Clinical management of idiopathic mastalgia: a systematic review

Abstract

INTRODUCTIONIdiopathic mastalgia (benign breast pain of unknown origin) is often poorly managed because of its subjective nature and unclear aetiology. Mastalgia is a reason for up to 50% of breast outpatient referrals. Existing systematic reviews discuss dated treatment options that provide limited symptomatic relief. METHODSA systematic review was conducted for aetiology and treatment of idiopathic mastalgia in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Databases such as PubMed, MEDLINE, Cochrane Database and the Clinical Trial Registry were searched (February 2016). RESULTSReassurance plus bra-fitting advice provides relief for most women. If symptoms persist, addition of topical non-steroidal anti-inflammatory drugs (NSAIDs) provides relief in 70–92% of women. There is some benefit in reducing dietary coffee and fat intake. Medical treatments have serious side-effects (often androgenic or menopausal) and should be considered only in cases resistant to simpler measures. Dopamine agonists are useful, but less effective than endocrine treatments such as Danazol or Tamoxifen. Of the Selective Oestrogen Receptor Modulator drugs, Ormeloxifene appears most effective, but is not licenced in the United Kingdom. Relaxation therapy, acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness. DISCUSSIONFirst-line management of breast pain should be explanation, reassurance and a bra-fitting advice. Subsequent drug therapy should be balanced against its side-effects; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects. Newer agents (Ormeloxifene) currently being used for mastalgia in India could be considered in the developed world.

No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic

“…It is an apposite moment to consider more suitable pathways for those women requiring high quality breast care advice but not a cancer diagnosis service. There is good level II evidence of the value of primary care reassurance and advice as a significant component in the care of women presenting with breast pain alone 40 . This can be reinforced with online resources 41 .…”

Vitamin B6 Effects on Breast Pain in Women of Reproductive Age: A Systematic Review

“…However, it should be noted that mastalgia is an uncommon symptom of cancer (4). Breast pain accounts for more than 50% of outpatient referrals to medical centers (5). The prevalence of mastalgia, which is defined as moderate to severe breast pain for more than five days, is 69%.…”

Comparative differential cytotoxicity of clinically used SERMs in human cancer lines of different origin and its predictive molecular docking studies of key target genes involved in cancer progression and treatment responses

“…Ormeloxifene was tested for its therapeutic efficacy against various cancer cell line models and in vivo animal model for breast cancer. Ormeloxifene is now at early stages of clinical development for the treatment of breast cancer, Osteoporosis and mastalgia ( Hafiz et al., 2018 ). In one clinical trial, breast cancer patients were treated with ormeloxifene (60 ​mg, three times a week) for 4–6 weeks.…”