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