A study on clinical profile and management of mastalgia
DOI:
https://doi.org/10.18203/2349-2902.isj20181604Keywords:
Bromocriptine, Cyclical mastalgia, Danazol, Mastalgia, Non-cyclical mastalgia, Topical non-steroidal anti-inflammatory drugs (topical diclofenac gel)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 non-specific 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.
References
Arslan M, Küçükerdem HS, Can H, Tarcan E. Retrospective Analysis of Women with Only Mastalgia. J Breast Health. 2016;12(4):151-4.
Ader DN, South-Paul J, Adera T, Deuster PA.Cyclical mastalgia: prevalence and associated health and behavioral factors. J Psychosom Obstet Gynaecol. 2001;22(2):71-6.
Holland PA, Gateley CA. Drug therapy of mastalgia. What are the options? Drugs. 1994; 48(5):709-16.
Thakur N, Zargar B, Nazeer N, Parray F, Wani R. Mastalgia – Use Of Evening Primrose Oil In Treatment Of Mastalgia. Int J Surg. 2010;24(2):1-6.
Wang DY, Fentiman IS. Epidemiology and endocrinology of benign breast disease. Breast Cancer Res Treat. 1985;6(1):5-36.
Ader DN, Shriver CD. Cyclical mastalgia: prevalence and impact in an outpatient breast clinic sample. J Am Coll Surg. 1997;185(5):466-70.
Ndhluni A. The ABC of benign breast disease. CME. 2010;28(1):6-8.
Geschickter CF. Mastodynia (Painful breasts) In: diseases of the Breast, 2nd Edition JB. Lippincott Co., Philadelphia;1945:183-99.
Guerriero S, Alcazar JL, Ajossa S, Galvan R, Laparte C, García MM, et al. Transvaginal colour Doppler imaging in the detection of ovarian cancer in a large study population. Int J Gynecol Cancer 2010;20(5):781-6.
Kumar S, Rai R, Das V, Dwivedi V, Kumar S, GG A. Visual analogue scale for assessing breast nodularity in non discrete lumpy breasts: the Lucknow Cardiff breast nodularity scale. The Breast. 2010;19(3):238-42.
Cairncross L. Mastalgia. Cont Medi Educa. 2010; 28(11):504-5.
Chowdhury RA, Hasan SK, Masud JMD. Analysis of breast pain: a study of 110 cases. J Medi. 2009; 10(2):77-81.
Furlong AJ, al-Nakib L, Knox WF et al. Periductal inflammation and cigarette smoke. J Am CollSurg 1994;179:417-20.
Rahal RMS, de Freitas-Junior R, Paulinelli RR. Risk factors for duct ectasia. Breast J. 2005;11:262-5.
Dixon JM, Ravisekar O, Chetty U, Anderson TJ. Periductal mastitis and duct ectasia: different conditions with different aetiologies. Br J Surg. 1996;83(6):820-22.
Khanna AK, Tapodar J, Misra MK; Spectrum of benign breast disorders in a university hospital. J Indian Med Assoc. 1997;95(1):5-8.
Rosolowich V, Saettler E, Szuck B, Lea RH. Mastalgia. J Obstet Gynaecol Can. 2006;28(1):49-71.
Colak T, Ipek T, Kanik A. Efficacy of topical non-steroidal anti-inflammatory drugs in mastalgia treatment. J Am Coll Surg. 2003;196(4):525-30.
Kontostolis E, Stefanidis K, Navrozoglou I, Lolis D. Comparison of tamoxifen with danazol for treatment of cyclical mastalgia. Gynecol Endocrinol. 1997; 11(6):393-7.
O’Brien PMS, Abukhalil IEH: Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol. Am J Obstet Gynecol. 1999; 180(1):18-23.
Baker H W, Snedecor P A. Clinical trial of danazol for benign breast disease. American Surgeon. 1979; 45(11):727-9.
Humphrey L J, Estes N C. Aspects of fibrocystic disease of the breast.Treatment with danazol. Postgrad Med J. 1979;55(5):48-51.
Nazli K, Syed S, Mahmood MR, Ansari F. Controlled trial of the prolactin inhibitor bromocriptine (Parlodel) in the treatment of severe cyclical mastalgia. Br J Clin Pract. 1989;43(9):322-7.
Mansel RE, Dogliotti L. European multicentre trial of bromocriptine in cyclical mastalgia. Lancet. 1990; 335(8683):190-3.