No Association Between Breast Pain and Breast Cancer. A Prospective Cohort Study of 10,830 Symptomatic Women Presenting to a Breast Cancer Diagnostic Clinic

Background Women with breast pain constitute upto 20% of breast clinic attendees. Aim: To investigate breast cancer incidence in women presenting with breast pain and establish health economics of referring women with breast pain to secondary care. Design & Setting: Prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months. Methods: Women were categorised by presentation into 4 distinct clinical groups and cancer incidence investigated. Results: Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms,1670 (15%) with ‘other’ symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in 8 (0.7%). In 1972 women with breast pain, breast cancer incidence was 0.4% compared with ~5% in each of the three other clinical groups. Using ‘breast lump’ as reference, odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval 0.02–0.09; P<0.001). Compared to reassurance in primary-care, referral was more costly (net cost £262) without additional health benefits (net Quality Adjusted Life Year (QALY) loss -0.012) Greatest impact on the incremental cost effectiveness ratio (ICER) was when QALY loss due to referral associated anxiety was excluded. Primary-care reassurance no longer dominated, but the ICER remained greater (£45,528/QALY) than typical UK National Health Service cost-effectiveness thresholds. Conclusions: This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.

Skin‐patch Of Ding Zi Gao on Relieving Local and Systemic Symptoms in Patients with Moderate to Severe Periodic Mastalgia: A Randomized, Double‐Blind Trial

Background and purpose: The use of hormone receptor agent drugs such as androgens (tamoxifen) for the treatment of moderate and severe breast pain has limitations such as cardiac, hepatic, and nephrotoxicity and gastrointestinal side effects. Therefore, there is a need to prescribe a new safe and effective topical treatment method to reduce the use of anti-inflammatory and hormonal agent drugs, the incidence of adverse effects and the financial burden on patients. This randomized controlled clinical trial investigates the clinical efficiency and safety of Skin‐patch of Ding Zi Gao (DZG) acupoint-application therapy for the treatment of moderate to severe Periodic mastalgia (MSPM), and provides a basis for the design of an optimized, safe and effective comprehensive treatment plan for MSPM.Methods: Sixty patients with moderate to severe Periodic mastalgia (MSPM) who met the inclusion criteria were selected from the breast clinic of Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University and randomly divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was treated by Skin‐patch of Ding Zi Gao (DZG) acupoint-application therapy, which was applied from the 3rd day after the end of menstruation, once a day, for 6-8 h each time, 14 times as a course of treatment, and the treatment was completed within 1 month, and the application was stopped during menstruation. The control group was treated with skin patches of placebo acupoint application, and the duration and course of treatment were the same as that of the treatment group. During the 14 day course of treatment and 2-month follow-up after the experiment, the main outcome indicators (including Breast pain improvement onset time, change in breast pain VAS score, change in patient's mood, sleep, Fullness in both flank, (McGill Pain Questionnaire) MPQ and secondary outcome indicators ( Including changes in breast nodule size and gland thickness guided by breast ultrasound, VAS pain score in the 2-month follow-up at the end of treatment, and adverse reactions), At the same time, the safety of the scheme was evaluated.RESULTS: There were no differences between the two groups in terms of age, body mass index, history of breastfeeding, family history of breast disease, history of allergies, history of breast surgery, or duration of breast pain (months) before recruitment. The comparison between pre-treatment and post-treatment showed that the time to onset of breast pain improvement, visual analogue score (VAS) of breast pain, improvement in mood, sleep, fullness in both flank and the MPQ were significantly lower in both groups after treatment, and the improvement was more significant in the treatment group than in the placebo control group (P < 0.05). Both groups showed significant reductions in improving patient mammography outcomes and VAS pain scores at two months of follow-up, but there were no significant differences between the groups. In terms of safety evaluation, no significant differences in the incidence of adverse events were found.CONCLUSION: point-application treatment with skin patches of Ding Zi Gao (DZG) therapy in patients with MSPM improved breast pain and swelling, reduced breast gland thickness, and decreased breast visual analogue pain score (VAS) and MPQ score. Its efficacy was significantly better than skin patches of placebo acupoint application therapy alone. This study provides a basis for the clinical application of DZG for MSPM.

Body Mass Index and Other Factors Related to Mastalgia: A Cross Sectional Study

BACKGROUND: Mastalgia is a common complaint in females aged 30–50 years. Mastalgia varies in degrees of severity. The quality of life of women may be adversely affected by severe mastalgia. It was associated with disturbance in sexual, social, and physical activities and behaviors. AIM: The main objective of this study is to investigate factors affecting mastalgia. METHODS: This is an analytical cross-sectional study. Conducted on 148 females attending the Family Medicine outpatient clinic. Mastalgia was assessed by new breast pain score. RESULTS: The mean age of patients was 32.6 and their mean body mass index (BMI) was 24.8. The majority of the cases were highly educated 48% and working 58.1%. There was a highly statistically significant difference between females with mild pain and those of moderate to severe pain regarding to BMI as the mean of BMI in patient with mild pain was 22.7 ± 2.5 while it was 27.6 ± 3.1., there was highly statistically significant difference between both groups as regards to the type of the contraception used that means females who used hormonal contraception had more pain. After logistic regression the only remaining significant factor was BMI 0.001. CONCLUSION: There are many factors affecting mastalgia as BMI, type of contraception, menstrual regularity, menstrual duration, breast pain duration, and premenstrual symptoms. But BMI is the most important factor affecting mastalgia.

A PROSPECTIVE STUDY TO COMPARE THE EFFICACY OF THREE TREATMENT MODALITIES ON BENIGN BREAST DISEASE VIZ. EVENING PRIMROSE OIL (EPO), DANAZOLAND CENTCHROMAN

Background: Breast pain among women, with or without lump is common complaint and a cause of signicant anxiety and fear of breast cancer. Breast feeding is additionally one of the reasons for non-cyclic pain, brocystic breast disease is otherwise called broadenosis. Material and Methods:This is prospective study in the Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar. Conclusion: Centchroman is a selective anti estrogen effective in the treatment of brocystic disease. Centchroman is effective in reducing the sizes of breast lumps, providing relief from mastalgia and in curing cyclical and noncyclical breast pain in the premenopausal women.

Breast surgery

This chapter outlines the surgical and medical treatment of breast cancer in females and males, breast cancer screening, benign breast conditions, breast pain and gynaecomastia. It describes the assessment of a breast lump with triple assessment and also how to perform a punch biopsy.

Breast

This chapter begins with a short introduction to the role of the breast complaint in a gynaecological setting, and how nurses can encourage breast awareness and participation in screening programmes. It then goes on to cover breast pain (mastalgia), various benign breast conditions, and breast history and examination. It describes screening and diagnosis of breast disease, the current clinical picture and treatment options for breast cancer, alongside associated risk factors and prevention.

Clinical and USG Findings of Patients Presented with Breast Pain

Introduction: Breast pain also known as mastalgia is the dull acne in the breast, cause is multifactorial. It can affect any age group. Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women aged 20-59 years worldwide. In India, breast cancer has ranked number one cancer among females, with age adjusted incidence as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Objective: To find out the Clinical and USG Findings of Patients Presented with Breast Pain. Settings and Design: Prospective cross-sectional descriptive study. Materials and Methods: Patients with complaints of breast pain in the age group 15 to 60 years with clinically no palpable mass attending to the Dept. of Clinical Oncology, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh between January 2020 to December 2020 were included in the study. Detailed history with particular reference to age, duration of symptoms, Size, menstruation, marital status, parity, lactation, Nipple discharge and tenderness are recorded. Pain intensity was evaluated as mild, moderate and severe. Ultrasound of the breast including the axilla was done for all cases and findings recorded to correlate with clinical features. Results: Out of 90 patients studied, majority was in the age group (21-30) years, (43%) followed by (31-40 years) (40%) respectively. 57(63%) were married and 33(43%) were single. 21 patients had 1 child, 18 had 2 children with 6 of them having no children. Out of 90 patients only 3 attained menopause, rest of them have their monthly cycles. 51 patients had cyclical breast pain and 39 had noncyclical breast pain, 39 had pain on right breast, 36 on left side and bilateral in 15 patients. Pain was mild in 15 patients, moderate in 27 patients and severe in 6 patients. Various USG findings of the affected breast were normal study in 48 patients followed by duct ectasia and hetrogenous ectogenicity fibroadenosis, small cystic lesion and enlarged axillary lymph nodes etc. Conclusion: The study results show that majority of patients with breast pain without clinically palpable lump had normal USG study. But it also detects other early changes in the breast tissue. It can be used as a baseline investigation for any breast pain without palpable lump.