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Mastalgia

  • Amit GoyalEmail author
  • Robert E. Mansel
Chapter

Abstract

Mastalgia is a common breast symptom that may affect up to 70 % of women in their lifetime. It is most common in women aged 30–50 years. Breast pain may be bilateral, unilateral, or in part of one breast. While most patients experience mastalgia of mild or moderate severity and accept this as a part of the normal changes that occur in relation to the menstrual cycle, a proportion (10–20 %) experience severe pain that causes distress, affects their daily lives, and leads them to seek treatment. The severity of pain associated with cyclical mastalgia can be substantial, similar in magnitude to chronic cancer pain and slightly less than that associated with rheumatoid arthritis. This chapter covers etiology, classification, clinical assessment, and treatment of mastalgia.

Keywords

Mastalgia Cyclical mastalgia Non-cyclical mastalgia Chest wall pain Psychosocial factors Breast cancer Clinical assessment Management 

References

  1. 1.
    Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: prevalence and associated health and behavioral factors. J Psychosom Obstet Gynaecol. 2001;22:71–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Cyclical breast pain–what works and what doesn’t. Drug Ther Bull. 1992;30:1–3.Google Scholar
  3. 3.
    Khan SA, Apkarian AV. The characteristics of cyclical and non-cyclical mastalgia: a prospective study using a modified McGill Pain Questionnaire. Breast Cancer Res Treat. 2002;75:147–57.CrossRefPubMedGoogle Scholar
  4. 4.
    Ader DN, Shriver CD. Cyclical mastalgia: prevalence and impact in an outpatient breast clinic sample. J Am Coll Surg. 1997;185:466–70.CrossRefPubMedGoogle Scholar
  5. 5.
    Rose DP, Boyar AP, Cohen C, Strong LE. Effect of a low-fat diet on hormone levels in women with cystic breast disease. I. Serum steroids and gonadotropins. J Natl Cancer Inst. 1987;78:623–6.PubMedGoogle Scholar
  6. 6.
    Wang DY, Fentiman IS. Epidemiology and endocrinology of benign breast disease. Breast Cancer Res Treat. 1985;6:5–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Wisbey JR, Kumar S, Mansel RE, Peece PE, Pye JK, Hughes LE. Natural history of breast pain. Lancet. 1983;2:672–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Santen RJ, Mansel R. Benign breast disorders. N Engl J Med. 2005;353:275–85.CrossRefPubMedGoogle Scholar
  9. 9.
    Ader DN, Shriver CD, Browne MW. Cyclical mastalgia: premenstrual syndrome or recurrent pain disorder? J Psychosom Obstet Gynaecol. 1999;20:198–202.CrossRefPubMedGoogle Scholar
  10. 10.
    Barton MB, Elmore JG, Fletcher SW. Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med. 1999;130:651–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Lumachi F, Ermani M, Brandes AA, Boccagni P, Polistina F, Basso SM, Favia G, D’Amico DF. Breast complaints and risk of breast cancer. Population-based study of 2,879 self-selected women and long-term follow-up. Biomed Pharmacother. 2002;56:88–92.CrossRefPubMedGoogle Scholar
  12. 12.
    Fariselli G, Lepera P, Viganotti G, Martelli G, Bandieramonte G, Di Pietro S. Localized mastalgia as presenting symptom in breast cancer. Eur J Surg Oncol. 1988;14:213–5.PubMedGoogle Scholar
  13. 13.
    Smallwood JA, Kye DA, Taylor I. Mastalgia; is this commonly associated with operable breast cancer? Ann R Coll Surg Engl. 1986;68:262–3.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Preece PE, Baum M, Mansel RE, Webster DJ, Fortt RW, Gravelle IH, Hughes LE. Importance of mastalgia in operable breast cancer. Br Med J (Clin Res Ed). 1982;284:1299–300.CrossRefGoogle Scholar
  15. 15.
    Plu-Bureau G, Le MG, Sitruk-Ware R, Thalabard JC. Cyclical mastalgia and breast cancer risk: results of a French cohort study. Cancer Epidemiol Biomarkers Prev. 2006;15:1229–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Goodwin PJ, DeBoer G, Clark RM, Catton P, Redwood S, Hood N, Boyd NF. Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study. Breast Cancer Res Treat. 1995;33:63–73.CrossRefPubMedGoogle Scholar
  17. 17.
    Plu-Bureau TJC, Sitruk-Ware R, Asselain B, Mauvais-Jarvis P. Cyclical mastalgia as a marker of breast cancer susceptibility: results of a case-control study among French women. Br J Cancer. 1992;65:945–9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Khan SA, Apkarian AV. Mastalgia and breast cancer: a protective association? Cancer Detect Prev. 2002;26:192–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Preece PE, Mansel RE, Hughes LE. Mastalgia: psychoneurosis or organic disease? Br Med J. 1978;1:29–30.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jenkins PL, Jamil N, Gateley C, Mansel RE. Psychiatric illness in patients with severe treatment-resistant mastalgia. Gen Hosp Psychiatry. 1993;15:55–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Ramirez AJ, Jarrett SR, Hamed H, Smith P, Fentiman IS. Psychosocial adjustment of women with mastalgia. Breast. 1995;4:48–51.CrossRefGoogle Scholar
  22. 22.
    Colegrave S, Holcombe C, Salmon P. Psychological characteristics of women presenting with breast pain. J Psychosom Res. 2001;50:303–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Fox H, Walker LG, Heys SD, Ah-See AK, Eremin O. Are patients with mastalgia anxious, or does relaxation therapy help? Breast. 2009;6:138–42.CrossRefGoogle Scholar
  24. 24.
    Barros AC, Mottola J, Ruiz CA, Borges MN, Pinotti JA. Reassurance in the treatment of mastalgia. Breast J. 1999;5:162–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Smallwood J, Ah-Kye D, Taylor I. Vitamin B6 in the treatment of pre-menstrual mastalgia. Br J Clin Pract. 1986;40:532–3.PubMedGoogle Scholar
  26. 26.
    Ernster VL, Goodson WH III, Hunt TK, Petrakis NL, Sickles EA, Miike R. Vitamin E and benign breast “disease”: a double-blind, randomized clinical trial. Surgery. 1985;97:490–4.PubMedGoogle Scholar
  27. 27.
    Parazzini F, La Vecchia C, Riundi R, Pampallona S, Regallo M, Scanni A. Methylxanthine, alcohol-free diet and fibrocystic breast disease: a factorial clinical trial. Surgery. 1986;99:576–81.PubMedGoogle Scholar
  28. 28.
    Allen SS, Froberg DG. The effect of decreased caffeine consumption on benign proliferative breast disease: a randomized clinical trial. Surgery. 1987;101:720–30.PubMedGoogle Scholar
  29. 29.
    McFadyen IJ, Raab GM, Macintyre CC, Forrest AP. Progesterone cream for cyclic breast pain. BMJ. 1989;298:931.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Maddox PR, Harrison BJ, Horobin JM, Walker K, Mansel RE, Preece PE, Nicholson RI. A randomised controlled trial of medroxyprogesterone acetate in mastalgia. Ann R Coll Surg Engl. 1990;72:71–6.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Goyal A, Mansel RE. A randomized multicenter study of gamolenic acid (Efamast) with and without antioxidant vitamins and minerals in the management of mastalgia. Breast J. 2005;11:41–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Blommers J, de Lange-De Klerk ES, Kuik DJ, Bezemer PD, Meijer S. Evening primrose oil and fish oil for severe chronic mastalgia: a randomized, double-blind, controlled trial. Am J Obstet Gynecol. 2002;187:1389–94.CrossRefPubMedGoogle Scholar
  33. 33.
    Boyd NF, McGuire V, Shannon P, Cousins M, Kriukov V, Mahoney L, Fish E, Lickley L, Lockwood G, Tritchler D. Effect of a low-fat, high-carbohydrate diet on symptoms of cyclical mastopathy. Lancet. 1988;2:128–32.CrossRefPubMedGoogle Scholar
  34. 34.
    Ingram DM, Hickling C, West L, Mahe LJ, Dunbar PM. A double-blind, randomized controlled trial of isoflavones in the treatment of cyclical mastalgia. Breast. 2002;11:170–4.CrossRefPubMedGoogle Scholar
  35. 35.
    Halaska M, Beles P, Gorkow C, Sieder C. Treatment of cyclical mastalgia with a solution containing a Vitex agnus castus extract: results of a placebo-controlled double-blind study. Breast. 1999;8:175–81.CrossRefPubMedGoogle Scholar
  36. 36.
    Colak T, Ipek T, Kanik A, Ogetman Z, Aydin S. Efficacy of topical nonsteroidal anti-inflammatory drugs in mastalgia treatment. J Am Coll Surg. 2003;196:525–30.CrossRefPubMedGoogle Scholar
  37. 37.
    Srivastava A, Mansel RE, Arvind N, Prasad K, Dhar A, Chabra A. Evidence-based management of mastalgia: a meta-analysis of randomised trials. Breast. 2007;16:503–12.CrossRefPubMedGoogle Scholar
  38. 38.
    Thomas EJ, Jenkins J, Lenton EA, Cooke ID. Endocrine effects of goserelin, a new depot luteinising hormone releasing hormone agonist. Br Med J (Clin Res Ed). 1986;293:1407–8.CrossRefGoogle Scholar
  39. 39.
    Shaw RW. An open randomized, comparative study of the effect of goserelin depot and danazol in the treatment of endometriosis. Zoladex endometriosis study team. Fertil Steril. 1992;58:265–72.CrossRefPubMedGoogle Scholar
  40. 40.
    Fraser HM, Sandow J. Suppression of follicular maturation by infusion of a luteinizing hormone-releasing hormone agonist starting during the late luteal phase in the stumptailed macaque monkey. J Clin Endocrinol Metab. 1985;60:579–84.CrossRefPubMedGoogle Scholar
  41. 41.
    Mansel RE, Goyal A, Preece P, Leinster S, Maddox PR, Gateley C, Kubista E, von Fournier D. European randomized, multicenter study of goserelin (Zoladex) in the management of mastalgia. Am J Obstet Gynecol. 2004;191:1942–9.CrossRefPubMedGoogle Scholar
  42. 42.
    O’Brien PM, Abukhalil IE. Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol. Am J Obstet Gynecol. 1999;180:18–23.CrossRefPubMedGoogle Scholar
  43. 43.
    Mansel RE, Wisbey JR, Hughes LE. Controlled trial of the antigonadotropin danazol in painful nodular benign breast disease. Lancet. 1982;1:928–30.CrossRefPubMedGoogle Scholar
  44. 44.
    Gateley CA, Miers M, Mansel RE, Hughes LE. Drug treatments for mastalgia: 17 years experience in the Cardiff mastalgia clinic. J R Soc Med. 1992;85:12–5.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Hinton CP, Bishop HM, Holliday HW, Doyle PJ, Blamey RW. A double-blind controlled trial of danazol and bromocriptine in the management of severe cyclical breast pain. Br J Clin Pract. 1986;40:326–30.PubMedGoogle Scholar
  46. 46.
    Fentiman IS, Caleffi M, Brame K, Chaudary MA, Hayward JL. Double-blind controlled trial of tamoxifen therapy for mastalgia. Lancet. 1986;1:287–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Messinis IE, Lolis D. Treatment of premenstrual mastalgia with tamoxifen. Acta Obstet Gynecol Scand. 1988;67:307–9.CrossRefPubMedGoogle Scholar
  48. 48.
    Fentiman IS, Caleffi M, Hamed H, Chaudary MA. Dosage and duration of tamoxifen treatment for mastalgia: a controlled trial. Br J Surg. 1988;75:845–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Kontostolis E, Stefanidis K, Navrozoglou I, Lolis D. Comparison of tamoxifen with danazol for treatment of cyclical mastalgia. Gynecol Endocrinol. 1997;11:393–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Mansel R, Goyal A, Nestour EL, Masini-Eteve V, O’Connell K. A phase II trial of Afimoxifene (4-hydroxytamoxifen gel) for cyclical mastalgia in premenopausal women. Breast Cancer Res Treat. 2007;106:389–97.CrossRefPubMedGoogle Scholar
  51. 51.
    Davies EL, Cochrane RA, Stansfield K, Sweetland HM, Mansel RE. Is there a role for surgery in the treatment of mastalgia? Breast. 1999;8:285–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Royal Derby HospitalDerbyUK
  2. 2.Cardiff UniversityMonmouthUK

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