MASTALGIA Mastalgia, also called mastodynia or breast pain. Mastalgia is classified as: Depends on whether its presence is related to the menstrual cycle. Cyclic: • Most common • Majority of breast pain is cyclic, occurring 1 to 2 weeks prior to menses. Noncyclic: • Less common Etiology: • Mild cyclic mastalgia is considered a normal, physiologic condition caused by the hormonal changes of the menstrual cycle. • Linked to the reproductive cycle, with onset at menarche, monthly cycling, and cessation at menopause. Three hormonally oriented theories have emerged to explain moderate or severe breast pain: 1. Increased estrogen secretion from the ovary 2. Deficient progesterone production 3. Hyperprolactinemia. Mastalgia can also be caused by certain medications, including: • Combined estrogen and progestin contraceptives (i.e., pills, vaginal ring, and transdermal patch) • Hormone therapy (HT) • Antidepressants, digoxin, methyldopa, cimetidine, spironolactone, oxymetholone, and chlorpromazine Diagnosis: Diagnostic imaging is frequently used in the evaluation of breast conditions; information about these tests is provided in Table 15-1. TABLE 15-1 Diagnostic Imaging Tests Test Source of Images Best for Detecting Limitations of Test Page 2 of 7 Mammogram X -rays Calcifications, masses, and architectural Cannot show if mass is solid or cystic; has lower Page 3 of 7 Test Source of Images Best for Detecting Limitations of Test distortion sensitivity in women with dense breast tissue Ultrasound (US) Sound waves Differentiation of solid and cystic masses Typically cannotshow calcifications Magnetic resonance imaging (MRI) Magnetic fields, must be enhanced with gadolinium contrast Tissue with increased blood flow such as tumors; high sensitivity and negative predictive value Expensive; limited to specific indications; high rate of false-positive results (lack of specificity) Tomosynthesis X-rays (provide 3-D digital images); use with a standard mammogram Architectural distortion, masses, and calcifications, in dense breast tissue Slight increase in radiation exposure versus standard mammogram, takes twice as long to read Treatment: Nonpharmacologic Therapies • Reassurance is the first-line treatment for mastalgia. • Wearing a supportive and well-fitting bra is frequently, especially with large, heavy breasts. • Reductions in caffeine and dietary fat • Supplementation with vitamins A, B, or E Pharmacologic Therapies • Danazol, tamoxifen, and bromocriptine - all three of these medications offer significant relief • Topical use of diclofenac diethyl ammonium gel (an NSAID), three times daily for 6 month. • Injection of 1 mL of 2% lidocaine and 40 mg of methyl prednisone at the area of maximum tenderness. Other methods: • Modifying the dose or route of HT, which can cause breast pain. • Different contraceptive method or delivery system, such as changing from combined oral contraceptives to a nonoral combined method (i.e., the ring or patch). • Some women report an improvement in mastalgia with use of hormonal contraception