Materiały źródłowe

• #1 Mastalgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK562195/

  Mastalgia, or breast pain, affects up to 70% of women and is a frequent concern in primary care, though it is rarely linked to breast cancer. […] Cyclic breast pain, the most common type, is primarily caused by physiologic hormonal changes associated with the menstrual cycle or exogenous hormones cyclically administered (eg, contraception, ovulation induction, regulation of menstrual cycles). […] These hormonal shifts lead to breast tissue changes, including lobule enlargement, basal epithelial cell proliferation, and stromal edema, which manifest as breast fullness and pain. […] In noncyclic mastalgia, changes are more varied and include localized inflammation, as seen in idiopathic granulomatous mastitis or mastitis, and structural changes, eg, breast cysts, fibroadenomas, or macromastia.

• #2 Mastalgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK562195/

  The exact pathophysiologic mechanisms that underlie mastalgia are unclear but are thought to be influenced by hormonal, structural, and systemic factors. […] Drinking caffeinated beverages may be associated with overstimulation of breast cells due to impaired adenosine triphosphate degradation by methyl xanthine. […] Some other causes, including the consumption of a high-fat content diet, smoking, and use of certain medications (eg, antidepressants, antibiotics, and antihistamines), have also been linked with mastalgia, but their exact pathophysiology is unknown.

• #2 Breast pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/breast-pain/symptoms-causes/syc-20350423

  Breast pain (mastalgia) can be described as tenderness, throbbing, sharp, stabbing, burning pain or tightness in the breast tissue. […] In men, breast pain is most commonly caused by a condition called „gynecomastia” (guy-nuh-koh-MAS-tee-uh). This refers to an increase in the amount of breast gland tissue that’s caused by an imbalance of the hormones estrogen and testosterone. […] Most times, breast pain signals a noncancerous (benign) breast condition and rarely indicates breast cancer. Unexplained breast pain that doesn’t go away after one or two menstrual cycles, or that persists after menopause, or breast pain that doesn’t seem to be related to hormone changes needs to be evaluated. […] Changing hormone levels can cause changes in the milk ducts or milk glands. These changes in the ducts and glands can cause breast cysts, which can be painful and are a common cause of cyclic breast pain. Noncyclic breast pain may be caused by trauma, prior breast surgery or other factors.

• #3

  https://www.redalyc.org/journal/2611/261162058005/html/

  Results: the physiopathology of the mastodynia is not caused by a single mechanism, but by different causes with independent pathways. The main mechanisms are hormonal, mammary density, neuropathic and extra-mammary. […] Conclusion: It is important to know the pathophysiology and classification of mastodynia, due to its therapeutic implications and possible association with breast cancer. […] The cause is not clear, but there are several theories. Hormonal etiology of mastalgia is suggested by the onset at the age of menarche, its relationship with the menstrual cycle and its resolution with menopause. However, hormone levels are similar among women with and without mastalgia. Theories suggest progesterone deficiency, excess estrogen and alterations in the progestin-estrogen ratio, alterations in the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), low levels of androgens, and high levels of prolactin (PRL), but none of them has been proven. It is speculated if instead of an alteration of the hormonal level, it could be a greater sensitivity of the receptor.

• #4 Work-up and management of breast pain – Li – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6968/html

  Cyclical breast pain is thought to be secondary to the normal hormonal variations of the menstrual cycle. Estrogen stimulates ductal elements, progesterone stimulates the stroma, and prolactin drives ductal secretion. As progesterone levels rise to promote ovulation, it stimulates the proliferation of glandular breast tissue. Subsequent edema of the breast stroma can give the sensation of breast fullness and pain. […] Noncyclical breast pain does not follow the menstrual cycle. Noncyclical breast pain is more likely to be unilateral, focal, and can be anywhere throughout the breast. It can be constant or intermittent. […] Because noncyclical breast pain is less commonly related to hormonal variations, there is more likely to be an anatomical cause. Large, pendulous breasts can contribute to non-cyclical breast pain. Without adequate support, Coopers ligaments are under stretch and can result in breast pain.

• #5 Breast Pain (Sore Breasts): Cyclical and Non Cyclical

  https://patient.info/womens-health/breast-problems/breast-pain

  Most women develop breast pain (mastalgia) at some stage in life. In most cases the pain develops in the days just before a period. […] Up to 7 in 10 women develop breast pain (mastalgia) at some stage in their lives. Breast pain is usually classed as either cyclical or non-cyclical: […] Cyclical breast pain is very common. It is thought that women with cyclical breast pain have breast tissue which is more sensitive than usual to the normal hormonal changes that occur each month. It is not due to any hormone disease or to any problem in the breast itself. It is not related to any other breast conditions. Although it is not serious, it can be a nuisance. […] Non-cyclical breast pain may be due to: Pain coming from the breast itself – for example, infection or breastfeeding; or Pain which does not come from the breast itself.

• #6 Breast Pain Treatment Melbourne, VIC | Mastalgia Treatment Melbourne, VIC

  https://www.melbournebreastcancersurgery.com.au/breast-painmastalgia.html

  Mastalgia means breast pain. Breast pain is extremely common, and for many women who attend this is their main and only symptom. Mastalgia affects up to 77% of women at some time in their lives, and is so common it is considered part of a normal bodily process rather than a disease. […] In most cases however breast pain will be the result of normal changes that occur in the breasts. […] Due to the relationship with the menstrual cycle, it is thought that the cause of cyclical mastalgia is hormonal. Circulating hormone levels in plasma have however shown no difference between patients with mastalgia and controls and it is thought that women with cyclical breast pain simply have breast tissue which is more sensitive than usual to the normal hormone changes that occur each month. […] It has also been suggested that an abnormality in the secretion of prolactin may be to blame, and certainly drugs that inhibit prolactin secretion have in the past been used in the treatment of breast pain.

• #7 Etiology and Management of Benign Breast Disease | Oncohema Key

  https://oncohemakey.com/etiology-and-management-of-benign-breast-disease/

  However, numerous studies have not shown differences in estrogen and progesterone between asymptomatic controls and patients with mastalgia. […] An impairment of the normal ability to counteract estrogen-induced PRL release by increasing the central dopaminergic tone has been suggested as a cause of mastalgia. […] Studies have shown increased serum epinephrine and norepinephrine and decreased baseline dopamine levels in patients with cyclic as well as noncyclic mastalgia. […] The increase or stimulation of adenylate cyclase activity in breast tissue appears to be an important step for triggering the intracellular cAMP-mediated events leading to symptomatic ANDI. […] Although it is difficult to prove, hormonal factors clearly play a role in the cause of cyclic mastalgia. […] The precise mechanism of danazol in reducing breast pain is unknown.

• #8 Breast Pain: Tenderness, Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15469-breast-pain-mastalgia

  Cyclic breast pain is often triggered by your natural menstrual cycle. Noncyclic breast pain causes may include: Birth control pills, Pregnancy, Infections like mastitis, Inflammation, Hormone therapy, Prior radiation therapy, Antidepressant medications like SSRIs (selective serotonin reuptake inhibitors), Breast cysts, Fibroadenomas (noncancerous lumps), Costochondritis (inflammation in the cartilage in your breastbone), Surgical scars, Trauma or injury. […] Not usually. People with breast cancer will likely develop lumps in their breast area that can be quite painful. But most sources of breast pain aren’t due to cancerous lumps or tumors. […] During pregnancy, your body begins producing more hormones than normal, specifically estrogen. This directly affects your breasts, often making both of them painful and tender.

• #9

  https://www.redalyc.org/journal/2611/261162058005/html/

  There is some evidence that suggests that women with mastalgia have increased levels of saturated fatty acids and reduced those of essential fatty acids, especially gamma-linoleic acid (GLA); apparently, this makes the cell membranes more sensitive to nociceptive depolarization and allows the estrogen receptor to be more available. […] Mastodynia has been attributed to water retention; however, a study measuring the total body water with radioactive water (D2O) in patients with mastalgia and asymptomatic, showed that there were no significant differences in the increase in body water between days 5 and 25 of the menstrual cycle. […] The scientific evidence addresses different concepts of the physiopathology of mastalgia, it is necessary an adequate classification because it entails an etiological approach and therefore greater therapeutic effectiveness. Frequently associated with estrogen hormone influx, breast tissue density and pain not mammary, it is infrequently seen in cases of breast carcinoma in early stages, which are diagnosed adequately by breast imaging tests.

• #10 Breast Pain Treatment Melbourne, VIC | Mastalgia Treatment Melbourne, VIC

  https://www.melbournebreastcancersurgery.com.au/breast-painmastalgia.html

  Evening primrose oil is felt to potentially work by replacing an essential fatty acid. There is some evidence that having low levels of the essential fatty acid called gamolenic acid (GLA) can contribute to cyclical breast pain. […] Tamoxifen is a drug more commonly used to treat and prevent breast cancer, however, research has shown it is also effective in the treatment of cyclical breast pain. It acts to selectively block oestrogen from its effect on breast tissue, thereby reducing pain related to hormonal stimulation. Low dose tamoxifen on a short term basis certainly merits consideration in cases of severe, refractory breast pain. Tamoxifen at a dose of 10mg daily is reported to relieve cyclical mastalgia in 70 to 90 per cent and non-cyclical mastalgia in 56 per cent of cases.

• #11 Breast pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/breast-pain/symptoms-causes/syc-20350423

  Breast pain is more common among people who haven’t completed menopause, although it may occur after menopause. Breast pain can also occur in men who have gynecomastia, and in transgender people who are undergoing gender reassignment. […] An imbalance of fatty acids within the cells may affect the sensitivity of breast tissue to circulating hormones.

• #12 Work-up and management of breast pain – Li – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6968/html

  The role of diet and lifestyle choices as the etiology of breast pain is uncertain. A high-fat diet, smoking and caffeine intake have all been associated with breast pain, but there is no definitive evidence to support this. […] Extramammary breast pain describes breast pain that originates from sources other than the breasts. This can include chest wall pain or pain from other medical conditions. Extramammary breast pain is not considered true mastalgia as it does not arise from the breast tissue. […] The history and physical exam help to further classify breast pain as cyclical or noncyclical, while also evaluating for infection and cancer. […] If there is a clear etiology for the breast pain, for example, a simple cyst or an infection, treatment should be directed towards the finding. Otherwise, the treatment of breast pain depends on type of pain and severity. The treatment for cyclical and noncyclical breast pain overlap, although cyclical breast pain is often more responsive to treatment.

• #13 Breast pain | Breast Cancer Now

  https://breastcancernow.org/about-breast-cancer/breast-lumps-and-benign-not-cancer-breast-conditions/breast-pain/

  Breast pain is very common in women of all ages and can also affect men. […] It can have lots of different causes but, on its own, breast pain is rarely a sign of breast cancer. […] Cyclical breast pain is linked to changing hormone levels during the menstrual cycle. […] Non-cyclical breast pain may be continuous or it may come and go. […] Its often unclear what causes non-cyclical breast pain. […] Chest wall pain may feel as though its coming from the breast, but really it comes from somewhere else. […] Research has shown that non-steroidal anti-inflammatory pain relief, such as ibuprofen, can help breast pain, particularly non-cyclical pain. […] Tamoxifen works by blocking the hormone oestrogen. […] Tamoxifen is not licensed to treat breast pain and is commonly used to treat breast cancer. Research has shown its also effective in treating cyclical breast pain, so its sometimes used for this.

• #14 11 causes of breast pain and how to manage them

  https://www.medicalnewstoday.com/articles/311833

  Some medications can contribute to the development of breast pain. […] People with breast pain should speak with a doctor to find out whether any of their medications could be causing their symptoms. […] Both surgery and radiation therapy for breast cancer can cause scar tissue formation. This can result in numbness, pain, and changes in breast texture and appearance. […] Breast pain can originate from outside the breast rather than within it. For example, sprains or injuries in the back, neck, or shoulder might cause pain that a person feels in the breast. […] Costochondritis is inflammation of the costal cartilage, which connects the ribs to the breastbone. The condition can cause sharp chest pain and tenderness, and it may have a gradual or sudden onset. […] Breast cysts are fluid-filled sacs. They are noncancerous, relatively soft, and more common in premenopausal females.

• #15 Reddit – The heart of the internet

  https://www.reddit.com/r/costochondritis/comments/1gubcnk/breast_pain_mastalgia_and_costo/

  „Mastalgia is pain in the breast. Up to 70% of women will experience this at some time during their life. The pain women describe as breast pain can arise either from the breast tissue itself or it can be referred pain, which is felt in the breast. The nerve supply to the breast is from the anterolateral and antermedial branches of the intercostal nerves from T3 to T5 and irritation of these nerves anywhere along their course can lead to pain that is felt in the breast or nipple. A branch of T4 penetrates the deep surface of the breast and runs to the ripple. Irritation of this nerve can result in shooting pain up to the nipple that many women describe. Pain can also be referred from the breast or chest well through the intercostobrachial nerve to the inner aspect of the arm.”

• #16 The Evaluation of Common Breast Problems | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0415/p2371.html

  The evaluation of breast pain begins with a thorough history and a careful physical examination. Special attention should be given to the type of pain, its location and its relationship to the menstrual cycle. […] Menstrual irregularity, emotional stress and medication changes have been shown to exacerbate mastalgia. […] In the vast majority of women with breast pain, the physical examination and mammography reveal no evidence of breast pathology. […] Because of the extreme variability in breast pain, only treatments that have been tested in randomized, controlled trials can confidently be considered beneficial. Danazol (Danocrine), an antigonadotropin, is the only drug labeled by the U.S. Food and Drug Administration for the treatment of breast pain. […] Caffeine avoidance has been a popular treatment measure in women with breast pain. Unfortunately, two randomized clinical trials and one case-control study failed to demonstrate a therapeutic benefit for caffeine restriction.

• #17 Work-up and management of breast pain – Li – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6968/html

  With normal findings on physical exam and breast imaging, all patients with any type of breast pain should be reassured that their symptoms are not caused by breast cancer. For the majority of patients, reassurance results in significant relief and no additional interventions are required. […] If breast pain is persistent, or significantly impacts quality of life, additional therapies can be considered. It is important to note that breast pain alone is never an indication for breast surgery. […] Conservative, non-pharmacological therapies should always be attempted first. Though there is little evidence for the success of conservative therapies, there is minimal risk involved. Good mechanical support for large, pendulous breasts can improve breast pain in many women. […] Multiple studies suggest that patients with breast pain have increased levels of anxiety. Because stress can exacerbate pain, relaxation and stress management could be helpful for patients with breast pain.

• #18 Breast Pain: Tenderness, Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15469-breast-pain-mastalgia

  Breast pain, also called mastalgia, is a very common condition that can affect anyone. The pain can vary from feeling mildly sore to throbbing or stabbing. Frequent or recurring breast pain can interfere with your life and make it hard to go about your daily activities. Breast pain that doesn’t go away can also point to an underlying condition that needs treatment from a healthcare provider. […] Things like hormonal changes (due to medications or menstruation), wearing a poor-fitting bra or infection can cause breast pain. A condition called gynecomastia is the most common cause of breast pain in men. Most cases of breast pain aren’t due to breast cancer. […] Common causes of breast pain can be hormones, infections, noncancerous cysts and more. Breast pain can happen for many reasons. Some are related to your menstrual cycle, but other causes can be infection, cysts or hormone therapy.

• #19 Breast pain – UpToDate

  https://www.uptodate.com/contents/breast-pain/print

  Breast pain (mastalgia) is common in women and occasionally occurs in men. Although it is usually mild and self-limited, approximately 15 percent of affected women require treatment. Evaluation of breast pain is important to determine whether the pain is due to normal physiological changes related to hormonal fluctuation or to a pathologic process such as breast cancer. Unfortunately, studies specific to breast pain are limited and often small in number, not well designed, and with limited follow-up. […] Breast pain is a rare symptom of breast cancer. Women who present with breast pain but who have a normal examination and imaging studies can be reasonably assured that their risk of breast cancer is similar to that of a woman without breast pain. Most patients do not seek further medical attention for the pain once they are assured that they do not have breast cancer.

• #20 Breast Pain: Tenderness, Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15469-breast-pain-mastalgia

  If the cause is noncyclic, the complications could include: Difficulty sleeping, Issues with sexual intimacy, Being unable to participate in exercise or high-impact activities. […] Rarely, cancer can cause breast pain. For this reason, if you experience breast pain for longer than two weeks or have symptoms like a lump, skin dimpling and nipple changes, contact a healthcare provider. […] Since cyclic breast pain is a regular part of your menstrual cycle, it doesn’t require as much treatment. There are some pain-relieving medications you can take to help with your symptoms if the pain is becoming unmanageable. […] If your breast pain is even more severe, your provider may suggest danazol or tamoxifen, which are two prescription medications. But these two medications also have certain side effects, which is why it’s important to talk with your doctor before taking them, to determine whether it’ll be worth it for your specific case.

• #21 Breast pain – Wikipedia

  https://en.wikipedia.org/wiki/Breast_pain

  Breast pain linked to the menstrual cycle is called cyclic breast pain or cyclic mastalgia. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS). Cyclic breast pain is often associated with fibrocystic breast changes or duct ectasia and thought to be caused by changes of prolactin response to thyrotropin. […] Breast pain that is not linked to a menstrual cycle is called noncyclic breast pain. Non-cyclical breast pain has various causes and is harder to diagnose and frequently the root cause is outside the breast. Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause and during pregnancy. After pregnancy, breast pain can be caused by breastfeeding. Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis and medications such as digitalis, methyldopa (an antihypertensive), spironolactone, certain diuretics, oxymetholone (an anabolic steroid), and chlorpromazine (a typical antipsychotic). Also, shingles can cause a painful blistering rash on the skin of the breasts. […] Some women who have pain in one or both breasts may fear breast cancer. However, breast pain is not a common symptom of cancer. The great majority of breast cancer cases do not present with symptoms of pain, though breast pain in older women is more likely to be associated with cancer.

• #22 12 Causes of Breast Pain

  https://www.health.com/condition/breast-cancer/breast-pain

  Everything from your period to workouts to the medications you’re on could cause breast pain and be why your breasts hurt when you press them. There are two types of breast pain (mastalgia): cyclical and non-cyclical pain. Cyclical pain is associated with your period, while non-cyclical pain is due to non-hormonal reasons like surgery. […] Breast cysts are most common in women aged 30 to 50. A cyst is a plugged or obstructed breast gland with fluid buildup. Cysts are generally harmless, but they can be painful. […] Inflammatory breast cancer is one of the few types of breast cancer that may involve pain. This rare and aggressive form of the disease accounts for about 1% to 5% of all breast cancers. […] Large breasts can cause enough strain that they stretch breast ligaments and tissues. This can cause pain in your breasts and possibly in your back, neck, and shoulders.

• #23 Breast pain: assessment, management, and referral criteria | British Journal of General Practice

  https://bjgp.org/content/70/697/419

  Inflammatory cancer can cause similar signs but characteristically without pain and does not resolve with antibiotic therapy. […] The management of extra-mammary pain requires a positive diagnosis and exclusion of breast pain by clinical assessment. […] Careful assessment is essential to avoid unnecessary referral, which can lead to anxiety or over-investigation. […] The National Institute for Health and Care Excellence (NICE) states that: breast pain is not a criteria for urgent referral, with a positive predictive value of 3% for breast cancer. […] Referral is recommended if cyclical breast pain is affecting quality of life or sleep, and has been ongoing for more than 3 months if the pain is unresponsive to first-line treatment. […] Explanation and support alone has a vital role to play in the management of mastalgia.

• #24 11 causes of breast pain and how to manage them

  https://www.medicalnewstoday.com/articles/311833

  Breast pain, or mastalgia, is very common. Possible causes of breast pain include hormonal changes, an incorrect bra fit, and infections. Breast pain management will depend on its cause, but painkillers and lifestyle changes can often help in mild cases. […] Tender or swollen breasts are usually related to the hormonal changes before a period, pregnancy, or menopause. This type of breast pain usually causes tenderness in both breasts, and it may extend to the armpit. […] When breast pain is related to the menstrual cycle, it is known as cyclic breast pain. Cyclic breast pain can be part of a set of symptoms that occur before a period, known as premenstrual syndrome (PMS), or it may occur on its own. […] PMS is temporary, but people can treat the symptoms by taking over-the-counter (OTC) pain relievers, wearing a comfortable and supportive bra, and using gentle heat to soothe the pain.

• #25 Breast pain: assessment, management, and referral criteria | British Journal of General Practice

  https://bjgp.org/content/70/697/419

  Dietary modification to avoid caffeine, cocoa products, and foodstuffs that contain methylxanthines and an increase in dietary soya may give some symptomatic relief, but the evidence for these modifications is poor and are not recommended by NICE. […] Topical NSAIDs such as diclofenac or piroxicam provide a benefit in many patients and should be considered a first-line treatment. […] Hormonal treatments may be considered in the secondary care setting; however, they have significant side effects limiting their use. […] Tamoxifen, an oestrogen receptor blocker, has the most evidence for efficacy in treatment of mastalgia, but the risk of venous thromboembolism must be considered. […] Breast pain can usually be safely managed in the primary care setting.

• #26 Pain at Midlife – Page 6

  https://www.medscape.com/viewarticle/494126_6

  However, danazol has a high side effect profile including irregular menses, nausea, headache, and depression. Tamoxifen, a partial antiestrogen/partial estrogen agonist has also been effective for breast pain. However, it is not approved by the FDA for breast pain and causes hot flashes. […] A randomized, prospective, blind, placebo-controlled study demonstrated that topical applications of NSAIDs were effective in both cyclic and noncyclic mastalgia, with minimal side effects.

• #27 Work-up and management of breast pain – Li – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6968/html

  As previously stated, the role of diet and lifestyle choices in breast pain is unclear. The elimination of caffeine has been shown to reduce breast pain in some studies but was not shown to be consistently effective in all studies. […] Medications can be considered for persistent or severe pain that does not respond to conservative therapy. Patient risk factors and medication side effects should be carefully considered before initiating these therapies. […] Topical nonsteroidal anti-inflammatory drugs (NSAIDs) can be given to treat breast pain with minimal risk. […] Danazol is an anti-gonadotropin agent with androgenic effects. It is the only medication approved by the US Food and Drug Administration for the treatment of breast pain. The standard dose is 100-400 mg/day. Danazol at various doses has been shown to reduce pain in patients with both cyclical and noncyclical breast pain.

• #28 Pain at Midlife – Page 6

  https://www.medscape.com/viewarticle/494126_6

  Breast fullness or tenderness often occurs in the luteal phase of the menstrual cycle; mastalgia is a more extreme form of this occurrence. […] Theories regarding the etiology of extreme breast pain in women include endocrine abnormalities involving estrogen, progesterone, and prolactin. It has been postulated that breast pain is associated with altered ratios of fatty acid esters, higher basal prolactin levels, increased prolactin response to stimulation, and high dietary fat. […] Often, due to the lack of consistent histologic, endocrine, or behavioral assessments available for the complaint of breast pain, its diagnosis can be unclear or missed. […] Once underlying disease processes have been excluded, treatment consists of reassurance about the benign nature of the condition. Pharmacologic therapy may include drugs such as danazol, an antigonadotropin, which has been shown to relieve pain in up to 93% of cases for women prior to menopause.

• #29 Work-up and management of breast pain – Li – Annals of Breast Surgery

  https://abs.amegroups.org/article/view/6968/html

  Tamoxifen is a selective estrogen-receptor modulator used as adjuvant treatment for hormone receptor positive breast cancer. It has also been used as a treatment for breast pain. Multiple randomized studies have noted that tamoxifen is effective at treating breast pain at 10 and 20 mg/daily, with fewer side effects reported at the lower dose. […] Breast pain is a very common symptom, but in the absence of concerning findings on physical exam or imaging, breast pain is rarely a symptom of breast cancer. All patients with breast pain should undergo a thorough history and physical exam to determine if further work-up with diagnostic imaging is indicated. Imaging work-up is determined by the age of the patient and type of breast pain. If there are no concerning findings on physical exam or breast imaging, management is based on the type of breast pain and severity. Frequently, reassurance is all that is required. Breast pain often spontaneously resolves, but if severe or persistent, conservative therapies should be attempted first. If pain is persistent or severe, there are several pharmacological therapies that can be considered, but patient should be appropriately counseled regarding the side effects of these medications.

• #30 Breast Pain Treatment Melbourne, VIC | Mastalgia Treatment Melbourne, VIC

  https://www.melbournebreastcancersurgery.com.au/breast-painmastalgia.html

  Evening primrose oil is felt to potentially work by replacing an essential fatty acid. There is some evidence that having low levels of the essential fatty acid called gamolenic acid (GLA) can contribute to cyclical breast pain. […] Tamoxifen is a drug more commonly used to treat and prevent breast cancer, however, research has shown it is also effective in the treatment of cyclical breast pain. It acts to selectively block oestrogen from its effect on breast tissue, thereby reducing pain related to hormonal stimulation. Low dose tamoxifen on a short term basis certainly merits consideration in cases of severe, refractory breast pain. Tamoxifen at a dose of 10mg daily is reported to relieve cyclical mastalgia in 70 to 90 per cent and non-cyclical mastalgia in 56 per cent of cases.

• #31 Breast Pain (Mastalgia) Information

  https://www.columbiadoctors.org/health-library/article/breast-pain-mastalgia/

  Breast pain can get worse with changes in your hormone levels or changes in the medicines you are taking. Stress can also affect breast pain. You are more likely to have breast pain before menopause than after menopause. […] Breast pain is not a common symptom of breast cancer. But in some cases painful lumps are caused by breast cancer. […] Danazol and tamoxifen citrate are prescription medicines used for the treatment of severe cyclic breast pain. These medicines are rarely used because they have significant side effects. It is important to determine whether the benefits will outweigh the risks of taking these medicines. […] Birth control pills (oral contraceptives) may help reduce cyclic breast pain and breast swelling before periods. If you are already taking birth control pills, sometimes adjusting the dose can help improve breast pain.

• #32 Breast Pain: Types, Causes, and Treatment Options | Breastlink

  http://breastlink.com/breast-cancer-101/common-breast-problems/breast-pain

  Breast pain, or mastalgia, is a common symptom that brings many women to their healthcare providers. […] Hormonal fluctuations during the menstrual cycle are the most common cause of breast pain. […] While breast pain is rarely the first symptom of breast cancer, in rare cases, it can be a sign of cancer. When breast cancer is associated with pain, the pain tends to be focal, i.e., in one spot in the breast. The pain also tends to get steadily worse over time. […] One of the most common side effects of estrogen is breast pain, and post-menopausal women on estrogen may experience breast pain. […] There are reports that iodine can reduce breast pain. Some women have reported benefits with over-the-counter iodine-containing products. However, further research is needed to confirm these reports, and no specific product can be recommended at this time.

• #33 Etiology and Management of Benign Breast Disease | Oncohema Key

  https://oncohemakey.com/etiology-and-management-of-benign-breast-disease/

  The theory of an inadequate luteal phase defect has never been confirmed. […] The mechanisms of LHRH analogs are thought to be their antigonadotropic action and direct inhibition of ovarian steroidogenesis, which almost completely induce ovarian ablation, resulting in extremely low levels of the ovarian hormones estradiol, progesterone, androgens, and PRL. […] Results of recent studies point toward a PRL secretory hypersensitivity for estradiol in patients with cyclic mastalgia.

• #34

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-87052019000200111

  Mastodynia is the most common symptom with a prevalence of 70% in women under 55 years. […] The physiopathology of the mastodynia is not caused by a single mechanism, but by different causes with independent pathways. The main mechanisms are hormonal, mammary density, neuropathic and extra-mammary. […] The cause is not clear, but there are several theories. Hormonal etiology of mastalgia is suggested by the onset at the age of menarche, its relationship with the menstrual cycle and its resolution with menopause. […] The mental and emotional state of women has shown association: those with symptoms of anxiety and adaptive disorders are more associated with severe mastalgia. […] There is some evidence that suggests that women with mastalgia have increased levels of saturated fatty acids and reduced those of essential fatty acids, especially gamma-linoleic acid (GLA); apparently, this makes the cell membranes more sensitive to nociceptive depolarization and allows the estrogen receptor to be more available.

• #35 Breast pain – UpToDate

  https://www.uptodate.com/contents/breast-pain/print

  While cyclical breast pain has traditionally been attributed to fibrocystic changes, chronic cystic mastitis, and mammary dysplasia, breast pain and nodularity are so common that the term fibrocystic „disease” has become obsolete, and we suggest that it no longer be used, although it is commonly used by the patient at presentation. […] This topic will discuss the etiology, evaluation, and treatment of breast pain in women. Evaluation of a breast mass or cancer is discussed separately. […] Breast pain caused by inflammatory or infectious etiologies (ie, mastitis) is discussed in other topics.

Zobacz więcej