Summary
Severe breast pain or mastalgia is a common symptom, affecting up to 70% of the female population at some time in their lives. It accounts for approximately 50% of referrals to a specialised breast clinic, two-thirds of patients having cyclical and one-third experiencing noncyclical mastalgia, or pain arising from the chest wall deep to the breast. After exclusion of breast cancer and proper reassurance, 85% of patients can be discharged from the clinic without specific treatment. In only 15% of patients is the pain severe enough to affect their lifestyle and warrant drug therapy.
Using EF-12 (gammalinolenic acid; gamolenic acid) as first-line therapy, with danazol and bromocriptine usually as second-line agents, a clinically useful improvement in pain can be anticipated in 92% of patients with cyclical and 64% with noncyclical mastalgia. Patients with severe recurrent or refractory mastalgia may require treatment with tamoxifen, goserelin or testosterone, but the short and long term adverse effects of these drugs preclude their use as first-line agents.
Chest wall pain is usually self-limiting, but symptomatic relief can often be obtained using steroidal and local anaesthetic injections or nonsteroidal anti-inflammatory drugs.
Similar content being viewed by others
References
Hughes LE, Mansel RE, Webster DJT. Breast pain and nodularity: benign disorders and diseases of the breast. London: Baillière Tindall, 1989: 75–92
Gateley CA, Miers M, Mansel RE, et al. Drug treatment for mastalgia: 17 years experience in the Cardiff mastalgia clinic. J R Soc Med 1992; 85: 12–5
Maddox PR, Harrison BJ, Mansel RE, et al. Non-cyclical mastalgia: an improved classification and treatment. Br J Surg 1989; 76: 901–4
Wisbey JR, Kumar S, Mansel RE, et al. Natural history of breast pain. Lancet 1983; 2: 672–4
Bishop HM, Blamey RW. A suggested classification of breast pain. Postgrad Med J 1979; 55: 59–60
Galea MH, Blamey RW. Non-cyclical breast pain: 1 year audit of an improved classification. In: Mansel RE, editor. Recent developments in the study of benign breast disease. Carn-forth: Parthenon Publishing, 1992: 75–80
Pye JK, Mansel RE, Hughes LE. Clinical experience of drug treatments for mastalgia. Lancet 1985; 2: 373–7
Boyd NF, McGuire V, Shannon P. Effect of a low-fat high carbohydrate diet on symptoms of cyclical mastopathy. Lancet 1988; 2: 128–32
Russell LC. Caffeine restriction as initial treatment for breast pain. Nurse Pract 1989; 14 (2): 36–7
Gateley CA, Maddox PR, Pritchard GA, et al. Plasma fatty acid profiles in benign breast disorders. Br J Surg 1992; 79: 407–9
Horobin DF. Cellular basis of prolactin action: involvement of cyclical nucleotides, polyamines, prostaglandins, steroids, thyroid hormones, Na/K ATPases and calcium. Relevance to breast cancer and the menstrual cycle. Med Hypoth 1979; 5: 599–614
Horrobin DF. Gammalinolenic acid. Rev Contemp Pharmacother 1990; 1: 2–5
Pashby NL, Mansel RE, Hughes LE, et al. A clinical trial of evening primrose oil in mastalgia. Br J Surg 1981; 68: 801
Mansel RE, Wisbey JR, Hughes LE. Controlled trial of the antigonadotrophin danazol in painful nodular benign breast disease. Lancet 1982; 1: 928–30
Harrison BJ, Maddox PR, Mansel RE. Maintenance therapy of cyclical mastalgia using low dose danazol. J R Coll Surg Edinb 1989; 34: 79–81
Kumar S, Mansel RE, Hughes LE. Prolactin response to thyrotrophin-releasing hormone stimulation and dopaminergic inhibition in benign breast disease. Cancer 1984; 53: 1311–5
Mansel RE, Dogliotti L. European multicentre trial of bromocriptine in cyclical mastalgia. Lancet 1990; 335: 190–3
Gateley CA, Maddox PR, Mansel RE, et al. Mastalgia refractory to drug treatment. Br J Surg 1990; 77: 1110–2
Fentiman IS, Caleffi M, Brame K, et al. Dosage and duration of tamoxifen therapy for mastalgia: a controlled trial. Br J Surg 1988; 75: 845–6
van Leeuwen FE, Benraadt J, Coebergh JWW, et al. Risk of endometrial cancer after tamoxifen treatment of breast cancer. Lancet 1994; 343: 448–52
Hamed H, Caleffi M, Chaudary MA, et al. LHRH analogue for treatment of recurrent and refractory mastalgia. Ann R Coll Surg Engl 1990; 72 (4): 221–4
Mansel RE. Goserelin - the British multicentre trial. Br J Clin Pract 1989; 43 Suppl. 68: 33
Laidlaw I, Gateley CA, Russell J, et al. The Manchester Restandol trial. In: Mansel RE, editor. Recent developments in the study of benign breast disease. Carnforth: Parthenon Publishing, 1992: 35–41
Peters F. Multicentre study of gestrinone in cyclical breast pain. Lancet 1992; 339: 205–8
Doherty HA, Owen D. Gestrinone in cyclical breast pain [letter]. Lancet 1992; 339: 554–5
European Multicentre Study Group for Cabergoline in Lactation Inhibition. Single dose cabergoline versus bromocriptine in inhibition of puerperal lactation: a randomised, double blind, multicentre study. BMJ 1991; 302: 1367–71
Preece PE, Richards AR, Owen GM, et al. Mastalgia and body water. BMJ 1975; 4: 498–500
McFayden JM, Forrest APM, Chetty U. Cyclical breast pain-some observations and the difficulties in treatment. Br J Clin Pract 1992; 46 (3): 161–4
Smallwood J, Ah-Key D, Taylor I. Vitamin B6 in the treatment of premenstrual mastalgia. Br J Clin Pract 1986; 40 (12): 532–3
Maddox PR, Harrison BJ, Horobin JM, et al. A randomised controlled trial of medroxyprogesterone acetate in mastalgia. Ann R Surg Engl 1990; 72 (2): 71–6
McFadyen W, Raab GB, Macintyre CCA, et al. Progesterone cream for cyclical breast pain. BMJ 1989; 298: 931
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Holland, P.A., Gateley, C.A. Drug Therapy of Mastalgia. Drugs 48, 709–716 (1994). https://doi.org/10.2165/00003495-199448050-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199448050-00005