-evaluating if observation continues to be the best management of idiopathic granulomatous mastitis. Surgery, 166(6):1176-1180.
28. Basim P, Argun D, Argun F (2022). Risk fac-tors for idiopathic granulomatous masti-tis recurrence after patient-tailored treatment: Do we need an escalating treatment algorithm? Breast Care (Basel), 17(2):172-179.
29. Bademler S, Ucuncu MZ (2018). Our Ther-apeutic Approach to Idiopathic Granu-lomatous Mastitis. Anatol Clin J Med Sci, 23(2):88-92.
30. Patmano M, Akcan A, Oz AB, et al (2019). Comparison of surgery and surgery plus corticosteroid therapy in idiopathic granulomatous mastitis, prospective randomized study. Ann Med Res, 26(12):2984-2989.
| Files | ||
| Issue | Vol 54 No 3 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Case-control study Granulomatous mastitis Breastfeeding Risk factor | ||
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How to Cite
1.
Alipour S, Tabatabaeian M, Aziminezhadan P, Saberi A, Daneshpazhooh M, Omranipour R, Famil-Amir P, Ahmadi N, Sarkardeh M, Nafissi N, Mazinani A, Joulaee A, Astaraki S, Zahernia-Shahrbabaki Z, Tahery-Mehr R, Gharini-Ahmadi M, Khajeh-Ali-Beiki B, Orouji M, Eslami B. Predisposing Factors for Idiopathic Granulomatous Mastitis: A Large Prospective Multicentric Study. Iran J Public Health. 2025;54(3):645-653.
