Mastalgia affects up to two-thirds of women at some time during their reproductive lives. It is usually benign, but thefear of underlying
breast cancer is why many women present for evaluation.
Mastalgia can be associated with
premenstrual syndrome,
fibrocystic breast disease, psychologic disturbance and, rarely,
breast cancer. Occasionally, extramammary conditions, like Tietzie syndrome, present as
mastalgia. A thorough clinical evaluation is required to assess the cause. The majority of women can be reassured after a clinical evaluation. Approximately 15% require
pain-relieving
therapy. Mechanical breast support; a low-fat, high-
carbohydrate diet; and topical
nonsteroidal antiinflammatory agents are reasonable first-line treatments. Hormonal agents, such as
bromocriptine,
tamoxifen and
danazol, have all demonstrated efficacy in the treatment of
mastalgia. Side effects, however, limit their extensive use.
Danazol is the only FDA-approved hormonal treatment and is best used in cyclic form to limit the adverse effects.
Lisuride maleate is a new agent recently studied for the treatment of
mastalgia. Initial data on this medication are encouraging. Sixty percent of cyclic
mastalgia recurs
after treatment. Noncyclic
mastalgia responds poorly to treatment but resolves spontaneously in up to 50% of cases.