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Breast pain

  • Commonest reason for referral to breast clinics
  • Accounts for 50% of all referrals
  • Only 7% of patients with breast cancer report breast pain
  • Assessment requires the keeping of a breast pain chart
  • Divided into cyclical and non-cyclical mastalgia

Cyclical mastalgia

  • Usually bilateral, affects upper outer quadrant
  • Mostly minor and accepted by many women as 'part of normal life'
  • Average age of onset is 24 years
  • No consistent hormonal abnormality
  • Prolactin levels may be increased
  • Essential fatty acid profiles may be abnormal
  • No evidence of psychopathology
  • In those with no palpable mass no imaging is required

Treatment

  • 80% require no treatment other than reassurance
  • Treatment should be considered if:
    • Symptoms for more than 6 months
    • For >7 days per cycle
  • Evening primrose oil (EPO)
    • Require treatment for at least 4 months
    • 50% response rate
    • 1% complications - nausea
  • Danazol
    • 80% response rate
    • 25% complications - acne, weight gain, hirsuitism
    • Requires mechanical contraception
  • Bromocriptine
    • 50% response rate
    • 20% complications - postural hypotension
  • Tamoxifen effective but not licensed for use in mastalgia
  • Diuretics or progestogens are not advised

Non-cyclical mastalgia

  • Affects older women
  • Average age = 45 yrs
  • Usually unilateral, often localised
  • True non-cyclical mastalgia
  • Usually has a musculoskeletal cause
  • Rarely cancer

Treatment

  • Support bra & NSAID

Bibliography

Mansel R E.  Breast pain.  Br Med J 1994; 309: 866-868.

 
 

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