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Höller M, Steindl H, Abramov-Sommariva D, Kleemann J, Loleit A, Abels C, Stute P. Use of Vitex agnus-castus in patients with menstrual cycle disorders: a single-center retrospective longitudinal cohort study. Arch Gynecol Obstet 2024; 309:2089-2098. [PMID: 38393671 PMCID: PMC11018691 DOI: 10.1007/s00404-023-07363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/24/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE To evaluate clinical characteristics, quality of life (QoL) and effectiveness in patients with menstrual cycle disorders (MCDs) including abnormal uterine bleeding, dysmenorrhea and mastodynia/mastalgia related to premenstrual syndrome taking the Vitex agnus-castus (VAC) products Cyclodynon® or Mastodynon® in a real-world setting. METHODS A single-center retrospective longitudinal cohort study (3 ± 1 months), using data obtained from healthcare data archive and telephone interviews. The main study variables were changes in bleeding, menstrual pain, breast tenderness and patients' QoL. RESULTS Data from 1700 women with a mean age of 30.2 years (± 6.3) were analyzed. The most common MCDs were dysmenorrhea (43.8%) and mastodynia/mastalgia (21.1%). Three-month treatment with VAC extract substantially decreased the percentage of patients with irregular cycle (from 9.1% to 0.1%) and breast tenderness (from 39.9% to 0.8%). Improvement in bleeding intensity, frequency and menstrual pain was experienced by 83.4%, 79.2%, and 85.2% of the patients, respectively. When analyzed by disease category, these parameters improved in almost all dysmenorrhea patients, while they improved to a lesser extent in mastodynia/mastalgia patients. QoL improved in all aspects, but was reported by a higher proportion of dysmenorrhea patients compared to mastodynia/mastalgia patients. Treatment was overall well tolerated with a favorable safety profile. CONCLUSION These real-world data demonstrate the effectiveness of the VAC-containing products Cyclodynon® and Mastodynon® in the three-month treatment of MCDs, with a pronounced improvement in key disease symptoms and QoL. Intriguingly, while QoL was generally greatly improved, the response to VAC therapy varied depending on the type of underlying MCD.
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Affiliation(s)
- Martina Höller
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | - Hubert Steindl
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | | | - Julia Kleemann
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | - Alexey Loleit
- Amstelveenseweg 122A2, 1075 XL, Amsterdam, The Netherlands
| | - Christoph Abels
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | - Petra Stute
- Department of Obstetrics and Gynecology, Inselspital Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland.
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Ellis KS, Robinson CE, Foster R, Fatayer H, Gandhi A. Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service. Ann R Coll Surg Engl 2024; 106:359-363. [PMID: 37642083 PMCID: PMC10981980 DOI: 10.1308/rcsann.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION There has been an almost 100% increase in referrals to breast cancer diagnostic clinics in the past decade. Breaching of the two-week cancer referral target is now commonplace, potentially delaying diagnoses of breast malignancy in many women. Almost one in five of these referrals are women with mastalgia, not a symptom linked to breast cancer. The objective of the study was the safe introduction of an advanced nurse practitioner-led telephone service for women with mastalgia to improve the service for women and create capacity for those with "red flag" breast symptoms. METHODS Referrals to clinic were triaged, women with mastalgia only were directed to a telephone-based assessment clinic and symptoms evaluated using a multidisciplinary created proforma. RESULTS Within 23 months, 1,427 women were assessed in the breast pain telephone assessment clinic: 863 (61%) were aged over 40 and 564 (39%) aged under 40. A total of 1,238 underwent telephone assessment. Reassurance and discharge only was needed for 365 (26%). The aetiology of pain was identified as musculoskeletal in 1,104/1,238 (89%) of patients, with only 39/1,238 (3.2%) identified as having true breast pain. Additional symptoms were mentioned by 264 women (18%) during the consultation; all immediately redirected back to a diagnostic clinic. Mammography was undertaken in 609 women (43%). Seven women (0.6%) were diagnosed with a breast malignancy. Patient survey indicated that 93% of patients were satisfied with the care received and 97% said they would recommend the service to a family member or friend. CONCLUSIONS Although face-to-face assessments for breast pain remain the standard practice in many breast units, data indicating the safety of a telephone assessment clinic, along with high levels of patient satisfaction, question whether services can be delivered differently.
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Affiliation(s)
- KS Ellis
- Manchester University NHS Foundation Trust, UK
| | - CE Robinson
- Manchester University NHS Foundation Trust, UK
| | - R Foster
- Manchester University NHS Foundation Trust, UK
| | - H Fatayer
- Manchester University NHS Foundation Trust, UK
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Laws S, Spiller K, Glew C. Evaluation of a pilot of a community virtual triage for breast symptoms outside of usual primary or secondary care pathways. Ann R Coll Surg Engl 2024. [PMID: 38404244 DOI: 10.1308/rcsann.2023.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Both primary and secondary care services in the NHS have been overwhelmed with an increase in referrals on the suspected cancer pathways. The years 2020/2021 saw 551,770 symptomatic breast referrals made in England alone. The Wessex Rapid investigations service in conjunction with the local district general hospital and primary care networks instigated a virtual triage for new breast symptoms. Over the course of a year, 664 people were assessed by either telephone or video using specially trained nurses. Appointments were given within 1-2 working days. The service was highly valued by patients and general practitioners. We were unable to confirm a reduction in referral to secondary care as the evaluation occurred during a postpandemic peak in referrals. We found that 10% of patients with new breast symptoms can safely self-manage. This percentage varied with the experience of the triage clinician. A specialist community face-to-face service could reduce further the need for full secondary care evaluation. Better integration and use of information technology systems would improve the service. The rapid responsiveness and length of consultations is valued by patients. Representation with the same symptoms was rare. This pathway utilises staff outside of the usual primary and secondary care providers and thus reduces the pressure on stretched systems.
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Affiliation(s)
- S Laws
- Hampshire Hospitals NHS Trust, UK
| | - K Spiller
- Wessex Rapid Investigation Service, UK
| | - C Glew
- Winchester Rural North and East Primary Care Network, UK
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Siddique AB, Nath SD, Mubarak M, Akter A, Mehrin S, Hkatun MJ, Liza AP, Islam MS, Amin MZ, Ferdous MZ. Assessment of prevalence and factors affecting Mastalgia among early reproductive-aged women in Bangladesh: a cross-sectional survey. BMC Public Health 2023; 23:2269. [PMID: 37978504 PMCID: PMC10656957 DOI: 10.1186/s12889-023-17173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Mastalgia, or breast pain, is a prevalent and distressing condition experienced by women, impacting their daily lives and causing complications. It is common among women of reproductive age, with associations found with premenstrual syndrome, fibrocystic breast disease, psychological distress, and, in rare cases, breast cancer. While Western societies have high frequencies of Mastalgia, it is less diagnosed in Asian cultures including Bangladesh. This study aimed to investigate the prevalence and factors associated with Mastalgia among early reproductive-aged women in Bangladesh. METHODS A cross-sectional survey was conducted, and data were collected from different regions of the country. A convenience sampling method was used to take 1,214 participants for the study. A pre-tested semi-structured questionnaire was used to collect data. Bivariate and multivariate analyses were conducted to ascertain factors that were significantly associated with Mastalgia. The data were analyzed using the SPSS software 26 version. RESULTS All the participants were female (mean age: 22.87 ± 2.64 years; age ranges: 18-35 years). The prevalence of Mastalgia was found to be 35.5%. The study was conducted using a self-reported semi-structured questionnaire. Participants with a higher education level and higher income were more likely to experience Mastalgia. A family history of breast cancer and severe abdominal pain during menstruation were also identified as associated factors for Mastalgia (p < 0.05). CONCLUSIONS This study enhances our understanding of Mastalgia in Bangladesh, offering insights for healthcare and policy. Further research is required to uncover its root causes and develop effective interventions. The study highlights the prevalence of mastalgia and its related factors, emphasizing the necessity for increased awareness and support for affected women.
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Affiliation(s)
- Abu Bakkar Siddique
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, 1342, Bangladesh.
| | - Sudipto Deb Nath
- Army Medical College Jashore, Jashore, 7403, Bangladesh
- Department of Genetic Engineering & Biotechnology, Jashore University of Science & Technology, Jashore, 7408, Bangladesh
| | - Mahfuza Mubarak
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Amena Akter
- Department of Agriculture, Bangabandhu Sheikh Mujibur Rahman Science & Technology University, Gopalganj, Dhaka, 8100, Bangladesh
| | - Sanjida Mehrin
- Department of Political Studies, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh
| | - Mst Jemi Hkatun
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | | | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, 1342, Bangladesh
| | - M Ziaul Amin
- Department of Genetic Engineering & Biotechnology, Jashore University of Science & Technology, Jashore, 7408, Bangladesh
| | - Most Zannatul Ferdous
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
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Pankaj H, Rai P, Singh A, Singh S, Srivastava R, Rudramani. Role of Reassurance and Proper Mechanical Support Advice on Quality of Life and Pain Relief in Patients of the Mastalgia-A Prospective Follow-up Study at A Tertiary Care Center in a Developing Country. Eur J Breast Health 2023; 19:210-214. [PMID: 37415657 PMCID: PMC10320641 DOI: 10.4274/ejbh.galenos.2023.2023-3-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To study the effect of reassurance and proper mechanical support on quality of life (QOL) and visual analogue score (VAS) pain assessment in patients with mastalgia at a range of follow-ups. MATERIALS AND METHODS A prospective follow-up study was conducted among women aged 15-45 years, complaining of breast pain without any abnormality detected clinically and radiologically. After consent to participate and enrollment, all the study participants were counseled and reassured about the non-neoplastic nature of the disease and about wearing proper mechanical support/Bra; this was repeated at each follow-up. VAS was used to assess the pain intensity perceived by the woman at each follow-up, post intervention. The Short Form-36 (SF-36) scale was used to evaluate health related QOL (HRQOL). RESULTS Among 80 patients, 31.2% were wearing a Bra of fabric other than cotton, 21.2% were wearing a loose fit mechanical support/Brassiere, while 10% were not wearing any mechanical support at baseline. The overall mean VAS score was significantly reduced with each follow-up, indicating decreased perception of breast pain over time. There was a significant difference between the mean SF-36 score between base line and after three months (p<0.0001). Mean scores in all domains of the SF-36 increased. The greatest reduction in mean VAS score was seen in 26-35 years age group and women with a body mass index <18.5 kg/m2. CONCLUSION Reassurance and wearing proper mechanical support/Bra are effective for improving QOL and alleviating breast pain/mastalgia. These simple processes should be used for the management of mastalgia.
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Affiliation(s)
- Harendra Pankaj
- Department of General Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Uttar Pradesh, India
| | - Priyanka Rai
- Department of General Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Uttar Pradesh, India
| | - Amarjot Singh
- Department of General Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Uttar Pradesh, India
| | - Sunil Singh
- Department of General Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Uttar Pradesh, India
| | - Rohit Srivastava
- Department of General Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Uttar Pradesh, India
| | - Rudramani
- Department of General Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Uttar Pradesh, India
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Komenaka IK, Nodora J, Martinez ME, Hsu CH, Wong T, Shah A, Caruso DM. Mastalgia is Not An Indication for Mammogram. J Am Board Fam Med 2022:jabfm.2022.AP.210476. [PMID: 36096656 DOI: 10.3122/jabfm.2022.ap.210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Mastalgia is a common breast complaint that is worrisome to patients. This study was performed to determine if mastalgia is a sign of breast cancer and to evaluate the benefit of its work up. METHODS: Retrospective review of prospectively collected data on 8960 consecutive patients at a safety net institution from June 1, 2006 to December 31, 2020. Data on patient reported mastalgia and diagnosis of breast cancer were collected. RESULTS: 8960 patients had a mean age of 45 years. The population was predominantly underinsured, 70% Hispanic, and 16% had adequate health literacy. Approximately 31% (2820 of 8960) of patients presented with a complaint of breast pain. Of 2820 patients with breast pain, 20 (0.7%) were found to have breast cancer. The average age of patients with breast cancer was 49 years. Physical examination identified a mass in 6 patients and only 3 patients had pain limited to the side of the cancer (10 bilateral, 7 contralateral). Of 1280 patients who were under age 40 years, 88% underwent breast imaging. The Cancer Detection Rate (CDR) was 0.9 per 1000 examinations. For 950 patients age 40 to 49 years and 590 patients age 50 years and older, 98% and 99% underwent breast imaging, respectively. The CDR was 10 per 1000 examinations for age 40 to 49 and 14 per 1000 examinations for age 50 years and older. CONCLUSIONS: Mastalgia is rarely associated with breast cancer. In the absence of other findings, imaging of patients less than age 40 is not recommended. Any workup beyond routine screening mammography in age-appropriate patients, to identify the "cause" of breast pain, does not seem warranted.
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Affiliation(s)
- Ian K Komenaka
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Jesse Nodora
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Maria Elena Martinez
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Chiu-Hsieh Hsu
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Tina Wong
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Anushi Shah
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
| | - Daniel M Caruso
- From Valleywise Health/Maricopa Medical Center, Phoenix, AZ (IKK, JN, MEM, CH, TW, AS, DMC); Ironwood Cancer and Research Centers, Chandler, AZ(IK); Arizona Cancer Center, University of Arizona, Tucson (IKK, CH); Moores UCSD Cancer Center, San Diego, CA (JN, MEM); Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson (CH); Maricopa Medical Center, Phoenix, AZ (TW, AS, DMC)
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Sinha MK, Barman A, Sahu S, Jha AK, Asharaf AA. Tamoxifen in mastalgia: A meta-analysis. J Obstet Gynaecol Can 2022; 44:1084-1094. [PMID: 35752405 DOI: 10.1016/j.jogc.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
| | - Apurba Barman
- Department of Physical Medicine and Rehabilitation, AIIMS Bhubaneswar, Odisha, India
| | - Shantanu Sahu
- Department of General Surgery, AIIMS Bhubaneswar, Odisha, India
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Pleasant V. Management of breast complaints and high-risk lesions. Best Pract Res Clin Obstet Gynaecol 2022; 83:46-59. [PMID: 35570155 DOI: 10.1016/j.bpobgyn.2022.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/02/2022]
Abstract
Benign breast disease including palpable breast mass, mastalgia, skin changes, and nipple discharge are common gynecologic symptoms. Practitioners should be well versed in the components of clinical breast care. Workup begins with taking a thorough medical and family history to assess risk and performing a clinical breast examination. Breast imaging is often indicated for further evaluation. A structured approach to the evaluation and management of these breast conditions is critical to distinguish benign disease from malignancy. High-risk breast lesions such as atypical hyperplasia and lobular carcinoma in situ are also frequently encountered, and while benign, they do increase the future risk of breast cancer and patients should be offered intensive surveillance and chemoprevention.
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Affiliation(s)
- Versha Pleasant
- University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Mohammed AA. Mammary duct ectasia in adult females; risk factors for the disease, a case control study. Ann Med Surg (Lond) 2021; 62:140-144. [PMID: 33520211 PMCID: PMC7820305 DOI: 10.1016/j.amsu.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Mammary duct ectasia is a common clinical condition characterized by abnormal dilatation of the central milk ducts with chronic inflammation and fibrosis, it may affect one or both breasts. Patients may be completely asymptomatic or have mastalgia or nipple discharge which is usually from multiple ducts. It mostly affects females and is very rare in males. Patients and methods This is a case control study which included 236 females grouped into two equal groups, the first group were patients with duct ectasia compared and the other one apparently healthy females and both groups were compared regarding different characteristics. Results Most patients were young with a mean age of 35 years, a most of them were overweight (42.4%) and obese (33.1%). Most were menstruating (86.4%) with regular cycles (79.7%). Most patients had breast pain (67.8%), tenderness (54.2%), and no nodularity (98.3%). About 47.5% had nipple discharge mostly from multiple ducts (43.2%), 52.5% had no discharge. There was a significant correlation between the development of duct ectasia and each of marital status, lactational status, coffee consumption, pain, nodularity, and breast tenderness (P values 0.026, 0.016, 0.034, 0.000, 0.000, and 0.000). Conclusion Duct ectasia is a very common complaint in females, it is commoner in overweight and obese females, married females and those with history of lactation. Coffee consumption may be a cause. The regularity of the menstruation has no correlation with its development. The presence of mastalgia, tenderness, and nodularity are highly suggestive for the disease. The breast is a dynamic structure that undergo various stages of development. Mammary duct ectasia is a common clinical condition. It may affect single breast or both breasts. It is common in obese females, married females and those with history of lactation. Patients have mastalgia, breast tenderness, and nodularity.
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Affiliation(s)
- Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Nakhoshkhana Road, 8 AM-1014, Duhok, Kurdistan Region, Iraq
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Godazandeh G, Ala S, Motlaq TM, Sahebnasagh A, Bazi A. The comparison of the effect of flaxseed oil and vitamin E on mastalgia and nodularity of breast fibrocystic: a randomized double-blind clinical trial. J Pharm Health Care Sci 2021; 7:4. [PMID: 33407941 PMCID: PMC7789497 DOI: 10.1186/s40780-020-00186-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Fibrocystic changes are a common benign condition in women aged 20–50. The medical intervention aims to stop fibrocystic disease progress and relieve the breast’s pain and tenderness. In the long-term, reversing the fibrocystic changes is also desirable. Methods In this randomized double-blind clinical trial, the effect of flaxseed oil on the severity of pain and breast nodularity was investigated against vitamin E. This study was conducted on 100 women with mastalgia. The intervention group received Flaxseed oil pearls and the control group received vitamin E pearl 200 IU twice a day for 2 months. The duration and severity of breast pain were evaluated by Cardiff chart and VAS (Visual Analogue Scale). The nodularity was assessed by Lucknow-Cardiff scale at baseline, then the first and second months of intervention. Results At baseline, there was no statistically significant difference between the two groups in characteristics. The breast pain improved in both groups during the first and second months of intervention (P-value within group< 0.001). However, the mean breast pain was not significantly different between the two groups at the end of the first and second month (P1= 0.54, P2= 0.73). Furthermore, the breast pain during four phases of the menstrual cycle showed no difference between vitamin E and flaxseed oil groups (menstruation phase= 0.76, follicular phase= 0.48, the first week of luteal phase= 0.86, the second week of luteal phase=0.30). The breast nodularity also decreased during the first and second months of intervention, yet no significant difference between the two groups was found (p= 0.9). Conclusions This study showed that flaxseed oil and vitamin E both could be effective in breast pain-relieving and decreasing nodularity with minimal side effects in contrast with the baseline. But there are no significant differences between these two agents. Larger scale prospective studies are needed to evaluate these effects in the long-term. Trial registration IRCT201612243014N18, Registration date: 2017-10-15.
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Affiliation(s)
- Gholamali Godazandeh
- Department of Thoracic Surgery, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahram Ala
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Km 18 Khazarabad Road, Khazar sq., Sari, Mazandaran Province, 4815733971, Iran.
| | - Tahereh Madani Motlaq
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Aliyeh Bazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Km 18 Khazarabad Road, Khazar sq., Sari, Mazandaran Province, 4815733971, Iran
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Belli AK, Dinc Elibol F, Acarbas A, Ozcan O, Dere O, Yazkan C, Elibol C, Tosun K, Nazli O. The Necessity of Upper Extremity Neurologic Examination while Evaluating Breast Pain. Breast Care (Basel) 2020; 15:506-510. [PMID: 33223994 DOI: 10.1159/000505364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Breast pain is one of the most frequent complaints and occurs in 45-69% of all women. Cervical disc herniation is a common cause of cervical radiculopathy with an incidence rate of 18.6 per 100,000, and it should be considered as a cause of breast pain. Objective To identify the extent to which upper extremity neurologic findings and cervical root disorders accompany breast pain. Methods We prospectively collected clinical features of patients with breast pain. An upper extremity neurologic examination was performed in patients and controls. Patients who had neurologic findings underwent cervical spine magnetic resonance imaging (MRI) to identify cervical root disorders. Results Out of the 554 participants, 233 had breast pain, and 321 were controls. Women with breast pain had more numbness (116 [49.8%] vs. 104 [32.4%], p < 0.001) and more dysesthesia (36 [15.5%] vs. 17 [5.3%], p < 0.001) than the controls, but they had similar upper extremity weakness (10 [4.3%] vs. 14 [4.4%], p > 0.05). The number of women with one neurologic finding was significantly greater in the group with breast pain (119 [51.1%] vs. 111 [34.6%], p < 0.001). Ninety (16.2%) patients underwent a cervical vertebra MRI, which showed that 86 (95.6%) patients had cervical root disorders including 21 (23.3%) cases of bulging, 9 (10%) of annular tear, and 56 (62.2%) of central disc protrusion; 4 (4.4%) patients had normal findings. The multivariate logistic regression analysis revealed that age was the only significant predictor of neurologic findings in patients with breast pain (p < 0.05, OR: 1.02, CI: 1.002-1.053). Conclusions Cervical root disorders should be considered as a cause of extramammary breast pain.
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Affiliation(s)
- Ahmet K Belli
- Department of General Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Funda Dinc Elibol
- Department of Radiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Arsal Acarbas
- Department of Neurosurgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Onder Ozcan
- Department of General Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Ozcan Dere
- Department of General Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Cenk Yazkan
- Department of General Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Cenk Elibol
- Department of Radiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Kursat Tosun
- Department of Biostatistics, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Okay Nazli
- Department of General Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
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Mohammed AA. Evaluation of mastalgia in patients presented to the breast clinic in Duhok city, Iraq: Cross sectional study. Ann Med Surg (Lond) 2020; 52:31-35. [PMID: 32194960 PMCID: PMC7078444 DOI: 10.1016/j.amsu.2020.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/17/2020] [Accepted: 02/29/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Mastalgia is a common condition that may affect up to two-thirds of patients during the reproductive period. It can be divided into cyclical and noncyclical. It is mostly due to benign causes, but breast cancer should be excluded. It may be associated with a high level of stress and anxiety. Patients need to be assessed fully, breast and general examinations, and investigations such as breast imaging and hormonal assay. PATIENTS AND METHODS This is a prospective study that was done in the breast clinic in the period between February 2019 and July 2019. A total number of 445 patients with mastalgia included were in the study. Patients were examined and evaluated using various imaging modalities. RESULTS The mean age of the patients was 34 years. Mastalgia was present in 54.2% of our patients, in about 70.1% of our patients it was noncyclical mastalgia. Mastalgia was positively correlated with smoking, oral contraceptive pills, and positive family history of breast cancer (p values: 0.000, 0.009, and 0.000) respectively with no correlation with other factors. The type of pain was less in women having early first pregnancy and with the site of the pain showed a positive correlation with the type of pain, (p values: 0.001 and 0.000) respectively. CONCLUSION Mastalgia is a common complaint which may affect most females. It is caused by benign breast disorders in the majority of patients. A systematic approach must be followed for the management of mastalgia. Reassurance, regular exercise, and local analgesics may be very effective initial measures. In severe, intractable cases, hormonal therapy may be used.
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Mohallem Fonseca M, Lamb LR, Verma R, Ogunkinle O, Seely JM. Breast pain and cancer: should we continue to work-up isolated breast pain? Breast Cancer Res Treat 2019; 177:619-27. [PMID: 31309396 DOI: 10.1007/s10549-019-05354-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/07/2019] [Indexed: 02/02/2023]
Abstract
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.
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Itsekson AM, Yonit B, Ze'ev IH, Matitiyahu Z, Shmuel K. Safety and value of skin test to sex hormones and sex hormone sensitivity desensitization in women with premenstrual syndrome. World Allergy Organ J 2019; 12:100041. [PMID: 31198489 PMCID: PMC6557725 DOI: 10.1016/j.waojou.2019.100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023] Open
Abstract
Background Hypersensitivity to one's own sex hormones is not a new concept but it is an underappreciated one. Such a phenomenon may explain a large proportion of symptoms related to the menstrual cycle (such as premenstrual syndrome, PMS), cyclic pain syndromes or unexplained infertility. In this study we propose a novel diagnostic tool of hormonal skin testing which reveals sex hormones sensitivity with high clinical correlation, and a subsequent successful desensitization technique. Methods A group of 35 women with confirmed diagnosis of PMS were enrolled in the study in which they underwent a hormonal skin diagnostic skin testing procedure by intradermal injections of Progesterone (P), Estradiol (E2), Estrone (E1) and Estriol (E3). Skin reaction was monitored, and according to the reaction the patients were treated by serial desensitization by similar serial injections or placebo solvent. Response to treatment was monitored by assessing the change in the severity of PMS related symptoms. Results We show a positive correlation between PMS severity and skin sensitivity to sex hormones. Subsequent desensitization procedure led to a significant improvement in the severity of PMS related symptoms. Conclusions The testing and desensitization procedure is safe, sensitive and bares a high therapeutic potential in approach to resistant hormonal cycle related syndromes. ClinicalTrials.gov Identifier NCT00873262: Evaluation of Safety/Efficacy of Diagnostic Skin Test Panel and Desensitization Hormone Kit for Treatment of Premenstrual Syndrome (PMS) 2009.
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Affiliation(s)
- Alek M. Itsekson
- Myofascial Pain Clinic, Rehabilitation Center, Sheba Medical Center, Israel
| | | | | | - Zolti Matitiyahu
- Department of Gynecology and PMS Clinic, Sheba Medical Center, Israel
| | - Kivity Shmuel
- Institute of Allergy and Clinical Immunology, Research Authority, Sourasky Medical Center, Israel
- Corresponding author.
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Hajizadeh K, Alizadeh Charandabi SM, Hasanzade R, Mirghafourvand M. Effect of vitamin E on severity and duration of cyclic mastalgia: A systematic review and meta-analysis. Complement Ther Med 2019; 44:1-8. [PMID: 31126540 DOI: 10.1016/j.ctim.2019.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022] Open
Abstract
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.
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Affiliation(s)
- Khadije Hajizadeh
- Students' Research Committee, Midwifery Department, Tabriz University of Medical sciences, Tabriz, Iran
| | | | - Robab Hasanzade
- Students' Research Committee, Midwifery Department, Tabriz University of Medical sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Iran.
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Abstract
INTRODUCTION Mastalgia, or breast pain, is one of the most important complaints referred to outpatient clinics. The objective of this study was to evaluate the factors causing mastalgia. All patients who presented to our clinic with complaints of mastalgia were assessed along with their type of mastalgia symptoms, menopausal status, and radiology results. METHODS A total of 3157 patients with mastalgia complaints visited our clinic between January 2015 and February 2018. Only 1294 of them were retrospectively screened. Age, sex, menopausal (premenopausal, postmenopausal) status, mastalgia type (cyclic, non-cyclic), and imaging findings of the patients were examined. RESULTS The mean age was 43.8 ± 11.8 (13-86) years, with 453 (35%) patients younger than 40 years and 841 (65%) older than 40. Cyclic mastalgia was found in 207 (16%) patients, and non-cyclic mastalgia was seen in 1087 (84%) patients. A total of 786 (60.7%) patients were premenopausal, and 508 (39.3%) were postmenopausal. Mammography was used in 545 (42.1%) patients; 1190 (92.0%) women had breast ultrasonography. CONCLUSION Although breast pain is a common symptom in women who are referred to breast outpatient clinics, we concluded that patients who complain of mastalgia should not be afraid of cancer. Despite this and for reassurance, clinical imaging may be necessary to alleviate these patients' suspicions.
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Groen JW, Grosfeld S, Wilschut JA, Bramer WM, Ernst MF, Mullender MM. Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments. Eur J Obstet Gynecol Reprod Biol 2017; 219:74-93. [PMID: 29059585 DOI: 10.1016/j.ejogrb.2017.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/14/2017] [Accepted: 10/16/2017] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Jan-Willem Groen
- Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Sissi Grosfeld
- Alexander Monro Clinics, Bilthoven, Professor Bronkhorstlaan 10, 3723 MB, The Netherlands
| | | | - Wichor M Bramer
- Medical Library, Erasmus MC, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Miranda F Ernst
- Alexander Monro Clinics, Bilthoven, Professor Bronkhorstlaan 10, 3723 MB, The Netherlands
| | - Magriet M Mullender
- Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Abstract
BACKGROUND Breast pain is one of the leading complaints that ends up with referral to breast surgery clinics. The purpose of the present study was to investigate the factors that cause mastalgia, and its relation with benign or malignant breast disease. METHODS The study was performed in 700 patients. Data obtained from surveys, and imaging findings were prospectively recorded, and analyzed. RESULTS The mean age was 45.20 ± 10.78 years. The mastalgia group included 500 cases; the asymptomatic group comprised 200 individuals. Stressful lifestyle, caffeine consumption, and smoking were associated with mastalgia (p < 0.05). Rates of women who had breast fed 3 times or more were higher in the mastalgia group (p < 0.05). Increased breast density, and breast imaging-reporting and data system (BI-RADS) 2 mammography findings were related with mastalgia (p < 0.05). Cysts and fibroadenomas were more common in the mastalgia group (p < 0.05). The incidence of a past history of malignant breast disease was significantly higher in the mastalgia group (p < 0.05). CONCLUSIONS Stress, caffeine, smoking, lactation frequency, and benign disorders were factors detected to be related with mastalgia. Although a significant relation between mastalgia and malignant breast disease was detected in our study, more controlled studies are still required to investigate this issue further.
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Affiliation(s)
- Tunc Eren
- Department of General Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Adem Aslan
- Department of General Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim A Ozemir
- Department of General Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Hakan Baysal
- Department of General Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Julide Sagiroglu
- Department of General Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Ekinci
- Department of General Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Orhan Alimoglu
- Department of General Surgery, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
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Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, Javadzadeh Y. Effects of Vitex agnus and Flaxseed on cyclic mastalgia: A randomized controlled trial. Complement Ther Med 2015; 24:90-5. [PMID: 26860808 DOI: 10.1016/j.ctim.2015.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Evidence on the effect of Vitex agnus and Flaxseed on cyclical mastalgia is not enough. This study aimed to assess the efficacy of V. agnus and Flaxseed on cyclical mastalgia. DESIGN AND SETTING This randomized controlled trial was conducted on 159 women referred to health centers of Tabriz, Iran. Subjects were allocated into three groups (n=53 per group) using block randomization. INTERVENTIONS AND MAIN OUTCOME MEASURES Group I received 25g daily Flaxseed powder and placebo of V. agnus; group II received daily 3.2-4.8mg V. agnus tablet and placebo of Flaxseed and control group received both placebo. Nominal day breast pain was applied at baseline, first, and second month after the intervention. Data was analyzed using general linear model. RESULTS There was no statistical significant difference between the three groups in terms of socio-demographic characteristics and baseline values. The breast pain improved significantly in both intervention groups during the first and second month after intervention. Mean NDBP score was significantly lower than that in the control group at the first month after the intervention in the Flaxseed [adjusted mean difference: -3.1 (95% CI: -4.2 to -2.0)] and V. agnus groups [-3.3 (-4.3 to -2.2)] and the second month after the intervention in Flaxseed [-7.0 (-8.1 to -5.9)] and V. agnus groups [-6.4 (-7.5 to -5.3)]. CONCLUSION Flaxseed and V. agnus are effective in short-term period in decreasing cyclical mastalgia. However, further studies are needed to examine the long-term effectiveness and sustainability of the effects after stopping the treatment in order to decide whether these alternative treatments are suitable to treat mastalgia or not.
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Affiliation(s)
| | | | - Parivash Ahmadpour
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Yousef Javadzadeh
- Department of Pharmacy, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
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Kanat BH, Atmaca M, Girgin M, Ilhan YS, Bozdağ A, Özkan Z, Yazar FM, Emir S. Effects of Mastalgia in Young Women on Quality of Life, Depression, and Anxiety Levels. Indian J Surg 2016; 78:96-9. [PMID: 27303116 DOI: 10.1007/s12262-015-1325-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022] Open
Abstract
The aims of this study are to evaluate whether or not there is a relationship between mastalgia with anxiety and depression in young women with mastalgia who do not have organic breast pathology and to examine the effect of pain on the quality of life. Forty female pre-menopausal patients between the ages of 20-40 years with mastalgia and 40 totally healthy volunteers with the same characteristics were investigated with the Short Form 36 (SF-36), Hamilton Depression Scale, and the Hamilton Anxiety Rating Scale prospectively following breast examination and radiological examination. Statistical assessments were performed using the SPSS 11.5. Anxiety levels were observed to be higher in the patient group (p = 0.04). The depression level was higher in the patient group; however, this was not statistically significant (p = 0.08). The quality of life of the mastalgia group was determined to be lower than that of the control group, and the sub-parameters of physical function (p = 0.04), body pain (p = 0.02), general health (p = 0.03), and energy (p = 0.008) were found to be significantly low. There may be a relationship between mastalgia and depression in young women with mastalgia; however, a closer relationship between anxiety and mastalgia is observed. Mastalgia affects the quality of life of an individual negatively at a significant degree.
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Abstract
BACKGROUND Mastalgia is a debilitating disorder, which has serious effects on one's daily life and causes significant medical costs. AIM Mastalgia patients determine the overall approach and improve the quality of life of patients. METHODS In this study, the outcomes of psychoeducation on anxiety and pain in a group of patients with mastalgia without an organic etiology have been investigated. 88 patients were included in this study. The socio-demographic data form, the Symptom Checklist 90 (SCL-90), the Toronto Alexithymia Scale-20 (TAS-20), the Hamilton Anxiety Scorer (HAM-A), the State-Trait Anxiety Inventory (STAI-I, STAI-2) and the Visual Analogue Scale (VAS) were all applied to the patients. 64 randomly selected patients (Group 1) were given psychoeducation while the remaining 24 (Group 2) were not. All patients were called back after 1 month for repeats of the HAM-A, STAI-I, STAI-2 and VAS tests. RESULTS The results of this study demonstrated that psychoeducation has positive impacts on the perception of pain besides stationary, contemporary and total anxiety scores. CONCLUSIONS It is concluded that the administration of psychoeducation is a good choice in the degradation of anxiety symptoms and pain.
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Affiliation(s)
- Agah B Öztürk
- Agah B. Öztürk, M.D., Adıyaman University, School of Medicine, Department of Family Medicine , Adıyaman , Turkey
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Yılmaz EM, Çelik S, Arslan H, Değer D. Relation between Mastalgia and Anxiety in a Region with High Frequency of Posttraumatic Stress Disorder. J Breast Health 2015; 11:72-75. [PMID: 28331695 DOI: 10.5152/tjbh.2015.2363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/22/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mastalgia, the most important breast-related symptom, refers to the pain that arises from breast tissue. Not only hormonal reasons but also psychogenic factors may cause mastalgia. Mastalgia is a subjective complaint and includes emotional components. The present study aimed to investigate the relation between mastalgia and level of anxiety in females. MATERIALS AND METHODS This case-control study had consisted of premenopausal females over the age of 20 years. Control group consisted of premenopausal females over the age of 20 years without mastalgia participated. The case and control groups each included 70 females. Females who had a previous breast surgery for any reason, were pregnant or in lactation period, or had a family history of breast cancer were excluded. The case and control groups each examined VAS and GAD-7 questionnaires. RESULTS The GAD-7 scale was performed for both the case and control groups to assess the level of anxiety. Test indicated that the level of anxiety was significantly higher in the cases with mastalgia than in the controls. The VAS and GAD-7 scale scores were compared in the case group to assess the relation between degree of pain and level of anxiety. There was no significant relation between these scores, which indicated that pain, contrary to expectations, was not increased as the level of anxiety increased. CONCLUSION Psychological factors such as anxiety, stress, and depression should be kept in mind after eliminating organic reasons via physical and necessary radiological examinations. A psychiatrist should be consulted since mastalgia is a condition that influences quality of life.
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Affiliation(s)
- Eyüp Murat Yılmaz
- Department of General Surgery, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Sebahattin Çelik
- Department of General Surgery, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Harun Arslan
- Department of Radiology, Van Regional Teaching and Research Hospital, Van, Turkey
| | - Deniz Değer
- Department of Psychiatry, Van Regional Teaching and Research Hospital, Van, Turkey
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Jain BK, Bansal A, Choudhary D, Garg PK, Mohanty D. Centchroman vs tamoxifen for regression of mastalgia: a randomized controlled trial. Int J Surg 2015; 15:11-6. [PMID: 25619124 DOI: 10.1016/j.ijsu.2014.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 10/29/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Several agents have been tried in the management of mastalgia. Centchroman (Ormeloxifene), a novel non-steroidal selective estrogen receptor modulator (SERM), has also been recently used in the management of mastalgia. METHODS Eligible patients, who had mastalgia for more than 3 months, were randomized into two groups - Group A received centchroman 30 mg daily and Group B received tamoxifen 10 mg daily. Treatment was continued for a total of 12 weeks; thereafter, patients were followed for another 12 weeks without medication to assess the continuum of relief. Pain severity was measured with VAS score. Patients were considered to have complete pain relief if their VAS score decreased to 3 or less. RESULTS Patients, in both the groups, showed gradual improvement in mastalgia with passage of time up to 12 weeks. Following cessation of treatment at 12 weeks, partial relapse of pain was observed at 24 weeks. There was no significant difference between Group A and Group B in terms of mean VAS Score and proportion of women reporting pain relief at 4, 8, 12, and 24 weeks. Fifteen patients in Group A had side effects namely dizziness, menstrual irregularities and development of ovarian cysts. There was no side effect noted in group B. CONCLUSION Centchroman and tamoxifen were found to be of similar effectiveness in providing pain relief in mastalgia. High frequency of side effects, particularly development of ovarian cyst, in patients receiving centchroman is a matter of concern.
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Affiliation(s)
- Bhupendra Kumar Jain
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India.
| | - Amit Bansal
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Deepti Choudhary
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India; Department of Surgical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Debajyoti Mohanty
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
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Özkan Z, Kanat BH, Gönen AN, Kanat Z, Buğra BM. A Rare Clinical Entity in the Differential Diagnosis of Mastalgia: Thoracic Zona. J Breast Health 2015; 11:168-171. [PMID: 28331716 DOI: 10.5152/tjbh.2015.2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/13/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mastalgia is the most common complaint of patients who are admitted for breast examination. Breast pain may originate breast tissue pathologies or non-breast pathologies adjacent organs. One of the causes of mastalgia is the varicella-zoster infection of the thoracic nerve ganglions. The zona zoster infection is painful, and vesicular lesions in the infected dermatomal regions can be observed because of the reactivation of the latent varicella (Herpes)-zoster virus (VZV) in the dorsal radix of medulla spinalis. There are no reviews of the zona cases of mastalgia patients in the literature. We aimed to investigate and represent the characteristics of these patients. MATERIALS AND METHODS Patients complaining of mastalgia and who were diagnosed with zona zoster infection after physical examination and clinical evaluation in the outpatients department of General Surgery were investigated retrospectively between January 2010 and January 2015. RESULTS The study included 12 patients. All of them were female, and the mean age of patients was 51.66 (36-72) years. Eight of the zona cases were seen in the right breast (66.6%), and four of them were seen in the left breast (33.4%). Complaints of patients were pain (100%), eruption (70%), and burning sensation (60%). Underlying pathology was seen in one of the cases. Physical examination at admission revealed that four of the patients did not have any physical abnormality (33.3%). On the contrary of vesicular lesions, typical physical findings of zona, were seen in eight patients (66.7%). CONCLUSION Detailed history analysis and physical examination of the breast should be performed, particularly in older patients with unilateral severe mastalgia, and zona should be considered.
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Affiliation(s)
- Zeynep Özkan
- Clinic of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Burhan Hakan Kanat
- Clinic of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Ayşe Nur Gönen
- Clinic of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Zekiye Kanat
- Clinic of Dermatology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Bozan Mehmet Buğra
- Clinic of General Surgery, Elazığ Training and Research Hospital, Elazığ, Turkey
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Dinç T, Coşkun F. Comparison of fructus agni casti and flurbiprofen in the treatment of cyclic mastalgia in premenopausal women. Turk J Surg 2014; 30:34-8. [PMID: 25931888 DOI: 10.5152/ucd.2014.2409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/02/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cyclic mastalgia is described as a diffuse, periodic and bilateral breast pain that can not be localized. Although there are several methods of treatment, the most efficient treatment method is still controversial. The aim of this study is to determine, compare and discuss the results of the patients under 40 years old age with a complaint of cyclic mastalgia and without any clinical signs, family history and ultrasonography finding, treated with fructus agni casti extract or flurbiprofen. MATERIAL AND METHODS One hundred and fourteen premenapousal patients younger than 40 years old with a complaint of cyclic mastalgia and without any clinical, family or ultrasonography findings were analyzed prospectively. Fructus agni casti extract (Group 1) or flurbiprofen (Group 2) were administered to the patients. VAS scores were accepted as full recovery whit a score of zero, as significant healing when the score improved more than 50%, as mild-moderate healing when the improvement was less than 50% and as no healing in case of no improvement. RESULTS The mean age in group 1 was 28.29±5.81, and in group 2 was 29.09±4.49. The mean number of days with pain was 6.0±1.70 days in group 1, and was 6.3±1.63 in group 2. There was no significant difference in VAS scores between the two groups after treatment. CONCLUSION Fructus agni casti extract and flurbiprofen are commonly used medications in the treatment of cyclic mastalgia. Both of these medications significantly reduce the complaints and have acceptable side-effects. There is no proven superiority over each other. Further clinical and laboratory studies are necessary to determine the ideal medication fort he treatment of cyclic mastalgia.
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Affiliation(s)
- Tolga Dinç
- Clinic of General Surgery, Dr. Sami Ulus Gynecology and Pediatrics Teaching and Training Hospital, Ankara, Turkey
| | - Faruk Coşkun
- Department of General Surgery, Hitit University Faculty of Medicine, Çorum Teaching and Training Hospital, Çorum, Turkey
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Abstract
Full understanding of benign breast disease should enable the obstetrician-gynecologist to appropriately evaluate symptoms, distinguish between benign and malignant processes, determine which benign breast lesions require surgical management, and identify patients who are at increased risk of developing breast cancer. This article reviews nipple discharge, breast pain, palpable breast masses, adolescent breast disorders, inflammatory lesions (including mastitis and breast abscesses), and benign breast abnormality detected on imaging and biopsy. Each topic provides a review of the clinical presentation, a discussion of the appropriate workup, and a further description of specific etiology within each category.
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Affiliation(s)
- Michaela Onstad
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
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Ölçücüoğlu E, Yılmaz G. Mastodynia: is imaging necessary in young patients? Ulus Cerrahi Derg 2013; 29:17-9. [PMID: 25931836 DOI: 10.5152/ucd.2013.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 01/09/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mastalgia is the most frequent symptom seen in patients who undergo breast imaging. There are various medical treatment methods in the literature. However, malignancy should be excluded before starting treatment. This is a prospective study, evaluating the necessity of imaging in patients who have applied for cyclic or non-cyclic breast pain, with normal physical examination, and without a family history. MATERIAL AND METHODS Two hundred women, younger than 30 years of age, who applied to Iğdır State Hospital general surgery department with complaint of cyclic or non-cyclic breast pain, were prospectively studied. Patients with nipple discharge, complaint of lump in their breast, who were pregnant or lactating, who had breast cancer history in their family and those who were found to have lumps on examination were excluded from the study. All patients underwent ultrasound imaging and the same radiologist evaluated them. RESULTS The breast examination was normal in all patients. Ultrasound imaging results were completely normal in 98 (48%) patients. 47 (23.5%) patients were found to have fibroadenoma, with a mean diameter of 9.6 mm (5 mm-14 mm). 45 (22.5%) patients had simple cysts with a mean diameter of 7.8 mm (3 mm-11 mm). 6 (3%) patients were found to have intraductal papillomas and 4 (2%) to have lipomas. All patients were classified as either BI-RADS 1 or BI-RADS 2. CONCLUSION It is recommended that malignancy should be eliminated before starting treatment in patients with breast pain. In this study, the necessity of imaging in patients younger than 30 years and who applied to the general surgery department for only breast pain, was investigated. None of the patients with a normal breast examination were found to have any lesions considered suspicious for malignancy. We believe that if breast examination is normal, the patient is equal to or younger than 30 years of age and there is no family history, imaging is not necessary and that medical therapy can be started directly after the patient is informed.
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Affiliation(s)
| | - Güliz Yılmaz
- Clinic of Radiology, Iğdır State Hospital, Iğdır, Turkey
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Kataria K, Dhar A, Srivastava A, Kumar S, Goyal A. A systematic review of current understanding and management of mastalgia. Indian J Surg 2013; 76:217-22. [PMID: 25177120 DOI: 10.1007/s12262-013-0813-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/09/2013] [Indexed: 11/26/2022] Open
Abstract
Breast pain or mastalgia is the common symptom in the breast. The two most common concerns of patients presenting with mastalgia are: the fear that breast pain is a symptom of breast cancer and the presence of severe pain that affects a woman's quality of life. Breast pain requires thorough assessment and should be investigated in the same manner as any other breast symptom. We conducted a systematic review of treatment for breast pain. We searched various reviews, randomized controlled trial, and observational studies over Pubmed and Medline via internet. Searches were carried out on MEDLINE (1950-present), EMBASE (1980-present), and CINAHL (1981-present) using the NHS Evidence Healthcare Databases Advanced Search interface. A further search was also carried out on Cochrane Database of Systematic Reviews (issue 12 of 12, Dec 2011) and Central Register of Controlled Trials (issue 4 of 4, Oct 2011). If no abnormality is found in the breast on assessment, then a combination of reassurance, breast support brassiere, and topical NSAID gel massage are usually effective. Antiestrogen (centchroman/tamoxifen) therapy for 3 to 6 months is the second-line treatment of choice. Danazol may be used in resistant cases. Gamma-linolenic acid or evening primrose oil though commonly prescribed is not effective.
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Affiliation(s)
- Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - Anita Dhar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - Anurag Srivastava
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| | - Sandeep Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Bhopal, India
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Tejwani PL, Srivastava A, Nerkar H, Dhar A, Hari S, Thulkar S, Chumber S, Kumar S. Centchroman regresses mastalgia: a randomized comparison with danazol. Indian J Surg 2011; 73:199-205. [PMID: 22654331 DOI: 10.1007/s12262-010-0216-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022] Open
Abstract
UNLABELLED We conducted a randomized trial to evaluate effectiveness of Centchroman in control of mastalgia and compared it with Danazol. Research Question- Is proportion of pain relief achieved by Centchroman similar to or inferior to that achieved by Danazol? In a randomized controlled trial of Centchroman vs. Danazol in mastalgia, 81 patients with mastalgia were studied. Thirty-nine patients were randomized to Danazol arm and 42 in Centchroman arm. The treatment was given for 12 weeks, followed by observation for 12 weeks. The pain was measured by visual analogue scale (VAS) of 0-10. At 12 weeks 89.7% women achieved reduction in pain score to ≤3 in Centchroman group (pvalue 0.001). In Danazol group 69.44% women achieved reduction in pain score to ≤ 3 (p = 0.001). Three months after stopping therapy, Centchroman was more effective in pain score reduction at 24 weeks as compared to Danazol (p = 0.019). Centchroman is an effective, safe and inexpensive alternative to Danazol for treatment of mastalgia. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (doi:10.1007/s12262-010-0216-z) contains supplementary material, which is available to authorized users.
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