New Concepts In Breast Pain

Abstract

Mastalgia is the commonest breast symptom presenting to general practitioners and breast surgeon alike. Two out of three women suffer from breast pain at sometime in their lives. Like any other breast problem, it can be worrying, but most breast pain can be treated easily. Women with severe, sustained breast pain that interferes with their quality of life may benefit from treatment with low-dose or luteal-phase medications such as danazol or tamoxifen. These medications have proven effectiveness; however, their benefit in ameliorating breast discomfort and pain must be balanced against their potential adverse effects. Selection of a specific agent is individualized. In certain circumstances, bromocriptine or a gonadotropin-releasing hormone agonist may be needed; however, approaches to decreased dosing to minimize adverse effects have not been established. To make a full assessment of the cause, all patients require a full history, examination and, sometimes, investigations. Dairy cards are often helpful. The commonest cause is cyclical mastalgia. Most women require reassurance only and the pain often settles spontaneously after few months. For the remainder, simple lifestyle changes should be suggested initially, such as wearing a well-fitted sports bra, weight reduction, regular exercise and reduction in caffee intake. Unfortunately, there is a paucity of evidence for the usefulness of these measures.