• In severe mastalgia:
    • Patients may require medications when other measures have failed
  • 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:
    • 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.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastExpert #BreastPain #Mastalgia #SevereMalstalgia #Danazol #Tamoxifen

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