Breast Pain Research Articles

Delayed presentation of breast cancer patients and contributing factors in East Africa: Systematic review and meta-analysis.

Breast cancer remains a significant public health issue, with delayed medical attention often leading to advanced stages and poorer survival rates. In East Africa, evidence on the prevalence and factors contributing to the delayed presentation of breast cancer is limited. As a result, this study aims to assess the pooled prevalence of delayed breast cancer presentation and identify contributing factors in East Africa. We conducted a systematic review of observational studies from East Africa using PubMed, Google Scholar, Embase, Cochrane Library, Hinari, and Mednar databases. The Newcastle Ottawa 2016 Critical Appraisal Checklist assessed methodological quality. Publication bias was evaluated using a funnel plot and Egger's test, and heterogeneity was examined with the I-squared test. Data were extracted with Microsoft Excel and analyzed using Stata 11. The pooled prevalence of delayed presentation among breast cancer patients in East Africa was 61.85% (95% Confidence Interval: 48.83%-74.88%). Significant factors contributing to delayed presentation included visiting traditional healers (Adjusted Odds Ratio: 3.52; 95% CI: 1.43-5.59), low educational levels (Adjusted Odds Ratio: 3.61; 95% CI: 2.39-4.82), age>40 years (Adjusted Odds Ratio 1.87; 1.03, 2.71), absence of breast pain (Adjusted Odds Ratio 2.42; 1.09, 3.74), distance >5km away from home to health institution (Adjusted Odds Ratio 2.89; 1.54, 4.24), and rural residence (Adjusted Odds Ratio: 3.33; 95% CI: 2.16-4.49). This meta-analysis's findings demonstrated that over half of breast cancer patients in East Africa delayed detection. Significant factors associated with delayed presentation include age over 40 years, illiteracy, rural residence, use of traditional healers, distance greater than 5 km from a health facility, and absence of breast pain. Healthcare stakeholders and policymakers must be focused on raising awareness and educating people to encourage early detection and prompt therapy.

Ultrahypofractionated Adjuvant Breast Radiotherapy (+/- Boost) and Virtual Consultations: Patient Perspectives at One Year

Purpose/Objectives: In March 2020, a 1 week ultrahypofractionated adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions and telehealth were adopted to reduce the risk of COVID-19 for staff and patients. This study describes real world 1 year late toxicity for ultrahypofractionation (including a sequential boost) and patient perspectives on this new schedule and telehealth workflows. Materials and Methods: Consecutive patients were enrolled Mar-Aug 2020. Patient reported outcome measures including the presence of breast pain, swelling, firmness, and others were recorded using the EORTC QLQ BR45 at baseline, 3 months, 6 months and 1 year. Virtual teleconferencing without video was utilised. Patients were invited to use video at 1 year for a physician based assessment including breast inspection. Patient reported experience measures were also collected at 1 year to capture how a shortened schedule and telehealth influenced patient experience. ResultsIn total, 121/135 patients completed at least two assessments of which 33 (25%) received a sequential boost. The majority of patients reported no toxicity or a mild toxicity at all three time points, 76% at 3 months, 76% at 6 months, and 82% at 1 year. When comparing 26Gy in 5 fractions alone versus 26 Gy in 5 fractions followed by a sequential boost, there was no difference in toxicity reported at one year.94% felt supported by the medical team throughout their treatment course using telehealth only consultations. Only 27% actually agreed to video consultation for the purpose of breast inspection when offered. ConclusionsUltrahypofractionated breast radiotherapy leads to acceptable late toxicity at 1 year even when followed by a hypofractionated tumour bed boost. Patient satisfaction with ultrahypofractionated treatment and virtual consultations without video was high. Further investigation concerning the patient acceptance of video consultations for a physician-based assessment including breast inspection is warranted.

FREQUENCY OF DIFFERENT CAUSES OF MASTALGIA WITHOUT NIPPLE DISCHARGE AMONG WOMEN PRESENTING AT TERTIARY CARE HOSPITAL

Mastalgia, or breast pain, is a common complaint among women, often impacting quality of life and requiring clinical attention. Understanding the underlying causes of mastalgia is essential to guide management and improve patient outcomes. Objective: The objective of this study was to determine the frequency and associated causes of mastalgia in women presenting to a tertiary care hospital. Methods: This cross-sectional study was conducted at the Department of Surgery, Civil Hospital, Karachi, from March 1, 2023, to August 30, 2023, after obtaining ethical approval from the institutional review board. A total of 176 female patients aged 18–49 years with complaints of mastalgia were included in the study through non-probability consecutive sampling. Both married and unmarried women were enrolled, and data were collected on demographic variables, lifestyle factors, and psychological factors. Statistical analysis was performed to evaluate associations between causes and mastalgia severity. Results:The most common causes of mastalgia identified were caffeine consumption (56%), depression (57%), and smoking (49%). Significant associations were found between mastalgia severity and both smoking (p=0.002) and caffeine consumption (p=0.003). Smokers and caffeine consumers reported higher levels of pain severity. Conclusion: Mastalgia is frequently associated with modifiable lifestyle factors such as smoking and caffeine intake, as well as psychological factors like depression. Addressing these factors may help manage and reduce the severity of mastalgia in affected patients.

The effect of spironolactone versus eplerenone on blood pressure targets in resistant hypertension patients

Abstract Objective to evaluate different effects on blood pressure (BP) control in two treatment options spironolactone (SPIR) versus eplerenone (EPL) as an add-on therapy in resistant hypertensive (RAH) patients. Design and methods: We studied 208 patients with true RAH confirmed by the office and ambulatory BP monitoring (ABPM) despite the use of 3 antihypertensive medications including a calcium channel blocker, a blocker of the renin-angiotensin system, and a thiazide diuretic with maximally tolerated doses for at least 3 months. Patients were randomized into 2 groups throughout 12 weeks of once-daily treatment with SPIR (25–50 mg) or EPL (25-50 mg) in addition to their baseline triple-combination and then rotated with drugs. BP was measured in the office and by ABPM. Changes in laboratory tests were also studied. The predictive values of plasma aldosterone, active renin concentration (ARC), aldosterone-renin ratio (ARR), and serum potassium were analyzed to determine the antihypertensive response. Results There were no significant differences in the reduction of average office BP, average systolic 24-h, daytime, and nighttime BP by SPIR and EPL. SPIR reduced average diastolic 24-h BP by 7.3 mm Hg, diastolic daytime BP by 7.2 mm Hg, and diastolic nighttime BP by 7.5 mm Hg compared with a reduction of 5.6 mm Hg (P = 0.01), 5.6 mm Hg (P = 0.03) and 4.2 mm Hg (P = 0.0001) with EPL, respectively. Overall, 40.7 % RAH patients achieved targets of clinical BP and 24-h ABPM levels on SPIR and 33.3 % on EPL (Р = 0.002). After 12 weeks of treatment mean plasma potassium concentrations increased by 7.1 (P = 0.0001) on SPIR and by 5.0 % (Р = 0.0001) on EPL, but eGFR did not significantly change on the two drugs. Plasma aldosterone (β = 0.498, Р = 0.02) and ARC (β= -0.374, Р = 0.04) were predictors of the BP-lowering effect of SPIR and plasma aldosterone (β = 0.453, Р = 0.04) was a predictor of reduction BP for EPL in multivariate modeling. Breast pain or tenderness, changes in sex drive, and irregular menstrual cycles or spotting were more often by SPIR than by EPL (5.2 % vs 1.9 %, respectively, P = 0.04). Conclusions The greater antihypertensive effect of SPIR is related to aldosterone status, ARS level in resistant hypertension. EPL may be recommended for RAH patients who have high serum potassium levels that cannot tolerate spironolactone and for people with systolic resistant hypertension.

Turmeric Topical Application: An effective solution for reducing breast milk secretion delays in new mothers

Background: The problem of low coverage of exclusive breastfeeding is partly influenced by insufficient breast milk production. The percentage of exclusive breastfeeding in infants under six months of age in Central Kalimantan in 2020 was 52.98%. This percentage was among the lowest nationally. In 2021, the coverage of exclusive breastfeeding in infants under six months of age reached 56.8%, and in 2022 it did 60.5%. The figure in 2022 exceeded the set target, but several regencies/cities still had low coverage. Insufficient breast milk supply impacts on the nutritional status of the child. Low breast milk production also arises due to several other factors during breastfeeding, namely late initiation of breastfeeding, long breastfeeding time, sore nipples, breast pain and swelling, and inverted nipples. Aims: The study sought to measure the level of success of turmeric topical application in shortening the time it takes to initiate breast milk secretion. Methods: The study uses a true experimental posttest-only control group design. A subject of 50 mothers having full-term spontaneous deliveries and with normal breasts was used in the study. The sample was divided into two groups: control and intervention groups. The sample was selected using a matching process based on age, parity, and early initiation of breastfeeding. Subjects who met the inclusion criteria were offered whether they were willing to be given turmeric compresses after the delivery process. Subjects who were willing were included in the intervention group and those who were not willing were included in the control group. Age and parity in the intervention group were all taken, while the control group was selected to match the intervention group. The intervention group was given a treatment with a turmeric compress on the breasts for six hours. All participants were then observed for time of breast milk secretion initiation. In this experiment, we didn't perform blinding, but we managed it by having the midwife administer the turmeric compress just once during the delivery process before sending the client home. Following this, we recorded the results, specifically the initial breast milk release in both the intervention and the control group. Results: The average time periods it took to initiate breast milk secretion in the intervention and control groups were 509.96 minutes (8.5 hours) and 1573.76 minutes (26.2 hours), respectively. There was a significant difference (p = 0.023) in the time of breast milk secretion initiation of 1063.8 minutes or 17.73 hours between both groups. Conclusion: Applying a turmeric compress on the breasts of postpartum mothers may shorten the time it takes to initiate breast milk secretion. Received: 05 August 2024, Reviewed: 23 August 2024, Revised: 21 September 2024, Accepted: 13 October 2024.

Drug treatment of true gynecomastia in overweight adult men

BACKGROUND: True gynecomastia is associated with excess body mass, which is caused by an imbalance of androgens/estrogens. Therefore, there is an interest in evaluating the possibility of drug therapy for this condition through the use of antiestrogens or aromatase inhibitors.AIM: To evaluate the possibility of drug therapy for true gynecomastia in adult men with excess body mass through the use of clomiphene or letrozole.MATERIALS AND METHODS: A retrospective study included men with newly developed gynecomastia and excess body mass who sought medical help at the Endocrinology Research Center from January 2020 to May 2024, and received either clomiphene therapy or letrozole for a period of 4 weeks. All patients were evaluated for the condition of their breast glands, total bilirubin, liver transaminases, creatinine, urea, luteinizing hormone, prolactin, sex hormone-binding globulin, estradiol, total testosterone, alpha-fetoprotein, and chorionic gonadotropin. The baseline level of statistical significance was set at p<0.05.RESULTS: With clomiphene treatment, no statistically significant differences were found in the evaluated parameters, except for estradiol and testosterone levels, which increased. Clomiphene therapy worsened the condition of three patients (13% (95% CI 2,8;33,6)) - they experienced breast pain that was not present at the time of prescription. With letrozole treatment, there was a positive trend - all evaluated parameters significantly improved. Comparing the changes in the studied parameters, it was found that letrozole treatment had a better effect in terms of the severity of gynecomastia (-1[0;-1] degree), reduction in estradiol levels (-31,7[-8,8;-90,8] pmol/l), and also reduced the number of patients willing to undergo surgical removal of gynecomastia (-63,4% (95% CI -46,9;-77,9)).CONCLUSION: The use of an aromatase inhibitor reduces the severity of gynecomastia and decreases the number of patients willing to undergo surgical removal.

7071 Cushing disease presenting with Dilated Cardiomyopathy

Abstract Disclosure: H. Majeed: None. C. Nguyen: None. R. Galagan: None. D. Lovre: None. Background: Hypercortisolism manifests with numerous ways due to the wide distribution of glucocorticoid receptors. Here we describe a case of Cushing’s disease presenting with reversible non-ischemic cardiomyopathy. Case Presentation: A 30-year-old male presented to ER with palpitations, dyspnea, and atypical chest pain. His exam was notable for a BMI of 30.26 kg/m2, HR 76 bpm and BP of 200/110 mm Hg. His EKG revealed Left ventricular hypertrophy. Echocardiogram (ECHO) showed an EF of 25-30% with diffuse hypokinesis. An angiogram demonstrated normal coronary anatomy. He was started on Lisinopril, Carvedilol, and Spironolactone for non-ischemic cardiomyopathy. He also complained of a 40 lb weight gain, loss of libido, hot flashes and breast tenderness. He was referred to endocrinology. Initial evaluation demonstrated total testosterone (TT) of 171 ng/dl (286-1511 ng/dl), FSH 3.8 IU/L (2-12 IU/L), LH 5.6 IU/L (2-9 IU/L) consistent with secondary hypogonadism. Further pituitary workup revealed AM cortisol level 31.22 mcg/dl (4.3-22.4mcg/dl), ACTH 79 pg/ml (7.2 - 63.3pg/ml), IGF-1 257 ng/mL (88-246 ng/mL), Prolactin 23.7 ng/dl (2.1- 17.7ng/dl), TSH 0.54 mIU/l (0.35-3.74mIU/l) and FT4 0.6 ng/dl (0.76-1.46 ng/dl). A 24hr urine cortisol was 167 ug(0-50ug/24h) and midnight salivary cortisol 0.160 ug/dl (<0.010-0.090 ug/dl). An overnight 1mg dexamethasone suppression test (DST) resulted in AM cortisol of 20.95 mcg/dl (<1.8mcg/dl) and 8mg DST cortisol fell from 34 mcg/dl to 4.16 mcg/dl. A pituitary MRI revealed a left 6 mm x 4 mm microadenoma. He was treated with levothyroxine pre-op for central hypothyroidism. He underwent transsphenoidal resection of the pituitary adenoma. Post-op AM cortisol was 1.1 mcg/dl. His steroid withdrawal syndrome was treated with a prolonged course of tapered hydrocortisone. Two months post-op ECHO showed EF of 55-60%. His BP normalized on carvedilol alone. Eighteen months post-op he no longer required any hormone replacement. Repeat ACTH 24.4 pg/ml, Total Testosterone 584ng/dl, TSH 0.57 mIU/l and FT4 0.93 and 24hr urine cortisol was 24ug/dl, MN salivary cortisol <0.10 ug/dl confirming remission of his cushing's disease and resolution of secondary hypogonadism and hypothyroidism. Conclusion: Prolonged hypercortisolism can cause abnormal cardiac remodeling resulting in cardiomyopathy. Surgical remission of Cushing’s disease reverses hypercortisolism which may restore normal cardiac function. Presentation: 6/2/2024

7019 Persistently Elevated Estradiol Levels in a Transgender Male; An Unexpected Pregnancy

Abstract Disclosure: M. Kanin: None. S. Grock: None. N. Agrawal: None. Background: Testosterone is the backbone of gender-affirming hormone therapy (GAHT) for transmasculine and non-binary individuals assigned female at birth (AFAB). While testosterone can affect fertility, it should not be used as contraception and is contraindicated in pregnancy. It is important to counsel patients on fertility preservation, pregnancy, and contraceptive options prior to testosterone initiation. However, the Endocrine Society Guidelines and World Professional Association for Transgender Health Standards of Care provide minimal guidance on reproductive health and contraceptive options. Case Description: An 18-year-old individual AFAB on GAHT with testosterone was referred to endocrinology for elevated estradiol levels. On presentation, the patient denied vaginal bleeding or breast tenderness. The date of last menstrual period was reported as two years prior. There was no significant past medical or surgical history. Medications included subcutaneous testosterone cypionate 20 mg weekly. Physical exam was notable for elevated BMI 42.6kg/m², mild facial hair and central adiposity. Hormone analysis revealed testosterone of 172 ng/dL (adult male: 200-1000) and estradiol 27,322 pg/mL (mid-cycle Female: 80-400). Estradiol by mass spectrometry obtained due to concern for immunoassay interference resulted at > 10,000 pg/mL. FSH <0.1 mIU/mL, LH<0.1 mIU/mL, DHEA-S 2,460 ng/mL (adult female: 400-3600), androstenedione 1.85 ng/mL (0.260 - 2.140), prolactin 328 ng/mL (3 -23.1). CT abdomen and pelvis and pituitary MRI were ordered to assess for ovarian, adrenal and/or pituitary tumor. Later that day additional laboratory tests revealed alpha fetoprotein 126 ng/mL (0 -6.7), progesterone 100.2 ng/mL (luteal phase: 3.0-25.0), beta-hCG 32,571 mIU/ml, inhibin B<10, inhibin A 500.1pg/ml (luteal phase: 40-80) and CA-125 19 U/mL (0 - 35). Given the elevated beta-hcg the patient was asked if they were having sex in a way that could result in pregnancy to which they answered affirmatively. CT and MRI were cancelled, and abdominal ultrasound was obtained which revealed a single living intrauterine pregnancy with estimated gestational age 35 weeks 2 days. Testosterone was stopped and they subsequently delivered a healthy baby girl. Conclusion: Gender diverse patients on testosterone can experience unplanned pregnancy. As testosterone is contraindicated in pregnancy, counseling on reproductive health and contraception is needed. A pregnancy test should be considered prior to initiating hormones for appropriate individuals. It is important to be aware that Individuals AFAB may not desire estrogen containing birth control and placement of intrauterine devices can be dysphoric. Further investigation into how contraceptive options may affect outcomes for individuals on GAHT is needed to minimize barriers to care and to enable patients to make well informed decisions. Presentation: 6/2/2024

7019 Persistently Elevated Estradiol Levels in a Transgender Male; An Unexpected Pregnancy

Abstract Disclosure: M. Kanin: None. S. Grock: None. N. Agrawal: None. Background: Testosterone is the backbone of gender-affirming hormone therapy (GAHT) for transmasculine and non-binary individuals assigned female at birth (AFAB). While testosterone can affect fertility, it should not be used as contraception and is contraindicated in pregnancy. It is important to counsel patients on fertility preservation, pregnancy, and contraceptive options prior to testosterone initiation. However, the Endocrine Society Guidelines and World Professional Association for Transgender Health Standards of Care provide minimal guidance on reproductive health and contraceptive options. Case Description: An 18-year-old individual AFAB on GAHT with testosterone was referred to endocrinology for elevated estradiol levels. On presentation, the patient denied vaginal bleeding or breast tenderness. The date of last menstrual period was reported as two years prior. There was no significant past medical or surgical history. Medications included subcutaneous testosterone cypionate 20 mg weekly. Physical exam was notable for elevated BMI 42.6kg/m², mild facial hair and central adiposity. Hormone analysis revealed testosterone of 172 ng/dL (adult male: 200-1000) and estradiol 27,322 pg/mL (mid-cycle Female: 80-400). Estradiol by mass spectrometry obtained due to concern for immunoassay interference resulted at > 10,000 pg/mL. FSH <0.1 mIU/mL, LH<0.1 mIU/mL, DHEA-S 2,460 ng/mL (adult female: 400-3600), androstenedione 1.85 ng/mL (0.260 - 2.140), prolactin 328 ng/mL (3 -23.1). CT abdomen and pelvis and pituitary MRI were ordered to assess for ovarian, adrenal and/or pituitary tumor. Later that day additional laboratory tests revealed alpha fetoprotein 126 ng/mL (0 -6.7), progesterone 100.2 ng/mL (luteal phase: 3.0-25.0), beta-hCG 32,571 mIU/ml, inhibin B<10, inhibin A 500.1pg/ml (luteal phase: 40-80) and CA-125 19 U/mL (0 - 35). Given the elevated beta-hcg the patient was asked if they were having sex in a way that could result in pregnancy to which they answered affirmatively. CT and MRI were cancelled, and abdominal ultrasound was obtained which revealed a single living intrauterine pregnancy with estimated gestational age 35 weeks 2 days. Testosterone was stopped and they subsequently delivered a healthy baby girl. Conclusion: Gender diverse patients on testosterone can experience unplanned pregnancy. As testosterone is contraindicated in pregnancy, counseling on reproductive health and contraception is needed. A pregnancy test should be considered prior to initiating hormones for appropriate individuals. It is important to be aware that Individuals AFAB may not desire estrogen containing birth control and placement of intrauterine devices can be dysphoric. Further investigation into how contraceptive options may affect outcomes for individuals on GAHT is needed to minimize barriers to care and to enable patients to make well informed decisions. Presentation: 6/2/2024

6823 A Puzzling Case: Complete Regression of Pituitary Macroadenoma

Abstract Disclosure: N.T. Mazengia: None. D.R. Vangipuram: None. S.K. Majumdar: None. Introduction: The natural course of nonfunctioning pituitary macroadenomas remains poorly understood, largely because the majority are surgically treated [1]. There are a few case reports describing the spontaneous regression of nonfunctioning pituitary macroadenomas. Here we describe a case of pituitary macroadenoma which completely regressed following childbirth and two months of cabergoline therapy. Case Presentation: A 25-year-old female presented with bilateral nipple discharge and persistently elevated prolactin levels ranging from 31µg/liter to 45.9 µg/liter (NV <25 µg/L). She did not have any signs and symptoms of hypo or hypersecretion of the pituitary hormones. All her pituitary hormone levels were within normal range. Initial MRI revealed a pituitary mass measuring 9x13x9mm (AP, TR, CC). Given her lack of symptoms, the decision was made to follow up without any intervention. A repeat MRI after one year showed the size of the mass to be 11x13x11mm. Two years after her initial diagnosis, the patient had a spontaneous pregnancy, during which she remained asymptomatic with normal pituitary hormone levels. She had Cesarean delivery at term with no complication. She was lost to follow-up for about two years after childbirth then presented with breast discomfort and galactorrhea at which time, she was started on cabergoline. A subsequent MRI done two months after the start of cabergoline showed asymmetric fullness of the pituitary gland on the right with no discrete measurable lesion. Conclusion: We currently lack a comprehensive explanation for the regression observed in our patient. Silent ischemia may have played a role, particularly considering the natural increase in pituitary gland size during pregnancy. We are not sure if the regression can be solely attributed to the two months of cabergoline treatment. In asymptomatic patients diagnosed with nonfunctioning pituitary macroadenoma, tumor regression can potentially occur through either a "wait and watch" strategy or medical management using dopamine agonists, specifically cabergoline. However, the use of cabergoline as a primary treatment for asymptomatic nonfunctioning pituitary adenoma warrants further investigation. This is especially crucial given that, in most cases, nonfunctioning pituitary macroadenomas tend to increase in size during follow-up without any intervention.

12330 Progestogen Experience And Perception Among Transfeminine Adults - A National Survey

Abstract Disclosure: J.J. Chang: None. N. Khai Tran: None. A. Flentje: None. M.E. Lubensky: None. J. Obedin-Maliver: Consulting Fee; Self; Ibis Reproductive Health, Hims, Incorporated, Folx, Incorporated, Upstream, Incorporated. M.R. Lunn: Consulting Fee; Self; Hims, Incorporated, Otsuka Pharmaceutical Development and Commercialization, Inc., American Dental Association. D. Ariel: None. Background: Current guidelines recommend estradiol with consideration of anti-androgens for gender-affirming hormone therapy (GAHT) in transfeminine adults. Many individuals also seek progestogens as part of feminizing GAHT, particularly to enhance breast development. Though progestogen use seems common, few studies describe its use, reported benefits, and side effects. SpecificAims: 1) To describe progestogen use in feminizing GAHT among transfeminine individuals in the U.S. 2) To evaluate reasons for progestogen initiation and perceived physical and emotional impact; 3) To investigate side effects and adverse events. Materials and Methods: In this cross-sectional study, participants were recruited from The PRIDE Study, a U.S.-based longitudinal cohort study of LGBTQIA+-identifying adults. Included participants were assigned male sex at birth and had a feminine/transfeminine or non-binary gender identity. Those assigned female sex at birth (AFAB) or born with 1 or more ovaries were excluded. Descriptive statistics were used to describe socio-demographic characteristics, progestogen use patterns, initiation reasons, perceived physical and mental impacts, side effects, adverse events, and care satisfaction. Results: 543 participants were eligible and completed the study. Mean age was 43.2 years (standard deviation: 14.9). Of 310 progestogen users, the most common progestogen forms were micronized progesterone (58.4% oral; 10.6% rectal) and medroxyprogesterone acetate (7.7% oral). Median progestogen use duration was 2 years (interquartile range: 1-4). Breast development (85.2%) and mimicking the hormone pattern of those AFAB (58.1%) were the two most reported reasons for progestogen initiation. Most progestogen users reported improved breast development (79.7%); none reported worsening. Sex drive, sleep, and concentration did not change with progestogen use in 46.5%, 51.3%, and 73.9% of participants, respectively. Adverse events included lower extremity deep vein thrombosis (n = 6) and pulmonary embolism (n = 4). The most common side effects were breast pain (28.7%), mood fluctuation (21.9%), fatigue (19.7%), and weight gain (19.0%). Most users expressed satisfaction with progestogens (71.9%) and would recommend to others (73.5%). Among 68 former progestogen users, 20.6% reported stopping progestogens due to negative side effects, and 32.4% stopped due to lack of perceived efficacy. Conclusions: In the largest study describing progestogens in GAHT to date, over half of transfeminine adults used progestogens, particularly for breast development. Most reported improvement with breast development and overall satisfaction. However, perceived impacts on other effects were variable. Future prospective studies are needed to investigate the effects of progestogens versus other components of feminizing GAHT. Presentation: 6/1/2024

12330 Progestogen Experience And Perception Among Transfeminine Adults - A National Survey

Abstract Disclosure: J.J. Chang: None. N. Khai Tran: None. A. Flentje: None. M.E. Lubensky: None. J. Obedin-Maliver: Consulting Fee; Self; Ibis Reproductive Health, Hims, Incorporated, Folx, Incorporated, Upstream, Incorporated. M.R. Lunn: Consulting Fee; Self; Hims, Incorporated, Otsuka Pharmaceutical Development and Commercialization, Inc., American Dental Association. D. Ariel: None. Background: Current guidelines recommend estradiol with consideration of anti-androgens for gender-affirming hormone therapy (GAHT) in transfeminine adults. Many individuals also seek progestogens as part of feminizing GAHT, particularly to enhance breast development. Though progestogen use seems common, few studies describe its use, reported benefits, and side effects. SpecificAims: 1) To describe progestogen use in feminizing GAHT among transfeminine individuals in the U.S. 2) To evaluate reasons for progestogen initiation and perceived physical and emotional impact; 3) To investigate side effects and adverse events. Materials and Methods: In this cross-sectional study, participants were recruited from The PRIDE Study, a U.S.-based longitudinal cohort study of LGBTQIA+-identifying adults. Included participants were assigned male sex at birth and had a feminine/transfeminine or non-binary gender identity. Those assigned female sex at birth (AFAB) or born with 1 or more ovaries were excluded. Descriptive statistics were used to describe socio-demographic characteristics, progestogen use patterns, initiation reasons, perceived physical and mental impacts, side effects, adverse events, and care satisfaction. Results: 543 participants were eligible and completed the study. Mean age was 43.2 years (standard deviation: 14.9). Of 310 progestogen users, the most common progestogen forms were micronized progesterone (58.4% oral; 10.6% rectal) and medroxyprogesterone acetate (7.7% oral). Median progestogen use duration was 2 years (interquartile range: 1-4). Breast development (85.2%) and mimicking the hormone pattern of those AFAB (58.1%) were the two most reported reasons for progestogen initiation. Most progestogen users reported improved breast development (79.7%); none reported worsening. Sex drive, sleep, and concentration did not change with progestogen use in 46.5%, 51.3%, and 73.9% of participants, respectively. Adverse events included lower extremity deep vein thrombosis (n = 6) and pulmonary embolism (n = 4). The most common side effects were breast pain (28.7%), mood fluctuation (21.9%), fatigue (19.7%), and weight gain (19.0%). Most users expressed satisfaction with progestogens (71.9%) and would recommend to others (73.5%). Among 68 former progestogen users, 20.6% reported stopping progestogens due to negative side effects, and 32.4% stopped due to lack of perceived efficacy. Conclusions: In the largest study describing progestogens in GAHT to date, over half of transfeminine adults used progestogens, particularly for breast development. Most reported improvement with breast development and overall satisfaction. However, perceived impacts on other effects were variable. Future prospective studies are needed to investigate the effects of progestogens versus other components of feminizing GAHT. Presentation: 6/1/2024

7013 An Inpatient Perspective: Hyperprolactinemia and Granulomatous Mastitis

Abstract Disclosure: A. Le: None. J. Wade: None. K. Martz: None. D. Girgis: None. M. Shahlapour: None. M.H. Horani: None. Introduction: Mastitis is a highly prevalent condition impacting thousands of women every year. Most commonly associated with lactation, mastitis is estimated to impact 2-20% of lactating women particularly in the first 4-6 weeks of breastfeeding (Wilson et al., 2020). The majority of cases are associated with bacterial infection with Staphylococcus aureus precipitated by nipple trauma and hyperlactation in the setting of genetic predispositions and disturbances to the human milk microbiota (Fernández et al., 2020). In rare cases, mastitis is seen outside of the context of lactation. One cause of non-lactational mastitis is idiopathic granulomatous mastitis (IGM). The pathogenesis of IGM is poorly understood, but there has been a rare association between IGM and hyperprolactinemia reported in the literature (Nikolaev et al., 2016). Case Presentation: In January 2022, A 20 year old female with past medical history of type 2 diabetes mellitus and hypertension, initially presented to the emergency department with complaints of headache. Patient’s history is notable for two years of amenorrhea and periodic nipple discharge. MRI scan of the head revealed a 1.6 cm pituitary macroadenoma which correlated with a markedly elevated prolactin level at 533.3. She was discharged with a prescription for Cabergoline 0.5 mg BID. In July 2022, the patient presented to the ED complaining of severe left breast pain with associated discharge for 4 days. She admitted to being non-adherent to Cabergoline treatment since April 2022 due to lack of endocrine follow-up. CT of the breast at that time showed a 3.8 cm subareolar abscess. Aspiration of the abscess revealed non-purulent fluid and cultures of the aspirate were negative. In February 2023, patient presented for right breast pain with a similar workup to previous hospitalization. MRI of the brain revealed a 1.6 cm sellar mass is unchanged since January 2022. Prolactin level was elevated at 652.4. Patient stated she has been off Cabergoline for the prior 5 months. She was subsequently seen for right and left mastitis 3 times over the next 12 months. Upon endocrine consultation, the patient was counseled on the importance of Cabergoline treatment in regression of future mastitis episodes, and the patient has subsequently not returned to our service. Conclusion: This case demonstrates the rare association between prolactin secreting pituitary adenomas and granulomatous mastitis that clinicians need to consider in order to avert delays in treatment and unnecessary hospitalizations. Specifically, when working up a patient with a history of IGM and prolactinemia, it is imperative to monitor prolactin levels periodically over an extended course of time with appropriate MRI imaging of the pituitary gland to assess for regression of prolactinoma and episodes of IGM. Presentation: 6/1/2024

The Relationship Between Mothers' Knowledge and Attitude in Breastfeeding and The Occurrence of Nipple Irritation in Pidie Regency

Research indicates that 40% of women do not breastfeed their infants due to experiencing breast pain and swelling, and fear of nipple soreness. This may be due to incorrect breastfeeding techniques, which are often overlooked by mothers who lack the proper breastfeeding management knowledge, thus requiring relevant training and education. Proper breastfeeding requires good attachment between the mother's areola and the baby's mouth so the baby can feed effectively and nipple irritation can be avoided. If not adhered to, nipple irritation may occur, causing mothers to be reluctant to breastfeed their infants, which may impact to the child's growth rate. Breast milk is an excellent source of nutrition for infants, as it contains essential nutrients needed for optimal growth and development (Prasetyono, 2012). Data from the Aceh District/City Breastfeeding Coverage in 2022 shows that the highest coverage was in Sabang City, with only 22.43% of the population (6,006 infants). This study used a cross-sectional design where 375 infants were breastfed, and the Slovin formula was applied. Samples were randomly selected from infants at health centers in Pidie District. Researchers used the Chi-square test for data analysis. The findings from this study, derived from bivariate statistical analysis using the Chi-square test with a 95% confidence level, resulted in a p-value of 0.000 (p < 0.05). This indicates that the knowledge variable significantly affects breastfeeding technique. The Chi-square test at a 95% confidence level with p=0.000 (p < 0.05) also shows that attitude has an impact on the mother's ability to breastfeed. The mother's knowledge and attitude significantly influence their breastfeeding practice. The best way to prevent nipple irritation is by educating mothers on proper breastfeeding techniques. Researchers state that improving maternal knowledge and attitudes can enhance behavior, especially in breastfeeding practices, to prevent irritation. Monitoring by health workers is expected to improve maternal knowledge and attitudes and minimize the incidence of nipple irritation.

Community breast pain clinics can provide safe, quality care for women presenting with breast pain.

Breast pain is not typically a symptom of breast cancer, yet nationally 20% of 2-week wait (2WW) breast referrals are breast pain alone. The East Midlands Breast Pain Pathway improves patient experience and frees capacity in secondary care diagnostic breast clinics, managing women with breast pain only in a community setting. We report the results of implementation of community breast pain clinics (CBPCs) at sites in Derbyshire (catchment population ~1 million), with 12 months follow-up data. 1036 patients were seen at CBPCs between June 2021 and February 2023. The median patient age was 49 (range 16-88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to familial cancer services for ongoing management. Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1000, confirming that this population is at low risk of developing breast cancer.Patient service satisfaction was high with 99% (n=1022) 'extremely likely or likely' to recommend the service. The results confirm the pathway is the first to demonstrate women can be safely managed with breast pain alone in a community setting with high levels of patient satisfaction.

A Silent Injury - Breast Pain And Injury Among Female Rugby Union Players

A Silent Injury - Breast Pain And Injury Among Female Rugby Union Players

The awareness, knowledge, and experience of female rugby players of contact breast injuries and exercise induced breast pain – An international survey

Objective: This study aimed to investigate the existing knowledge, awareness, and experience among female Rugby Union players of contact breast injuries (CBI) and exercise induced breast pain (EIBP) internationally.Methods: A cross sectional survey on CBI and EIBP, targeting active, adult female Rugby Union players, was developed and internationally disseminated. Responses were collected using Qualtrics and analysed using Microsoft PowerBI.Results: Responses from 483 female Rugby players (age 27.1±6.4 years, height 167.4±9.8 cm, mass 75.0±15.6 kg) from 29 different countries were collected. The overall awareness of CBI or EIBP and their potential future complications was poor, with 55.4% and 64.0% of responses respectively being either unaware or very unaware of same. Only 24.7% of respondents were likely or very likely to report either CBI or EIBP to team personnel. Main reasons for unwillingness to report included a lack of awareness of potential future complications or treatment modalities, and a perception that the breast pain or injury incurred was not severe enough. Of those who had suffered from either CBI, EIBP or both (51.8%), between 22.2% and 23.7% chose not to report the pain or injury. Less than 10% of those who did report, received treatment.Conclusion: The study identified a noteworthy occurrence of CBI and EIBP but reluctance and barriers to report same. Knowledge of potential future complications and treatment options for CBI and EIBP was poor. Future education pieces should address these shortfalls. The study further uncovers the need for structured prospective recording of CBI and EIBP.

Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy

PurposeThis study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil beam scanning (PBS). MethodsIn January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot-spot evaluation as a SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally <50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded. Results84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated to the intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs. 30%, p<0.0001, for those treated without versus with a SSPT. Maximum %Rx to the skin-eval volume of 0.03 cc, 0.3cc, and 1cc was higher in patients treated without versus with a SSPT (103.1% vs. 101.5%; 101.3% vs. 100.4%; and 101.8% vs. 99.7% (all p=<0.0001)), respectively. There was a small difference in the mean CTV V97.5%Rx in patients treated without versus with the SSPT (97.8% vs. 96.5%, p=0.0003). Patients planned utilizing the SSPT demonstrated reduced rates of Grade 1 breast pain at Week 2 (12% vs. 33%, p=0.0424) and Grade 2 and 3 dermatitis at Weeks 4 and 5 (Week 4 dermatitis ≥ grade 2, 18% vs. 43%, p=0.0224; Week 5 dermatitis ≥ grade 2, 45% vs. 69%, p=0.0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs. 1) in the pre-SSPT cohort. ConclusionsUse of a SSPT may reduce acute skin toxicity in breast cancer patients treated with PBS.

Primary Breast Necrotising Fasciitis in an Elderly Woman Managed with Nipple–Areola Conservation and Delayed Primary Closure in a Resource-Poor Setting A Case Report

Abstract Primary breast necrotising fasciitis is a rare disease that can rapidly progress with high morbidity and mortality rates. Due to its rare occurrence, it is often misdiagnosed. This case was a 65-year-old, obese, immobile, and newly diagnosed woman who presented with a 2-week history of progressive left breast pain and swelling with associated darkening of the breast skin and discharge of foul-smelling fluid. There was no history of fever and the nipple–areola complex was spared. The surrounding healthy skin has a characteristic peau d’orange and erythematous. Two discrete and slightly tender left axillary lymph nodes were noted. At the presentation, her blood sugar was high. Initially, a breast malignancy was suspected but later an ultrasound showed increased fibrous and fatty tissue architecture of the mammary gland. It also noted inflammatory collections within the mammary glands and thus concluded breast inflammation. Early intervention with antibiotic cover and wound debridement forestalled the progress of the disease and nipple–areola salvage. The wound was later covered by delayed primary closure after 14 days of wound dressing with a silver-based solution. Breast asymmetry was noted as a surgical complication. Early aggressive intervention in necrotising fasciitis of the breast in an elderly woman with comorbidities contributed to the preservation of nipple–areola complex with eventual satisfactory management using direct wound closure.

Mucormycotic late seroma after Poland syndrome correction with implant-enhanced latissimus dorsi flap – A case report

Introduction. Breast malformation correction with implants is a com-mon procedure, and a potential complication is the development of a late seroma, defined as occurring more than one year post-implan-tation. Etiologies include infectious, auto-inflammatory, and neoplastic factors. This case report presents an unusual case of seroma due to mycosis emerging 15 years after amastia correction using a latissimus dorsi flap (LD) and implants. Materials and methods. In 2006, a 44-year-old patient underwent amastia correction with an LD flap and implants in Ecuador. She pre-sented with sudden breast volume increase, tension, and pain in the left breast. Urgent intervention involved implant removal, collection evacuation, and total capsulectomy. Cytological/histological analysis ruled out neoplasia, while microbiological examination identified Muco-rales as the cause. After an uneventful postoperative period, a definitive breast prosthesis was implanted two years later, following ultrasound evaluation and inflammation indices. Discussion. Mucorales are opportunistic pathogens, particularly in im-munocompromised or uncontrolled diabetes patients, causing infections in sinuses, brain, and lungs. Mucormycosis linked to breast implants in immunocompetent individuals is rare and poorly defined in literature. Conclusions. Late seroma onset post-breast implants is rare, and a prompt differential diagnosis is crucial due to potential malignancies like BIA-ALCL. Mucormycosis, a potentially lethal condition, requires medical and sometimes surgical intervention. The incidental discovery of Mucorales infection facilitated complete eradication of the patholo-gy, resulting in full recovery.