Evaluation and management of breast pain

Knowledge and awareness of breast cancer signs and symptoms among Jordanian women

BACKGROUND

Breast cancer (BC) remains the most common cancer among women worldwide. Early detection plays a vital role in reducing morbidity and mortality. This study aimed to assess Jordanian women's awareness of BC signs and symptoms to support timely recognition and intervention.

RESEARCH DESIGN AND METHODS

A nationwide cross-sectional study was conducted involving 381 Jordanian women from the general community. Participants completed a self-administered questionnaire assessing their knowledge of BC signs and symptoms using a three-point Likert scale ("Yes," "Unsure," "No"). Demographic variables were analyzed for association with knowledge levels using Pearson's Chi-square or Fisher's Exact Test.

RESULTS

80.3% of participants demonstrated good awareness of BC signs and symptoms. Significant associations were found between knowledge levels and marital status (p = 0.000), age (p = 0.033), having children (p = 0.000), number of children (p = 0.003), education specialty (p = 0.000), and working area (p = 0.005).

CONCLUSIONS

Most participants demonstrated a strong awareness of BC signs and symptoms. However, educational interventions are needed to target knowledge gaps, particularly among unmarried women.

How are female rugby players affected by contact breast injuries and exercise-induced breast pain - an international survey

Female Rugby Union players were affected by contact breast injuries (CBI) and exercise-induced breast pain (EIBP). Hundred and eighty-two female Rugby players from 25 different countries reported incurring a CBI or EIBP which affected sport performance. A higher percentage of 7s players (7s: 64.3%, 15s: 51.9%) reported at least one CBI over a 12-month period. EIBP frequency, during the same period, was notably low for 7s and 15s. Sprinting, jumping and running were the most frequent activities precipitating the severest EIBP. Being tackled or tackling most frequently caused a CBI. Respondents affected by either CBI (57.3%) or EIPB (51.3%) reported always playing-on during matches despite their pain or injury. Between 19.4% and 32.1% of the respondents did not have a CBI or EIBP prevention strategy. A paucity of player knowledge on prevention strategies was noted, indicating a need for education addressing breast pain and injury among players.

Effect of Flaxseed on Pain Relief and Quality of Life in Patients With Mastalgia: A Single Arm Interventional Study

Objective

Mastalgia, a common complaint among women, denotes breast discomfort that can manifest as cyclical or non-cyclical. Reassurance, mechanical support and various non-pharmacological treatments, like flaxseeds, have been seen to have a good effect in treating mastalgia. Thus, the aim of this study was to investigates the efficacy of flaxseed in alleviating pain associated with mastalgia and its impact on the overall health-related quality of life among female patients.

Materials and Methods

Conducted at a tertiary care center in Northern India over 18 months, it employed a single-arm interventional design. The participants included females aged 18 years and older presenting with breast pain at the Department of General Surgery. The intervention involved daily consumption of 30 g of milled flaxseed for each participant, administered over a period of six months. Pain severity was assessed using the visual analogue scale (VAS) before supplementation and at follow-up intervals up to six months. Concurrently, the Short Form-12 (SF-12) items Health Survey measured health-related quality of life, encompassing both physical and mental health domains. Statistical analysis employed parametric (paired t-test) and non-parametric tests (chi-square, McNemar) where appropriate, with statistical significance set at p<0.05.

Results

Two hundred women with mastalgia were included with a significant reduction in mean VAS scores from 6.03±0.83 at baseline to 2.19±0.66 at six months post-intervention (p = 0.0001). This reduction in pain intensity demonstrated a positive correlation with duration of flaxseed supplementation, notably declining after the initial three months. The mean difference in physical and mental SF-12 score at first visit and at 6 months after intervention was significant (p = 0.0001).

Conclusion

This study underscores the potential of flaxseed as a therapeutic option for managing mastalgia and enhancing health-related quality of life among affected individuals.

Hongjin Xiaojie Capsule, a Chinese patent medicine, for treating moderate to severe cyclical breast pain: A single-blind randomized controlled trial

BACKGROUND

Moderate to severe breast pain has major effects on the quality of life for patients. Patent Chinese medicines are widely used in the treatment of breast pain due to their stable dosage form and good efficacy.

OBJECTIVE

To evaluate the beneficial effects and safety of Hongjin Xiaojie Capsule (HJXJC), a Chinese patent medicine, for the treatment of cyclical breast pain.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

This is a multicenter, single-blind randomized controlled trial conducted in 3 medical centers in China from 2019 to 2021. Patients with moderate to severe cyclic breast pain were randomly divided into the intervention group (who took HJXJC, four capsules per dose, three times a day for 12 weeks) and the control group (waiting for the treatment) in a 1:1 ratio.

MAIN OUTCOME MEASURES

The primary outcome was pain duration, and the patients recorded measurements at baseline and at the end of weeks 4, 8, 12 and 16 on a patient log card.

RESULTS

The full analysis set (FAS) population included 298 participants (intervention group, n = 150; control group, n = 148), while the per-protocol analysis set (PPS) included 274 participants. After 12 weeks, the duration of breast pain was significantly shorter in the intervention group (FAS: mean difference, -6.69; 95% CI, -7.58 to -5.80; P < 0.01, vs control. PPS: mean difference, -7.09; 95% CI, -8.01 to -6.16; P < 0.01, vs control). The Short-form McGill Pain Questionnaire (SF-MPQ) scores were significantly lower in the intervention group (FAS: mean difference, -12.55; 95% CI, -13.90 to -11.21; P < 0.01, vs control. PPS: mean difference, -13.07; 95% CI, -14.48 to -11.66; P < 0.01, vs control). The above indicators continued to be significantly different through week 16. Moreover, in the intervention group, breast lumps shrank after 12 weeks and the size of breast lumps was statistically smaller than that in the control group (P < 0.05), whereas the sizes of breast nodules and uterine fibroid showed no statistically significant difference compared with the control group (P > 0.05). At weeks 8 and 12, the dysmenorrhea scores in the intervention group were lower than those in the control group (P < 0.05). No obvious adverse reactions were observed in any group.

CONCLUSION

HJXJC can significantly shorten the duration of breast pain, reduce breast pain, reduce the size of breast lumps, and relieve dysmenorrhea. However, it has no significant effect on the size of breast nodules or uterine fibroid.

TRIAL REGISTRATION

This trial has been registered at the ISRCTN Registry. Number: ISRCTN44184398.

PLEASE CITE THIS ARTICLE AS

Zhang Q, Fan YY, Wu XQ, Huo YD, Wang CH, Liang SB, Wang T, Zhong R, Wang X, Lai BY, Pei XH, Liu JP. Hongjin Xiaojie Capsule, a Chinese patent medicine, for treating moderate to severe cyclical breast pain: A single-blind randomized controlled trial. J Integr Med. 2024; 22(5): 552-560.

Effectiveness of Evening Primrose and Vitamin E for Cyclical Mastalgia: A Prospective Study

BACKGROUND

Cyclical mastalgia, which is characterized by cyclic breast pain associated with the menstrual cycle, is a common condition among premenopausal women. Despite their prevalence, effective treatment options remain limited. Evening primrose oil (EPO) and vitamin E have been proposed as potential therapies for cyclical mastalgia; however, their efficacy remains uncertain, particularly when used in combination.

OBJECTIVE

This study aimed to evaluate the efficacy of EPO, vitamin E, and their combination in alleviating breast pain associated with cyclical mastalgia through a randomized controlled trial.

METHODS

Premenopausal women (n=126) with cyclical mastalgia were recruited from gynecology clinics and randomized to receive EPO (1000 mg twice daily), vitamin E (400 mg once daily), their combination, or a placebo for six months. Randomization was performed using computer-generated random numbers. Participants were assessed at baseline and monthly intervals for six months. The primary outcome was the change in breast pain severity measured using a validated pain questionnaire such as the short-form McGill Pain Questionnaire. The secondary outcomes included changes in breast pain characteristics, adverse effects, and treatment adherence.

RESULTS

A total of 126 participants participated in this study. The combination of EPO and vitamin E demonstrated superior efficacy in reducing breast pain severity compared with individual treatments and placebo (p < 0.001). Participants in the combination group experienced a mean reduction in breast pain severity of 4.5 points on the pain scale, whereas those in the EPO and vitamin E groups experienced reductions of 2.5 and 3.0 points, respectively. Both EPO and vitamin E alone also showed significant improvements compared with placebo (p < 0.05), with mean reductions in breast pain severity of 2.0 and 2.5 points, respectively. Adverse effects were minimal and comparable across the treatment groups.

CONCLUSION

Combination therapy with EPO and vitamin E appears to be an effective treatment option for cyclical mastalgia, offering superior pain relief compared with individual treatments and placebo.

Breast gel based on Boswellia serrata, Betaine and myo-Inositol improves cyclic mastodynia in fertile women: A retrospective clinical study

BACKGROUND

The management of mastodynia plays a central role in improving women quality of life. Despite its high occurrence, specific therapeutic guidelines for mastalgia are still lacking. Available therapies include unspecific anti-inflammatories, even though they may often expose to undesirable effects and low compliance.

OBJECTIVE

The aim of this study was to highlight the efficacy of the topical application of combined natural molecules including Boswellia serrata, Betaine and myo-Inositol in improving cyclic mastalgia.

METHODS

In this retrospective pilot clinical study, patients with cyclic mastalgia applied a specific breast gel for three months. The severity of the pain was measured through the Visual Analogue Score (VAS) in the treated group compared to untreated one. Treated patients also filled in a questionnaire evaluating acceptance and safety of the breast gel.

RESULTS

This pilot clinical study demonstrated for the first time the efficacy of the topical application of a breast gel based on Betaine, Boswellia serrata, and myo-Inositol in improving cyclic mastodynia. The completed questionnaires also revealed high levels of acceptance, as both safety and compliance.

CONCLUSIONS

Besides confirming the positive effects of these natural molecules in the management of conditions affecting breast physiology - so far evaluated as oral supplementation - the obtained results pave the way for further studies supporting the use of such molecules as a tailored medical device in the management of breast pain, thus also opening toward a combined oral and topical approach.

Clinicopathological profile of mastalgia in females: incidence, types, and pathological correlations. a cross-Sectional study

Introduction

Mastalgia was the most common symptom in patients attending a breast clinic. The two most common types of mastalgia were (cyclical and non-cyclical). The common cause of cyclical was Physiological changes due to premenstrual tension syndrome fibrocystic changes or fibroadenosis and (Aberrations in the Normal Development and Involution of the breast ). Non-cyclical diseases are mainly benign rather than malignant. Solid masses (fibroadenomas), cysts, infections, abscesses, trauma, and nipple discharge (hormones) are rare diseases associated with breast cancer. The aim of this study is to study the incidence of mastalgia, types (cyclical and non-cyclical) and pathological types of mastalgia (benign and malignant pathologies).

Material and methods

A cross-sectional descriptive study of mastalgia was carried out at the Breast Center Department of Maternity Teaching Hospital located in Erbil, from January 2014 to September 2015. A total of 150 breast pain cases (available clinical data) were studied in detail.

Results

There are two types of mastalgia based on triple assessments, these are as follows, cyclical 90 cases (60%) and non-cyclical 60 cases (40%). Fibrocystic breast changes or fibroadenosis 35 cases (23.3%) and thirdly nipple discharges as part of fibrocystic (fibroadenosis) five cases (3.3%). Non-cyclical mastalgia was subdivided into benign breast pathologies, fibroadenoma 30 cases (20%), breast cyst 10 cases (6.7%), nipple discharge (hormonal) five cases (3.3%), mastitis three cases (2%) abscess two cases (1.3%), fat necrosis one case (0.7%), and malignant breast pathologies, cancer three cases (2%). Clinicopathological correlations in the current study were highly significant (P<0.005).

Conclusion

Not all discomfort or pain can be diagnosed as mastalgia; occasionally, chest wall, referral pain, and systemic causes can mimic mastalgia. These results highlight the importance of differentiating between cyclical and non-cyclical mastalgia using clinical assessment, sonography, mammography, and blood investigations. Most mastalgia cases are benign, with cyclical mastalgia primarily related to hormonal changes during the menstrual cycle.

Patient-centered Care: Value Added by Breast Radiologists in the Management of Breast Pain

With the shift of the healthcare system toward patient-centered, value-based care, the role of the breast radiologist is essential and increasingly multifaceted. Beyond sole image interpreters, breast radiologists serve as subject matter experts within multidisciplinary care teams, acting as advocates and initiators into the healthcare system and providing patient-centered care through effective communication and patient education. These vital roles are well demonstrated through the imaging evaluation and management of the most common breast symptom that affects the majority of the patient population-mastalgia. By leveraging the opportunities provided during the evaluation of the symptomatic breast to optimize patient communication and education, as well as integration of care delivery, breast radiologists add significant value to patient care and ultimately improve patient outcomes.

Efficacy and Safety of Acupuncture for Cyclic Mastalgia: Study Protocol for a Randomized, Sham-Controlled Trial

Purpose

Cyclic mastalgia is prevalent among women and negatively impairs their daily life and work. There is still a lack of effective therapies for mastalgia, and acupuncture may be a promising method. We design this multicenter randomized trial to evaluate the efficacy and safety of acupuncture on cyclic mastalgia.

Study Design and methods

Sixty participants with moderate-to-severe cyclic breast pain (with a duration of 5-21 days and the worst pain scoring 5 points or more on Numerical Rating Scale [NRS]) will be recruited at three hospitals in China. They will be randomly assigned to acupuncture group or sham-acupuncture group at 1:1 ratio to receive 16-session treatment during 3 consecutive menstrual cycles, and follow-up for 6 menstrual cycles after treatment. The primary outcome is the change from baseline in the NRS score on the worst breast pain during the third cycle of treatment period. All statistical tests will be two-sided and P value <0.05 will be considered statistically significant.

The effect of the herbal medicine on severity of cyclic mastalgia: a systematic review and meta-analysis

Cyclic mastalgia is one of the most prevalent problems in women of reproductive age and sometimes it is so severe that it influences their activities and requires treatment. The available drug treatments for mastalgia are not satisfactory and most patients have inclined towards complementary and alternative medicine including herbal medicines. Therefore, in order to evaluate the effectiveness and side effects of herbal medicines conducting systematic review studies and meta-analysis seems essential, thus this systematic review was conducted with the aim of determining the effect of herbal medicines on cyclic mastalgia and its probable side effects. The databases of Pubmed, Medline, Embase, ProQuest, Scopus, Web of science, Complementary Medicine Database, SID (Scientific information database), Magiran and Iranmedex were searched from 1997 to 2020 and limited only for English and Persian languages. The studies were appraised according to the Cochrane Collaboration's tool. Meta-analysis was conducted using RevMan software. Standardized mean difference (SMD) was calculated to assess an overall estimate of effectiveness for the continuous data. Odds ratio (OR) was calculated for dichotomous data. Thirty papers were included in the study. Meta-analysis of data demonstrated that herbal medicine was an effective method in reducing the severity of mastalgia compared to the placebo (SMD: -3.26, 95% CI: -5.05 to -1.46, p=0.00004). Subanalysis of data showed no difference between the effectiveness of herbal medicine on the severity of mastalgia compared to the pharmacologic treatment. This research demonstrated efficacy of herbal medicines in alleviating cyclic mastalgia. Therefore, these herbal medicines can be regarded as an alternative treatment for women suffering from cyclic mastalgia. However, due to the limited number of studies in relation to each specific herbal treatment, conducting further studies in this area is recommended.

Effectiveness of acupuncture in the treatment of cyclic mastalgia: a study protocol for a randomized controlled trial

Background

About 68% of women aged 18–44 years have experienced cyclic mastalgia (CM), which occurs during the luteal phase of the menstrual cycle when elevated hormone levels induce greater breast gland thickness. CM has a moderate-to-severe impact on a woman’s quality of life. Prior research has suggested that acupuncture may be beneficial for breast pain relief. In this study, we investigate the effectiveness of manual acupuncture (MA) in the treatment of CM compared with that of sham acupuncture (SA).

Methods

This is a multicenter, randomized, controlled trial. A total of 108 eligible CM patients will be randomly assigned to either MA (n = 54) or SA (n = 54) group using a 1:1 ratio and a stratified, blocked randomization. Acupuncture will be performed two weeks prior to menstruation and discontinued when menses begins. In both the MA and SA group, participants will be given acupuncture three times per week for 2 weeks per menstrual cycle for three consecutive menstrual cycles, encompassing a total of 18 sessions. The primary outcome will be the change in the average daily Breast Pain Visual Analog Scale (VAS-BP) over the first two weeks of menstruation from baseline to endpoints. The number of nominal days of breast pain (NDBP) two weeks before menstruation, World Health Organization Quality-of-Life Scale-Short Form scores, global patient assessment, breast glandular-section thickness, and breast-duct width three days before menstruation will also be measured as secondary outcomes.

Discussion

This prospective randomized trial will help evaluate the efficacy of acupuncture in treating CM. The results of this study will provide evidence of the therapeutic effectiveness of acupuncture on CM.

Trial registration

ClinicalTrials.gov Identifier: NCT05408377, registered on June 7, 2022. 

Open-Label Three Arm Trial Comparing Ormeloxifene, Gamma Linolenic Acid With Methylcobalamine + Vitamin C and Placebo in Mastalgia

OBJECTIVE

We evaluated the beneficial effect of Ormeloxifene (Centchroman) versus a combination of Gamma Linolenic acid (GLA), methylcobalamine and vitamin C on mastalgia in a three-arm, open-label, placebo-controlled trial.

MATERIALS AND METHODS

Patients aged above 18 years with mastalgia were recruited between January 2019 and July 2021. Patients were divided in three arms: Ormeloxifene arm, GLA arm and Placebo arm. Response was evaluated using visual analogue scale (VAS) and score below 3/10 was defined as complete relief.

RESULTS

A total of 113 consecutive women with mastalgia were randomized to the GLA group (Group 1, n = 39 women), Ormeloxifene (Group 2, n = 36) and Placebo (Group 3, n = 38). Complete response was observed in 94% patient in Group 1, 96% in Group 2 and 87% in Group 3 at the end of 12 weeks and it was not significant (p = 0.49). Adverse events were reported by eleven patients taking Ormeloxifene, compared to none in the other two groups.

CONCLUSION

In this study Ormeloxifene and GLA were not superior to placebo for pain relief in mastalgia. Furthermore, there were concerning side effects associated with Ormeloxifene therapy. The role of Ormeloxifene in mastalgia needs further evaluation before recommending it as preferred therapy.

Tamoxifen in mastalgia: A meta-analysis

OBJECTIVES

Tamoxifen is prescribed for chronic mastalgia at a dosage of one 10- or 20-mg tablet for 3-6 months. A topical preparation of this drug has recently been approved. The aim of this study was to meta-analyze the effectiveness of tamoxifen and its different regimens for the treatment of mastalgia. We also sought to summarize the side effects and the follow-up results of these treatments.

DATA SOURCES

We searched the databases of PubMed/ MEDLINE, Central, Embase, and EBSCO from August 2021 to September 2021.

STUDY SELECTION

Articles on the effects of tamoxifen in mastalgia were searched, and randomized controlled trials were retrieved for inclusion in this study. PRISMA guidelines were followed, and we selected 9 articles for the meta-analysis.

DATA EXTRACTION AND SYNTHESIS

A proforma was prepared for data collection. RevMan 5.4 software was used for methodological quality assessment, statistical analysis, and preparation of forest plots. Oral tamoxifen performed better than placebo (RR 2.04; 95% CI 1.49-2.78, P < 0.001). No significant difference in efficacy was seen between the 10- and 20-mg dosages (RR 1.08; 95% CI 0.97-1.21, P = 0.18) when used for 3 months.

CONCLUSION

Oral tamoxifen is helpful in long-standing mastalgia. It is safe and effective at an oral dose of 10 mg.

Factors associated with the diagnosis of depression in women followed in gynecological practices in Germany

BACKGROUND

There are many diagnoses in the field of gynecology that can severely impact the lives of patients and that are associated with an increased risk of developing depression. The goal of this study was to investigate which gynecological diagnoses are associated with depression.

METHODS

This retrospective case-control study based on the Disease Analyzer database (IQVIA) included 5893 women aged 18 years or older with depression and 5893 age-matched pairs followed in 256 gynecological practices in 2019 (index date). A multivariate logistic regression model was used to study the association between 33 pre-defined diagnoses documented within five years prior to the index date and depression diagnosis.

RESULTS

In total, 9 diseases were significantly associated with diagnosis of depression. The strongest association was observed for breast cancer (Odds Ratio (OR: 2.11 (95% Confidence Interval (CI): 1.76-2.52)), followed by female infertility (OR: 1.91 (95% CI: 1.48-2.47)), cancer of female genital organs excl. breast (OR: 1.87 (95% CI: 1.32-2.66)), and sexual dysfunction (OR: 1.63 (95% CI: 1.27-2.09). Other diseases that showed a significant association with depression included endometriosis, mastodynia, candidiasis, infections with a predominantly sexual mode of transmission, and urinary incontinence. Patients with a higher number of different disorders were more likely to be diagnosed with depression (ORs from 1.40 for two disorders to 2.38 for >6 disorders as compared to no disorders).

CONCLUSION

A wide range of diseases documented in gynecologists' practices were associated with depression diagnosis. Understanding all of these associations may help gynecologists to refer women promptly to psychologists or psychiatrists who may help to manage depression in this population.

Evaluation of Treatment Methods and Clinical Characteristics of Patients Applying to the Outpatient Clinic with Complaint of Mastalgia

Objective: Mastalgia or breast pain is one of the most vital complaints among women patients. This study aims to determine the prevalence of mastalgia and the properties of pain, elucidate the associated factors, particularly modifiable ones, and establish a treatment of standard. Methods: The study evaluated 685 female patients admitted to our outpatient clinic with a complaint of mastalgia in the period between 2017 and 2019. Results: Mean age of the patients was 35.20 ±10.28 (13–86). The pain was experienced in the right breast of 123 (17.9%) patients, in the left breast of 141 (20.6%) patients, and in both breasts of 422 (61.5%) patients. The mean pain value was found to be 5.29. The study population comprised 61 (8.9%) patients in the menopause state, whereas 624 (91.1%) patients were not in menopause. The pain was noncyclic in 519 (75.8%) patients, while cyclic for 166 (24.2%) patients. For treatment, a restricted diet in terms of coffee, salt, and fat as well as wearing supportive bra were recommended for 456 (66.5%) patients, while 181 patients with pain VAS (Visual Analog Scale) score of 8 and above was initiated with vitex agnus-castus. No patient was initiated with local or systemic analgesics and LHRH (luteinizing hormone-releasing hormone) analogs. Conclusion: The prevention and management of mastalgia reflected that restricted salt intake, regulated diet, and the use of properly fitted bras could significantly improve the quality of life. Appropriate radiological imaging could eliminate patients’ concerns regarding developing cancer. Keywords: Breast cancer, Diet, Mastalgia, Risk factor

Sleep disturbances and non-cyclical breast pain: where to break the vicious cycle?

Purpose

This study aimed to assess the sleep quality of patients with the complaint of non-cyclical breast pain (NCBP), compare them to a healthy control group, and analyze the interrelationship of sleep quality with pain, anxiety, depression, and quality of life.

Methods

This cross-sectional study was conducted in consecutive women presenting to the general surgery clinic between May 2020 and December 2020. Patients diagnosed with NCBP formed one group for study and 44 receiving routine well-woman care formed the control group. Evaluations were undertaken using the Nottingham Health Profile (NHP), short-form McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI).

Results

Of 160 consecutive patients, 116 were diagnosed with NCBP and 44 controls. Poor sleep quality (PSQI > 5) was present in 59% (n = 69) of the women with NCBP and 38% (n = 17) of the controls (p = 0.018). According to PSQI global score, overall sleep quality was significantly lower in the NCBP group compared to the control group (p < 0.007). Sleep latency, sleep duration, and daytime dysfunction were the major components determining the PSQI global score (p = 0.004, p = 0.004, and p < 0.001, respectively). The correlation matrix revealed a statistically significant correlation between the HAD-A, HAD-D, and SF-MSQ and NHP subgroups and PSQI global score in the NCBP group (p < 0.001) whereas this significant correlation was detected with only the NHP subgroups among the controls.

Conclusions

A considerable proportion of NCBP patients, regardless of sensory or affective characteristics and trajectory of pain, experience significant sleep disturbances. Further studies should be conducted to evaluate the existence of central sensitization syndrome in NCBP patients to determine the required pharmacological treatment.

[The HRT follow-up consultation. What to do in case of breast pain. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]

Breast pain is a concern in perimenopausal and postmenopausal women, quantifiable using validated tools, and may pre-exist or appear after initiation of a HRT.

OBJECTIVES

A review of the literature was conducted to evaluate the frequency of breast pain, its evolution with age, its changes under HRT, its link with a possible risk of subsequent breast cancer, and the diagnostic (breast imaging) or therapeutic management modalities (pharmacological or other) in women taking HRT.

METHOD

A review of the literature was carried out by consulting Medline, Cochrane Library data and international recommendations in French and English up to the end of 2019.

RESULTS

Published data confirm the importance of breast pain in relation to breast cancer risk. Women with breast pain prior to or related to the use of HRT have a significantly increased risk of breast cancer compared to women without breast pain. The risk is increased in cases of moderate to severe breast pain. In the presence of diffuse breast pain without abnormalities on clinical examination, it is not recommended to change the usual indications for screening, whether organized or individual. For focal breast pain, breast imaging (mammography and possibly ultrasound) is recommended. In the absence of abnormalities on breast imaging, a reassuring dialogue has to take place. With regard to HRT, doses of estrogens should be reduced until the breast pain decreases, or even stop the HRT if this symptom persists despite the use of low doses. Wearing a bra brassiere-type can also reduce breast pain.

Noncyclical and cyclical mastalgia in Turkish women: Prevalans, risk factors, health-care seeking and quality of life

Our aim in this study was to determine the prevalence of cyclical and noncyclical mastalgia, its underlying risk factors, and to examine its effect on women's quality of life. This study was conducted on 415 women, among whom the prevalence of mastalgia was found as 20.7%. It was found that experiencing intense stress, daily coffee and chocolate consumption, breast surgery history and the menstruation pattern were risk factors associated with mastalgia. Some domains of quality of life were found to be negatively affected in women who had mastalgia. Awareness among women about the risk factors of mastodynia and lifestyle changes is needed to improve mastalgia management.

An alternative yogic approach for cyclical mastalgia-A narrative review

Background

Mastalgia or breast pain common benign breast disorder in women in her reproductive life. Mastalgia estimate prevalence 41-71%. It affects to overall quality of life and associated with anxiety, stress, and other psychological factors.

Objective

The purpose of the study was to conduct a review of alternative therapy in the management of mastalgia.

Method

A review was conducted using search terms cyclical mastalgia (CM), yoga therapy, breast treatment, primrose oil, oestrogen, progesterone and all the probable term in national and international data repositories such as PubMed, Scopus, science direct, google scholar, web of science in English language.

Result

The review of alternative therapies in the management of CM suggests that most of the studies used primrose oil, vitamins, and physical activity. There are very few studies conducted in relation to yoga and cyclical mastalgia. Further, most of the studies explored effect of alternative therapies on psychological outcomes. None of the studies investigated efficacy of these therapies on hormonal changes.

Conclusion

Evidence suggests that biochemical clinical trial is effective with side effect, primrose oil and seeds treatment is less effective. One evidence-based study with integrated yoga therapy should be considered in the management of cyclical mastalgia. More high-quality trial with yogic approach needed to first line management of patients presenting with CM.

Effects of sagging breasts and other risk factors associated with mastalgia: a case-control study

The aim of this study is to compare patients with and without mastalgia and to analyze the factors affecting mastalgia and its severity. The patient’s age, height, weight, educational status, marital status, and occupation were recorded in all subjects. In addition, the women were asked about the presence of any risk factors for mastalgia, such as tea and coffee consumption, smoking, alcohol consumption, and weight gain. The sternal notch to nipple distance (SNND) was measured to determine whether there was breast sagging. Mastalgia was significantly more common in women with BMIs of > 30 kg/m² (OR: 2.94, CI 1.65–5.24), those who were primary school graduates or illiterate (OR: 2.96, CI 1.6–5.46), and those with SNND values of 22–25 cm (OR: 2.94, CI 1.79–4.82). In these women, drinking more than 6 cups of tea a day (OR: 2.15, CI 1.32–3.5), smoking at least 10 cigarettes a day (OR: 2.94, CI 1.78–4.83), and drinking alcohol at least once a week (OR: 2.1, CI 1.12–3.91) were found to be important factors that increased the risk of mastalgia. As a result, it has been found that severe mastalgia complaints cause by obesity, sagging breasts, never giving birth, unemployment anxiety, regular smoking, alcohol use, and excessive tea consumption.

Relationship Between Mastalgia And Anxiety-Depression: An Observational Study

Background: Mastalgia is one of the most common breast disorders and may adversely affect a person's daily activities and health-related quality of life, along with possible psychological discomfort. In our study, we investigated whether there is a relationship between mastalgia and anxiety and depression.

Methods: In this prospective study, patients with mastalgia comprised the mastalgia group (n=130) and those without any complaints were included as the control group (n=128). Sociodemographic characteristics such as age, marital status, and educational level were recorded. Both groups were evaluated using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI).

Results: The mean age of the participants was 34.45 ± 6.06 years for the mastalgia group and 35.15 ± 6.39 years for the control group. There was no statistically significant difference between the two groups in terms of age (p = 0.371), marital status (p = 0.336), job status (p = 0.320) or educational level (p = 0.285). However, the anxiety scale and depression scale scores were significantly higher in the mastalgia group compared to the control group (p < 0.001). In addition, the evaluation showed that the BAI and BDI scores were significantly high in the cyclic mastalgia group (p < 0.001). The correlation analyses of the patient group revealed that there was a positive correlation between duration of disease and BAI and BDI scores [(r=0.453, p<0.001); (r=0.228, p=0.009), respectively]. Similarly, there was a positive correlation between educational level and BAI and BDI scores [(r=0.579, p<0.001); (r=0.523, p<0.001), respectively].

Conclusion: In our study, anxiety and depression were found to be more common in mastalgia patients than healthy controls for various reasons. Thus, physicians should look for any signs of psychological discomfort in patients presenting with mastalgia and, if necessary, consult a psychiatrist.

Is it mastalgia or myofascial pain? A clinical confusion

Objectives

This study aims to investigate the frequency of myofascial pain syndrome (MPS) and its characteristics in mastalgia patients.

Patients and methods

The localization of pain, age, education, menopausal status, hormone replacement and employment status, and existence of comorbid diseases were reviewed on consecutive 131 female mastalgia patients (mean age 43.3±9.4 years; range, 18 to 75 years) in this prospective study conducted between June and December 2019. A total breast pain index (IBP) was obtained and mastalgia was classified according to these scores as mild, moderate, and severe. Patients were divided into four diagnostic groups of MPS, cyclic mastalgia, fibrocystic breast disease, and mastitis.

Results

The total IBP was significantly higher in MPS group (129.2±49.5) than in cyclic mastalgia group (98.3±11.9) (p<0.05). However, it was significantly higher in mastitis group (230.7±17.6) compared to MPS group (p<0.05). The fibrocystic disease group was similar to MPS group in terms of total IBP (p>0.05). Considering the localization of pain according to the quadrants where the pain was felt, 57.1% of the patients who felt pain in the upper quadrants were from MPS group (p=0.001) and 45.3% of the patients who felt pain in the lower quadrants were from cyclic mastalgia group (p=0.001). Myofascial pain was observed particularly in upper quadrants and almost all was unilateral; however, cyclic mastalgia was observed bilaterally in the majority, particularly in lower quadrants.

Conclusion

Myofascial pain syndrome should be kept in mind as an extramammary disorder in the differential diagnosis of particularly unilateral upper quadrant mastalgia. It may be for the benefit of patients complaining of mastalgia with no primary breast disorder to be consulted with a physiatrist.

Chinese herbal medicine (Rupi Sanjie capsule) for the treatment of breast pain: A systematic review and meta-analysis of randomized clinical trials

Background

Breast pain is one of the most common breast disorders, affecting 41%–69% women in the clinical populations. Chinese herbal medicine (Rupi Sanjie, RPSJ) capsule has been recommended to be commonly used for breast pain in China. This review aimed to systematically collect latest evidence and critically evaluate the eff ;ectiveness and safety of RPSJ capsule for breast pain.

Methods

We searched 6 databases from their inception to June 1, 2020 for randomized clinical trials (RCTs) comparing RPSJ capsule with conventional drug therapies, placebo or no treatment. Primary outcomes were breast pain relief, reduction of breast mass and clinical cure rate.

Results

Seventeen RCTs were included in total, involving 2899 participants with breast pain. RPSJ capsule showed a significant effects in shortening duration of the breast pain (MD-6.51 days, 95%CI [-8.57, -4.45], n = 82, 1 trial), shortening the duration of breast mass (MD-5.17 days, 95%CI [-7.56, -2.78], n = 82, 1 trial), improving clinical cure rate (RR 1.55, 95% CI [1.21, 2.00], I² = 64%, n = 1398, 10 trials) and total effective rate (RR 1.08, 95% CI [1.03, 1.14], I² = 71%, n = 2170, 14 trials) compared to Tamoxifen (TAM). The meta-analysis showed that the incidence of total adverse events was higher in TAM group than the RPSJ capsule group (RR 0.30, 95%CI [0.21, 0.42], I² = 49%, n = 2122, 13 trials).

Conclusions

RPSJ capsule appears to be a potentially effective in treating breast pain and seems generally safe for clinical application. However, this potential benefit is inconclusive due to generally weak evidence, and the findings should be further confirmed in large and rigorous trials.

A Review of Breast Pain: Causes, Imaging Recommendations, and Treatment

Over two-thirds of women will experience breast pain in their lifetime. As one of the leading breast symptoms for which women seek medical attention, breast pain is suspected to be underreported and under-studied. Cyclical breast pain is related to hormonal changes. Noncyclical breast pain is independent of the menstrual cycle and can be idiopathic and related to chronic pain syndromes, infections, ill-fitting bras, musculoskeletal abnormalities, pregnancy, perimenopause, and postsurgical causes. Breast pain can also present in transgender patients and may require additional considerations as to the underlying cause. Imaging of mastalgia depends upon the suspected etiology. Inappropriate imaging for breast pain is associated with significant utilization of health care resources. Cyclical breast pain does not require an imaging work-up. The work-up of focal, noncyclical breast pain includes ultrasound for women aged younger than 40 years, and mammography and ultrasound for women aged 40 years and older. Management of breast pain is often supportive, as most breast pain resolves spontaneously. If pain persists, imaging and management should follow a step-wise approach. If conservative measures fail, second-line therapy is topical nonsteroidal anti-inflammatory drugs. If breast pain is severe and resistant to conservative methods, additional third-line therapies can be added by breast care specialists with specific knowledge of the potential deleterious side effects of these medications. While the causes of mastalgia are overwhelmingly benign, breast pain can significantly impact quality of life, and the breast radiologist should be familiar with causes, management, and treatment recommendations from a multidisciplinary approach.

Current Management and Treatment Options for Breast Pain

Breast pain is a commonly experienced symptom in women of all ages and can significantly impact quality of life. Fear of cancer prompts many patients to report their pain, although risk for malignancy is low in the absence of a palpable mass or other abnormal finding on breast examination. All patients with breast pain should have a thorough history and physical examination to determine if diagnostic imaging is indicated. Management of breast pain without anatomic or radiographic abnormalities depends on pain type and severity. Often, no intervention is required. However, for women with pain that adversely impacts daily living, short-term therapies may be considered. For mild to moderate pain, a trial of conservative, nonpharmacologic strategies should be tried first. For those with severe symptoms impacting quality of life, a trial of pharmacologic therapy can be considered after appropriate counseling for medication-related adverse effects. Herein, we have provided a concise summary of a generalized approach to classification, assessment, and management of breast pain.

Effective Medicinal Plants in the Treatment of the Cyclic Mastalgia (Breast Pain): A Review

Introduction

Mastalgia is the most common benign breast disorder during the fertility period of women. So far a wide range of natural or complementary medicines is used to cure mastalgia. Sanitary organizations need complete and suitable details to help women, for making the proper decision for alternative treatment based on the evidence. The aim of the present study is to introduce medicinal plant-based treatments about mastalgia and summarizes clinical trials about this disorder.

Method

The articles were provided using mixture of keywords including cyclic pain, breast, treatment, therapeutics, therapy, clinical trial, herbal, drug, mastalgia and all the probable terms, in national and international databases SID, Iran Medex, Magiran, PubMed, Scopus, Medline, Science direct and Cochrane library, in both Persian and English languages. All cross-sectional and review articles about herbal treatment of mastalgia until 2018 November were studied.

Results

Nineteen articles from all of the available articles (45 cases) and a sample size about of (1987 cases) were included in our study. The articles were clinical trials. The results revealed that mastalgia could be healed by Nigella sativa, Vitex agnus-castus, curcumin, Hypericum perforatum, Citrus sinensis, wheat germ, and Ginkgo biloba.

Conclusion

Most of the evaluated medicinal plants possessing antioxidant compounds with anti-inflammatory and analgesic properties, exhibited healing effects in the treatment of mastalgia. Thus, medicinal plants can be considered in the treatment of mastalgia; however, further investigations are needed to obtain more details about their probable side effects.

Upper back pain in postmenopausal women and associated physical characteristics

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31–0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28–0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically.

Existence of Cervical Discopathy in Non-Cyclic Mastodynia

Background

Mastodynia is a subjective symptom that impairs the quality of life. It may be directly related with breast disorders. Moreover, a substantial rate is caused of reflective pain.

Objectives

Non-cyclic mastodynia is multifactorial, and treatment should be planned according to the underlying cause. In this study, we aim to evaluate the existence of cervical discopathy via cervical magnetic resonance imaging (MRI) in the etiology of non-cyclic mastodynia.

Methods

The study included 60 patients with normal physical examination results and imaging findings. Management was determined individually in patients. Patients with pathological MRI findings were evaluated by physical therapy, rehabilitation, and neurosurgery specialists, and appropriate treatment was planned. Patients were evaluated with the visual analogue scale (VAS) scoring system at initial presentation and after 1 and 3 months of treatment.

Results

The majority of patients had positive findings on MRI (53 [88.4%] vs. 7 [11.6%]). The mean VAS scores at the time of presentation, after 1, and after 3 months of treatment were 7.41, 6.39, and 3.35, respectively. The decrease in the scores was statistically significant (p ≤ 0,01).

Conclusions

We suggest that cervical discopathy should be kept in mind in cases of idiopathic non-cyclic mastodynia. Furthermore, cervical discopathy-related mastodynia seems to have a good response to appropriate treatment.

Assessment of menstrual health status and evolution through mobile apps for fertility awareness

For most women of reproductive age, assessing menstrual health and fertility typically involves regular visits to a gynecologist or another clinician. While these evaluations provide critical information on an individual's reproductive health status, they typically rely on memory-based self-reports, and the results are rarely, if ever, assessed at the population level. In recent years, mobile apps for menstrual tracking have become very popular, allowing us to evaluate the reliability and tracking frequency of millions of self-observations, thereby providing an unparalleled view, both in detail and scale, on menstrual health and its evolution for large populations. In particular, the primary aim of this study was to describe the tracking behavior of the app users and their overall observation patterns in an effort to understand if they were consistent with previous small-scale medical studies. The secondary aim was to investigate whether their precision allowed the detection and estimation of ovulation timing, which is critical for reproductive and menstrual health. Retrospective self-observation data were acquired from two mobile apps dedicated to the application of the sympto-thermal fertility awareness method, resulting in a dataset of more than 30 million days of observations from over 2.7 million cycles for two hundred thousand users. The analysis of the data showed that up to 40% of the cycles in which users were seeking pregnancy had recordings every single day. With a modeling approach using Hidden Markov Models to describe the collected data and estimate ovulation timing, it was found that follicular phases average duration and range were larger than previously reported, with only 24% of ovulations occurring at cycle days 14 to 15, while the luteal phase duration and range were in line with previous reports, although short luteal phases (10 days or less) were more frequently observed (in up to 20% of cycles). The digital epidemiology approach presented here can help to lead to a better understanding of menstrual health and its connection to women's health overall, which has historically been severely understudied.

Breast pain and cancer: should we continue to work-up isolated breast pain?

PURPOSE

To assess the cancer detection rate (CDR) in patients presenting with isolated breast pain.

METHODS

A retrospective review was performed of consecutive patients presenting to a large tertiary care academic center or an affiliated hospital with isolated breast pain from October 1, 2013 to September 30, 2015. Medical records were reviewed for patient demographics, pain characteristics, imaging findings, and outcome.

RESULTS

The study cohort was comprised of 971 exams in 953 patients, with a median age of 50 years. A total of 62.5% (607/971) of the cases were assessed by mammography and ultrasound, 24.4% (237/971) by ultrasound only, and 13.1% (127/971) by mammography only. Including the abnormalities detected in the asymptomatic breast, 88.7% (861/971) of the cases were negative or had benign findings (BI-RADS 1 and 2), 6.8% (66/971) were probably benign (BI-RADS 3), 3.9% (38/971) were suspicious (BI-RADS 4), and 0.6% (6/971) were highly suggestive of malignancy (BI-RADS 5). CDR on initial work-up was 0.8% (8/953), of which 0.6% (4/690) was in average-risk patients while 1.5% (4/263) was in higher-than-average risk patients.

CONCLUSIONS

CDR in patients presenting with isolated breast pain overall was low, comparable to the expected incidence of breast cancer in asymptomatic women. Work-up for isolated breast pain may therefore be unnecessary and lead to overutilization of healthcare resources. Routine screening mammography should be encouraged and higher-than-average risk patients may benefit from additional tests.

Effect of vitamin E on severity and duration of cyclic mastalgia: A systematic review and meta-analysis

OBJECTIVES

A systematic review was conducted to assess the effect of vitamin E on the severity and duration of Cyclic Mastalgia compared to vitamin B6, fish oil, herbal medicines and placebo.

DESIGN

A systematic review and meta-analysis of clinical trials.

METHODS

A search was carried out in PubMed, Cochrane Library, Embase, Scopus and Google Scholar and Persian databases for articles published from 1980 to 2018. The data obtained were analyzed in RevMan and reported in forest plots. The Odds Ratio (OR) was used to find the effect for the dichotomous data and the Standardized Mean Difference (SMD) for the continuous data. The heterogeneity of the studies was assessed using I² and the Random Effects Model was used instead of the Fixed Effects Model if I²>25%.

RESULTS

A total of 1051 titles and abstracts were extracted. Fourteen articles ultimately remained, and 11 of them were entered into the meta-analysis. The meta-analysis showed significant differences between vitamin E and placebo in the severity (SMD=-0.51; 95% CI=-0.21 to -0.82) and duration (MD=-1.47; 95% CI=-0.91 to -2.57) of cyclic mastalgia, although herbal medicines had a greater effect on the severity of mastalgia than vitamin E (SMD = 0.51, 95% CI = 0.06 to 0.96).

CONCLUSION

Although herbal medicines are more effective than vitamin E, vitamin E reduces both the severity and duration of the disorder compared to placebos, which only reduce its severity, and can therefore be considered a treatment with minimum side-effects. Due to the high heterogeneity of the studies, the researchers recommend further research on the subject using a standard tool based on the CONSORT statement.

Reminders of cancer risk and pain catastrophizing: relationships with cancer worry and perceived risk in women with a first-degree relative with breast cancer

First-degree relatives of women with breast cancer may experience increased worry or perceived risk when faced with reminders of their own cancer risk. Worry and risk reminders may include physical symptoms (e.g., persistent breast pain) and caregiving experiences. Women who engage in pain catastrophizing may be particularly likely to experience increased distress when risk reminders are present. We examined the degree to which persistent breast pain and experience as a cancer caregiver were related to cancer worry and perceived risk in first-degree relatives of women with breast cancer (N = 85) and how catastrophic thoughts about breast pain could impact these relationships. There was a significant interaction between persistent breast pain and pain catastrophizing in predicting cancer worry (p = .03); among women who engaged in pain catastrophizing, cancer worry remained high even in the absence of breast pain. Pain catastrophizing also moderated the relationships between caregiving involvement and cancer worry (p = .003) and perceived risk (p = .03). As the degree of caregiving responsibility increased, cancer worry and perceived risk increased for women who engaged in pain catastrophizing; levels of cancer worry and perceived risk remained low and stable for women who did not engage in pain catastrophizing regardless of caregiving experience. The results suggest that first-degree relatives of breast cancer survivors who engage in pain catastrophizing may experience greater cancer worry and perceived risk and may benefit from interventions aimed at reducing catastrophic thoughts about pain.

The effect of centchroman on mastalgia: a systematic review

OBJECTIVES

We carried out a systematic review of the literature to evaluate the effect of centchroman on mastalgia as well as any side effects.

METHODS

The databases of the Cochrane Library, Medline (PubMed), Embase, ProQuest and ClinicalTrials.gov were systematically searched. The quality of randomised controlled clinical trials (RCTs) was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised clinical trials. The quality of non-randomised clinical trials was assessed using the Cochrane risk of bias assessment tool for non-randomised studies of interventions (ROBINS-I). Owing to different outcomes reporting, a meta-analysis of the results was not possible.

RESULTS

Thirteen papers were included in the study. Of these, 12 showed a significant effect of centchroman in reducing breast pain at 3 months. One study that compared the effect of centchroman with that of tamoxifen reported a significant reduction in breast pain in both groups at 3 months; the difference between the two groups was not significant. Six studies showed the effectiveness of centchroman at 6 months. None of the papers reported any serious side effects of centchroman.

CONCLUSIONS

Since a meta-analysis could not be conducted and the quality of the papers was low, there was insufficient evidence to evaluate the effect of centchroman on mastalgia. It is therefore recommended to conduct well-designed RCTs to compare the effect of centchroman on mastalgia with that of a placebo or other medication.

The Role of Nutrition in Women with Benign Cyclic Mastalgia: A Case-Control Study

Objective

Smoking, caffeine, oral contraception, and exercise are the most cited factors for premenstrual mastalgia in the literature, but remain controversial. In this study, we aimed to investigate the most often proposed nutritional factors for cyclic breast pain.

Materials and Methods

Patients who met the criteria for participation in the mastalgia or control group were included in this case-control study. The age, body mass index, educational status, duration of breast pain, visual analog scale (VAS) pain score (0 to 10), number of births, use of oral contraception, exercise habits, drinking coffee, tea, alcohol and water, smoking history, and eating fast food and dessert were examined using a questionnaire.

Results

The mean age of mastalgia (n=256) and control (n=200) patients were 35.9±11.0 and 36.6±10.6 years, respectively. In the mastalgia group, the mean duration of cyclic breast pain time was 22.8±33.0 months and mean the VAS score 4.0±2.1. Body mass index and the mean number of births were higher in the mastalgia group than control group (p<0.005). There were no differences in smoking, oral contraceptive use, and drinking alcohol and tea (p>0.005). Compared to the mastalgia group, the control group ate more fast food and desserts, drank more water and coffee, and exercised less (p<0.005).

Conclusion

The causes of mastalgia remain controversial. Our data supports some of the published studies, but not others. We propose that nutritional factors contribute less to the risk of mastalgia than is generally thought.

Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments

CYCLIC AND NON-CYCLIC BREAST-PAIN

A systematic review on pain reduction, side effects, and quality of life for various treatments.

BACKGROUND

No clear systematic-review on all the various treatment regimen for (Non-) cyclical-breast-pain currently exists.

OBJECTIVES

The aim of this study was to assess the various forms of therapy for treatment of breast-pain and the evidence for their effectiveness.

SEARCH STRATEGY

Search-terms included 'mastalgia' and 'therapy' or 'hormones' or 'nsaid' or 'psychotherapy' or 'analgesia' or 'surgery', and synonyms.

SELECTION CRITERIA

The review was conducted according to the Preferred Reporting Items for Systematic-reviews and Meta-Analysis guidelines. RCT's and pro-/retrospective studies reporting on treatment of breast-pain were considered eligible. Minimal follow-up and sample-size criteria were 6 months and 10 patients respectively.

DATA COLLECTION AND ANALYSIS

Data was extracted using standardized tables and encompassed number of subjects, type of breast-pain and treatment, efficacy of treatment and clinical complications/side-effects. No pooling of data could be achieved due to heterogeneity amongst studies.

MAIN RESULTS

Twenty-three studies were included, that reported on 2100 patients in total. Topical-Diclofenac was found to reduce pain by 58.7 and 63.3 on a Visual-Analogue-Scale (VAS) in cyclical and non-cyclical-breast-pain respectively. Persistent cyclical-breast-pain can be treated with short courses (2-6 months) of either Bromocryptine (VAS↓=25.4) or Danazol (VAS↓=33.6) as long as benefits outweigh the side-effects. Last-resort options for unresponsive and severe debilitating breast-pain include surgery in the form of bilateral mastectomy with reconstruction.

CONCLUSIONS

Pain reduction in patients with breast-pain can be achieved with analgesics, hormonal-regimen and possibly surgery as a last resort. Additional studies are needed with well-described patient-characteristics, robust study set-up, and longer follow-up times.

To image or not in noncyclic breast pain? A systematic review

PURPOSE OF REVIEW

Investigation of noncyclic mastalgia in women without signs or risk factors for cancer is controversial. An initial imaging strategy can diagnose breast cancer early, potentially leading to better treatment and survival. However, cancer diagnosis is very uncommon in these cases, and this approach can be harmful, as false positives or suspicion results will lead to unneeded interventions and follow-up. The purpose of this review is to analyse the trade-offs between desirable and undesirable consequences of initial imaging tests against clinical follow-up.

RECENT FINDINGS

We found seven relevant studies, all observational, with some methodological limitations and very low-quality evidence. They showed low breast cancer prevalence (around 1-2%, increasing with age), high sensitivity to rule out disease but moderate specificity to rule it in using mammography and echography, and lacked evidence on follow-up and final outcomes.

SUMMARY

There is a low prevalence of breast cancer in patients with painful breast with negative physical examination, and very little research to inform about the effect of performing or avoiding initial imaging test on outcomes of interest. With such limited evidence, only a weak recommendation to reinforce shared decision making about what should be done in the primary care setting can be made, with the backup of a specialized breast unit.

Benign Breast Diseases: Evaluation and Management

Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.

Practice Bulletin No. 164: Diagnosis and Management of Benign Breast Disorders

Breast-related symptoms are among the most common reasons women present to obstetrician-gynecologists. Obstetrician-gynecologists are in a favorable position to diagnose benign breast disease in their patients. The purpose of a thorough understanding of benign breast disease is threefold: 1) to alleviate, when possible, symptoms attributable to benign breast disease, 2) to distinguish benign from malignant breast disease, and 3) to identify patients with an increased risk of breast cancer so that increased surveillance or preventive therapy can be initiated. Obstetrician-gynecologists may perform diagnostic procedures when indicated or may make referrals to physicians who specialize in the diagnosis and treatment of breast disease. The purpose of this Practice Bulletin is to outline common benign breast disease symptoms in women who are not pregnant or lactating and discuss appropriate evaluation and management. The obstetrician-gynecologist's role in the screening and management of breast cancer is beyond the scope of this document and is addressed in other publications of the American College of Obstetricians and Gynecologists ().

Can breast ultrasound reduce patient's level of anxiety and pain?

BACKGROUND

Breast pain is one of the most common complaints of women attending a gynecology clinic and general practitioners. This pain can cause anxiety and, consequently, reduce the woman's quality of life. The objective of this study was to assess the severity of pain and anxiety in patients with breast pain and normal examination, before and after breast sonography.

MATERIALS AND METHODS

Among the patients with breast pain and normal examination who came for breast sonography in three centers in Shiraz during 2011-2012, 51 patients agreed to cooperate in this project. These patients filled out the questionnaire for evaluation of pain and anxiety before and after breast sonography.

RESULTS

Sonography findings indicated that 88% of patients have normal sonography without any finding. The average amounts of pain severity before and after sonography were 3.3 and 2.4, respectively (p < 0.005). The average amounts of anxiety severity in patients before and after sonography were 51.9 and 37.9, respectively (p < 0.005).

CONCLUSION

This study shows the severity of pain and anxiety after ultrasonography decreased significantly. It can be concluded that ultrasound findings, which reassure the patients that they do not have specific pathology, can reduce the pain and anxiety by its impact on psychological status of the patient.

The effects of exercise on mastalgia

OBJECTIVE

Mastalgia is often ignored by physicians although it is the most common breast-related complaint among women. The effectiveness of exercise therapy for mastalgia is unclear. The aim of this study is to investigate the effects of exercise on mastalgia.

METHODS

A randomized controlled trial was conducted with twenty women with complaints of mastalgia fulfilling the inclusion and exclusion criteria. Patients were randomly assigned to the control group and to the exercise group. Sports brassiere, refraining from caffeine- and methylxanthine-containing foods, and simple analgesics were recommended for two groups. In the exercise group, an exercise program was conducted three times a week for 6 weeks. Participants in both groups were evaluated for breast pain and using the Short-Form Health Survey (SF-36) questionnaire before and six weeks after study. Serum cytokine levels were also collected and analyzed.

RESULTS

No significant differences were detected with respect to age, body mass index, menopausal status, psychiatric condition, and existence of unexplained pain syndromes between the groups. Total breast pain scores were similar in both groups. The sensory component of breast pain questionnaire and visual analogue scale values significantly improved via exercise in only exercise group (p = 0.012 and p = 0.016). There was no significant difference between groups in serum levels of cytokines. SF-36 subscale scores for general health and social functioning significantly improved in the control group and scores for role physical, bodily pain, and social functioning improved in exercise group.

CONCLUSIONS

Based on our preliminary findings, exercise treatment is beneficial for patients with mastalgia and it can be suggested by clinicians.

Effectiveness of Centchroman on Regression of Fibroadenosis and Mastalgia

INTRODUCTION

Fibroadenosis and mastalgia are common among the women in reproductive age group. Treatment for these conditions is not yet standardised. Most of the drugs used for fibroadenosis and mastalgia are expensive and have side effects.

AIM

To find out the efficacy of centchroman, a Selective Estrogens Receptor Modulator (SERM) on regression of fibroadenosis and mastalgia.

MATERIALS AND METHODS

Fifty one patients with mastalgia/fibroadenosis were treated with centchroman 30mg once daily on alternate days for a period of 3 months and followed up weekly for six months with Mastalgia chart and Visual Analog Scale (VAS) pain score.

RESULTS

Before starting treatment, four patients presented with pain score of 6 followed by, 37 patients with a score of 4 and 10 patients with a score of 2. All the patients were started on tab centchroman 30mg OD alternate days and were reviewed on weekly basis with Mastalgia chart and VAS pain score for three months. On fifth and sixth visit, 46 patients reported with pain score 0, one with pain score of 2 and four with pain score of 6. The efficacy of centchroman was found to be significant (p-value = 0.001). Three patients (5.9%) reported epigastric pain and ten patients (19.6%) reported menstrual delay. A total of 38 patients did not complain of any side effect.

CONCLUSION

Our study proves that centchroman is a safe and cost effective drug with significant efficacy on regression of fibroadenosis and mastalgia with minimal side effect.