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Breast pain - cyclical - Management
Basis for recommendation
Reassurance
- Two epidemiological studies suggest that women with cyclical breast pain (and no other features of malignancy) have a lower risk of breast cancer.
- A matched cohort study compared the prevalence of breast cancer in 987 women referred for imaging because of breast pain and 987 women referred for screening mammography [Duijm et al, 1998]. In women with breast pain the prevalence of breast cancer was 0.4%, and in women having screening mammography the prevalence was 0.7%.
- A study of women consulting a specialist breast care centre found that the risk of breast cancer was lower in women with breast pain: the odds ratio for breast cancer adjusted for risk factors (early menarche, late first birth, late menarche, hormone treatment, positive family history of breast cancer) was 0.63 (95% CI 0.49 to 0.79) [Khan and Apkarian, 2002].
Wearing a well-fitting bra and cyclical breast pain
- The advice to wear a well-fitting bra is based on expert opinion. There is limited evidence from a case series to suggest that a well-fitting bra reduces cyclical breast pain. The recommendation for wearing a soft support bra at night is pragmatic and there is no evidence to support this.
Simple oral analgesia as first-line treatment for cyclical breast pain
- The recommendation to offer simple oral analgesia as first-line treatment is pragmatic.
Topical nonsteroidal anti-inflammatory drugs (NSAIDs) for cyclical breast pain
- There is evidence from one randomized controlled trial that topical NSAIDs may be more effective than placebo in reducing breast pain. Irregular usage and abruptly stopping treatment created no serious problems.
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