EDDY HERMAN TANGGO, 09114594D (2008) THE ROLE OF IMMUNE RESPONSE TO MAMMOTROPIC HORMONE ON NON CYCLIC MASTALGIA (Observational study and Longitudinal design). Disertasi thesis, UNIVERSITAS AIRLANGGA.

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Abstract

Breast pain (mastalgia) is one of the most common breast symptom experienced by woman (45-78%) during her lifetime, that strong related to menstrual cycles. There were 35- 40 mastalgia patients undergo medical treatment each month at clinical oncology RSUD Dr Soetomo general Hospital Surabaya. Conventional therapy with hormonal or non-hormonal agent like herbal drug, and non steroidal anti-inflammation drug unsuccessful yet due to highly side effects, and more relapsed (30-60%). Cyclic mastalgia (CM) is breast pain that has a clear relationship to the menstrual cycle and more influenced by hormonal appearance, contradictive with Non cyclic mastlagia (NCM) which interference by a little hormonal activity. Cyclic mastalgia is usually involved bilateral breast and diffuse and the pain may be sharp and shooting with radiation to the axilla or arm. NCM is more defined in one site of the breast and more localized with duration tends to be shorter 2-7 days, and the frequency may 2-3 times in a period. NCM may be arise from CM continuity after menstrual period finished and still exist or episode during post menstruation, it is mean there is a little hormonal effect. During menstrual period, endometrial wall disruption, circulating effector cells (neutrophils, macrophages activated, NK cells) act to early phagocyte and killing microbes and secretion of cytokines that stimulate inflammation, lysis of infected cells, activation of macrophages, as an immune response to maintain homeostasis. It is mean that NCM is a part of immunologic reaction, even if the mechanism of action is still unclear. The aim of study: are there inflammatory cytokines could influence breast pain post menstruation on non cyclic mastalgia patients. Try to explore this mechanism, observation longitudinal study design was performed. 27 NCM patients eligible this study consist of 16 palpable with pain, 11 non-palpable with pain, 18-45 years old, mean 33,3 y. Serum examination underwent twice on premenstrual and post menstrual situation. Cytokines analysis is performed by product R &amp;D system and Diaclone, while hormones assay by Elyze/Advia method. The analytical study by Logistic Regression was suggestion which independent variables are interleukin-1, interleukin-2, interleukine-6, interleukin-10, and intermediate variables are estrogen, progesterone and prolactine. Dependent variable is breast pain. Result: There is strong correlation designated by interleukin-1 to modulate pain post menstruation on non cyclic mastalgia patients, significant value p = 0,039 (p < 0,05). Not significant shown on interleukin-2, interleukin-6, interleukin-10, estrogen, progesterone and prolactin. Conclusion: Inflammation cytokine could influence breast pain on post menstrual non cyclic mastalgia. In order to achieve maximal interference the other inflammation cytokines, suggestion to performed several times to examine serum samples in a period of menstrual cycles. It is suggestion to examine others inflammation cytokines, and to perform tissue biopsy on breast tissue to determine cytokines receptor and hormonal receptors. Treatment non cyclic mastalgia not interference with hormonal agent but more suggestion to cytokines inhibitor or another modalities need more study further.

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