Surgical management of periductal mastitis

Abstract

Although the clinical manifestations of periductal mastitis are now well recognized, the role of cigarette smoking in disease aetiology, and its effect on outcome, are unclear.‘-3 Initial reports that heavy cigarette smoking led to the disease have been verified.2,3 Over 90% of women with mammary duct fistulae, non-lactating breast abscesses and periductal mastitis are heavy cigarette smokersm3 Smoking correlates with the amount of histological periductal inflammatory infiltrate and squamous neoplasia of the terminal lactiferous ducts (leading to duct obstruction) is reported almost exclusively in heavy smokers.’ Altered bacterial population, toxic metabolites (e.g. epoxides), increased tissue damage and microvascular injury have all been suggested as mechanisms by which smoking causes the disease.’ Yet petiductal mastitis is a relatively rare condition, representing only 7% of referrals to a benign breast clinical, even though 33% of women are reported to smoke cigarettes regularly. The recent finding that postmenopausal women with N-acetyl-transferase 2 (NAT2) genetic polymorphisms which leads to slow acetylation and detoxification of carcinogenic aromatic amines in cigarette smoke predisposes women to breast cancer may provide a further clue.” Aromatic amines formed by cigarette smoke are known to cause DNA damage in breast epithelium and induce mammary tumours in laboratory animals. Altered detoxification of aromatic amines caused by inherited genetic polymorphisms, may alter an individual woman’s risk of developing periductal mastitis.6 In this issue of