by: E. Loren Buhle, Jr. Ph.D.
December 5, 1994
Abstract: Mastalgia is a common but often poorly understood condition with little Australian data available on the subject. Details are presented of 170 patients who have attended a specific mastalgia clinic at the Princess Alexandra Hospital, Brisbane, Queensland, over a 3 year period. The aims and management protocol of the clinic are outlined. The mastalgia sufferer in this study had an average age of 42 years and 87% were multiparous. Cyclical pain occurred in 59% as determined by a daily pain record chart. Unilateral pain occurred in 38%. Lack of previous breast feeding and low levels of regular physical exercise were identified as two significant factors in the history of those attending the clinic. The responses to treatments are outlined. Response rates of 18 and 26% to two commonly used 'natural products', Vitamin B6 and Evening Primrose Oil, respectively, are considered little better than placebo effect. A complete response was achieved in 67% of women who took low dose danazol with minimal side effects. The overall response rate to all treatments was 65% with a mean follow up of 15.5 months for those women who continued to attend the clinic. For women with mastalgia, a systematic approach can achieve relief of pain.
Abstract: This paper describes a retrospective study of the clinical aspects and treatment of 566 women with cyclical breast pain over a seven-year period. Figures for the effectiveness of simple treatments including some homeopathic drugs are reported. The article concludes that reassurance is the fundamental treatment. Good responses are obtained from simple and safe drugs (oil of evening primrose, vitamin B6) with minimal side-effects. The use of stronger hormone drugs such as tamoxifen and danazol was only necessary in a small proportion of patients and resulted in a higher incidence of side-effects.
Abstract Mild breast pain and nodularity are common and may be considered normal. Only when symptoms are severe enough to affect the patient's lifestyle should drug treatment be considered. Using danazol, bromocriptine or evening primrose oil a clinically useful improvement in pain can be anticipated in 77% of patients with cyclical mastalgia and 44% with non-cyclical mastalgia. Benign nodularity should not be biopsied surgically as it is unnecessary and makes subsequent assessment of the breast difficult.
Abstract In order to establish the current treatment of cyclical mastalgia, a postal questionnaire was sent to 276 consultant general surgeons (over 25% of the UK total), randomly selected from the 12 UK regional health authorities. Surgeons were questioned about their choices of treatment for cyclical mastalgia, after initial resassurance, and for persistent pain. Two hundred and forty-five (89%) responded, out of whom 219 saw patients with breast disease. Twenty-three (11%) of these surgeons were identified as having a major interest in breast disease. Danazol, used by 75% of surgeons, was the drug most commonly prescribed. Initial treatments by non-specialist surgeons included danazol (31%), analgesia (19%) and diuretics (17%), and by breast surgeons evening primrose oil (30%), tamoxifen (13%) and vitamin B6 (13%). For persistent pain 46% of non-specialist surgeons prescribed danazol and 18% surgery, whereas 65% of breast surgeons prescribed danazol and 30% bromocriptine. A wide variety of therapies are used, but danazol is the most common. For persistent unresponsive pain, local excision biopsy surgery is frequently considered by non-specialist surgeons. Breast specialist tend initially to use other methods that are associated with fewer side-effects and reserve other treatments such as danazol and bromocriptine for persistent cases.
Abstract The therapeutic effectiveness of evening primrose oil (Efamol, Vita-Glow) in the relief of 10 symptoms associated with premenstrual syndrome (PMS) as well as menstrual symptoms was studied in 38 women. The prospective trial was randomised, double-blind and placebo-controlled and was crossed-over after three cycles. Although the results showed an improvement in symptoms of PMS during the trial, no significant differences in the scoring between the active and placebo groups were found over six cycles. No "carry-over" effect of active medication was observed; the beneficial effect on all symptoms (psychological, fluid retention, breast) was rapid, the scores decreasing in the first cycle but increasing slightly at the change-over period after the third cycle, irrespective of whether the active or placebo medication was next given. These findings indicate that the improvement experienced by these women with moderate PMS was solely a placebo effect.
Abstract Two hundred women with breast cysts proven by aspiration were entered into a randomized double-blind trial of Efamol (evening primrose oil) at a dose of 6 capsules daily or equivalent placebo dose for a year. Cysts were categorized by initial electrolyte composition, and follow-up continued for 1 year posttherapy. Recurrent cyst formation in the first year was slightly (but not significantly) lower in the Efamol group compared with the placebo-treated group. The Efamol treatment was well tolerated as the dropout rate was only 7% and equal in both the active and placebo groups. The initial electrolyte composition did not predict for cyst recurrence.
Abstract Cyclical breast pain or mastalgia occurs in up to 70% of the female population. After exclusion of breast cancer and proper reassurance, only 15% of patients initially presenting will require drug treatment. Using bromocriptine, danazol and evening primrose oil some 77% of patients treated can obtain useful relief of their symptoms.