A study on clinical profile and management of mastalgia

Abstract

INTRODUCTIONMastalgia, or breast pain, is a common complaint that may affect up to 70% of women in their lifetime.1 It is not unusual for women to have 2-3 days of mild breast pain premenstrually but 8-30% of women report moderate to severe breast pain with duration of 5 or more days each month.2 Fifteen percent of women who present to a breast clinic with mastalgia will require treatment. 3Breast pain is classified as cyclical mastalgia, noncyclical mastalgia and non-specific extra-mammary pain. Cyclical mastalgia is a breast pain that has clear relationship to the menstrual cycle. Non-cyclical ABSTRACT Background:The aim of the present study is to observe the clinical profile and management of mastalgia. The objectives of the present study were to assess the clinical profile of breast diseases causing mastalgia, to study the response of mastalgia to the following three drugs: Danazol, Bromocriptine, topical non-steroidal anti-inflammatory drugs (topical diclofenac gel). Methods: It was prospective type of study. Inclusion criteria: Patients of age group 15-50 years, all patients suspected or diagnosed for breast pathology with mastalgia. Exclusion criteria: immune-compromised patients, all patients undergoing surgical removal of breast lump, pregnant females. Evaluation of pain was done using visual analog scale, prior to giving the treatment and after giving the treatment each week for the first month and thereafter monthly for the next 6 months. Results:The clinical profile of mastalgia was as follows: fibroadenosis accounting for 37 (46.25%), followed by 10 (12.5%) cases of fibroadenoma, 08 (10%) cases of mastitis, 06 (7.5%) cases of breast abscess, 03 (3.75%) cases of duct ectasia, 02 (2.50%) cases of galactocoele, 02 (2.50%) cases of breast carcinoma and 12 (15%) cases of nonspecific extra-mammary pathology. Patient's response rate to different drugs included in the study was: 64.8% to danazol, 56.9% to bromocriptine and 76.01% to topical diclofenac gel. Conclusions: Cyclical mastalgia accounted for more proportion of patients than non-cyclical mastalgia. Common causes of mastalgia being fibroadenosis, followed by fibroadenoma, mastitis, breast abscess, duct ectasia, galactocoele, breast carcinoma and non-specific extra-mammary pathology. Danazol and bromocriptine are effective in treatment of mastalgia, though they show different side effect profiles and varying patient compliance.

Response to different medical treatment options for mastalgia in fibrocystic breast disease

“…Clinical presentations in initial visit showed maximum respondent had cyclical mastalgia (57.78%) and 42.22% had non-cyclical mastalgia. Similar observation was noted in a previous study by Rajswaroob et al 17 and Nirhale et al 8 In this study maximum respondents (60%) had both breasts involvement, 26.7% had left breast and 13.3% had right breast involvement. In a previous study by Sangma MB et al 18 observed maximum respondents had right breast involvement (48%), the left breast was affected in 40% patients while only 12% cases both breasts were affected, that differs from our observation.…”

“…Almost similar observation was seen in some previous study by Rajswaroob et al 17 and Neogi P et al 21 and Nirhale et al 8 There are some limitations of our study. This study was performed in a single tertiary care hospital among small available population size.…”

“…7 Recent population based and breast clinic-based studies suggest that up to 70% of women experience breast pain in their lifetime. 8 Moreover, 10% of symptomatic participants had suffered breast pain for over half their lives. Of the symptomatic participants, 41% and 35% reported breast pain affecting the quality of life.…”

“…9 Fifteen percent of women who present to a breast clinic with mastalgia will require treatment. 8,9 Non pharmacological options of medical managements includes some life style modifications (LSM) like-an appropriately fitting and supportive bra, avoidance of caffeine drinks, reduction of dietary fat, increase fiber rich diet, physical exercise to reduce weight and relaxation training are said to be helpful for the treatment of mastalgia 10 and some nutritional supplementations like oil of evening primrose (EPO) will help more than half of these women 5,10,11 . For those with intractable symptoms, Pharmacological options of medical management like-an anti-gonadotropin, (Danazol 6) , or a prolactin inhibitor (Bromocriptine 5) , may be tried.…”

Vitamin E versus Evening Primrose Oil versus Placebo for the Treatment of Cyclic Mastalgia: A Double-Blind Randomized Controlled Trial

“…In this case, a single patient occasionally complained of several adverse symptoms. In several earlier research by Rajswaroob et al [18] , Neogi et al [19] and Nirhale et al [20] , a nearly same observation is made. In our study, the reported side effects due to Primrose use were comparable to Mostary et al [21] who reported bloating in 6.7% and headache in 2.2% of patients treated with primrose.…”