Mastalgia

• In severe mastalgia:
  • Patients may require medications when other measures have failed
• A meta-analysis of randomized trials evaluating bromocriptine, danazol, evening primrose oil, and tamoxifen:
  • Found that only danazol and tamoxifen:
    • Conferred significant reductions in pain
• Danazol:
  • A gonadotropin secretion suppressor:
    • Is the only medication approved by the U.S. Food and Drug Administration for treatment of mastalgia:
      • However, it does have significant androgenic side effects:
        • Which often limits the duration of use
• Tamoxifen:
  • Is a selective estrogen receptor modulator:
    • Which has been found to reduce severe breast pain:
      • But has an associated increased risk of endometrial cancer and deep venous thrombosis
• When comparing the efficacy of each treatment and the relative side effects:
  • The meta-analysis concluded that tamoxifen is the treatment of choice:
    • It can be used as an off-label treatment as long as the patient understands the potential risks
• Another study found that the most important factor associated with persistent breast pain:
  • More than 5 years after treatment for breast cancer:
    • Was the presence of lymphedema:
      • Referral to a lymphedema specialist is recommended for these women
• References:
  • 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(5):503- 512.
  • Bell RJ, Robinson PJ, Nazeem F, Panjari M, Fradkin P, Schwarz M, et al. Persistent breast pain 5 years after treatment of invasive breast cancer is largely unexplained by factors associated with treatment. J Cancer Surviv. 2014;8(1):1-8.

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