Abordaje diagnóstico y terapéutico de la mastalgia. Un reto cotidiano en la consulta ginecológica.
[Diagnostic and therapeutic approach to mastalgia. A daily challenge in the gynecological visit.]Luz del Carmen Sanabria Villegas1, Leopoldo Santiago Sanabria2, Mario Villafán Athié3, Ximena van Tienhoven3, Renata Fernanda Rodríguez Castro3, Ariel Zoilo De la Puente Gómez3
1. Departamento Ginecología y Obstetricia, Hospital Ángeles, Villahermosa, México; 2. Departamento Ginecología Oncológica, Unidad Médica de Alta Especialidad 4 - Luis Castelazo Ayala, Ciudad de México, México; 3. Departamento Ginecología y Obstetricia Universidad Panamericana, Ciudad de México, México;
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Resumen
La mastalgia es uno de los principales motivos de consulta diaria para el ginecólogo. Se estima que alrededor del 70% de las mujeres experimentará mastalgia en algún momento de su vida, además que es un síntoma que puede presentarse de manera reincidente. Es un cuadro que suele representar gran angustia en la paciente dada la posible asociación con algún proceso maligno, lo cual se ha demostrado que tan solo ocurre hasta en el 3% de los casos, por lo que se debe tranquilizarla durante la consulta de primer contacto. Se trata de un síntoma con múltiples etiologías, que en la mayoría de los casos se deben a patologías benignas de la glándula mamaria. La evaluación por estudios de imagen debe apegarse a las recomendaciones emitidas por las diferentes guías internacionales y no solicitar estudios innecesarios que lleven a un sobrediagnóstico y sobretratamiento. El abordaje en el tratamiento puede representar un gran reto para el ginecólogo, ya que existen diversas opciones que abarcan desde terapéuticas no farmacológicas, como son modificaciones en el estilo de vida y múltiples terapéuticas farmacológicas, sin embargo, existen pocos ensayos clínicos aleatorizados que permitan demostrar la superioridad de uno. En objetivo del presente es revisar las diversas recomendaciones en el abordaje diagnóstico y tratamiento que sustentan el manejo clínico de la mastalgia.
Abstract
Mastalgia is one of the main reasons for daily consultation with the gynecologist. It is estimated that approximately 70% of women will experience mastalgia at some point in their lives, and it is also a symptom that can occur recurrently. It is a condition that usually represents great distress in the patient given the possible association with some malignant process, which has been shown to only occur in up to 3% of cases, so she should be reassured during the first contact consultation. It is a symptom with multiple etiologies, which in most cases are due to benign pathologies of the mammary gland. Evaluation by imaging studies should adhere to the recommendations issued by the different international guidelines and not request unnecessary studies that lead to overdiagnosis and overtreatment. The treatment approach can represent a great challenge for the gynecologist, since there are various options that range from non-pharmacological therapies, such as lifestyle modifications and multiple pharmacological therapies, however, there are few randomized clinical trials that allow demonstrating one's superiority. The objective of the present is to review the various recommendations in the diagnostic approach and treatment that support the clinical management of mastalgia.
Citas
[1] Hubbard TJE, Sharma A, Ferguson DJ. Breast pain: Assessment, management, and referral criteria. Br J Gen Pract. 2020;70(697):419–20.
[2] Adni LLA, Norhayati MN, Rosli RRM, Muhammad J. A systematic review and meta-analysis of the efficacy of evening primrose oil for mastalgia treatment. Int J Environ Res Public Health. 2021;18(12).
[3] Dave R V., Bromley H, Taxiarchi VP, Camacho E, Chatterjee S, Barnes N, et al. No association between breast pain and breast cancer: a prospective cohort study of 10 830 symptomatic women presenting to a breast cancer diagnostic clinic. Br J Gen Pract. 2022;72(717):E234–43.
[4] Gao S, Sun Y, Shi H, Fang J, Liu Z. Efficacy and Safety of Acupuncture for Cyclic Mastalgia: Study Protocol for a Randomized, Sham-Controlled Trial. Int J Womens Health. 2023;15(May):845–55.
[5] Ghodsi F, Bahrami N, Mafi M, Olfati F. The effect of sex counseling based on (permission, limited information, specific suggestions, intensive therapy) model on sexual satisfaction in women with cyclic mastalgia: A randomized controlled clinical trial. Iran J Nurs Midwifery Res. 2021;26(6):562–8.
[6] Alimoǧullarl M, Buluş H. Existence of Cervical Discopathy in Non-Cyclic Mastodynia. Breast Care. 2020;15(2):178–81.
[7] Mareti E, Vatopoulou A, Spyropoulou GA, Papanastasiou A, Pratilas GC, Liberis A, et al. Breast disorders in adolescence: A review of the literature. Breast Care. 2021;16(2):149–55.
[8] Basım P, Tolu S. Sleep disturbances and non-cyclical breast pain: where to break the vicious cycle? Sleep Breath [Internet]. 2022;26(1):459–68. Available from: https://doi.org/10.1007/s11325-021-02407-y
[9] Groen JW, Grosfeld S, Bramer WM, Ernst MF, Mullender MM. Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments. Eur J Obstet Gynecol Reprod Biol [Internet]. 2017;219:74–93. Available from: http://dx.doi.org/10.1016/j.ejogrb.2017.10.018
[10] Freire de Carvalho J. Tietze´s Syndrome. Mediterr J Rheumatol. 2022;33(3):467–8.
[11] Mettola G, Perricone C. Tietze Syndrome. Mediterr J Rheumatol. 2020;31(2):224.
[12] Belli AK, Dinc Elibol F, Acarbas A, Ozcan O, Dere O, Yazkan C, et al. The Necessity of Upper Extremity Neurologic Examination while Evaluating Breast Pain. Breast Care. 2020;15(5):506–10.
[13] Bergstrom C, Keshvani N, Conzen S. Diagnostic Imaging for Breast Pain. A Teachable Moment. JAMA Intern Med. 2020;10(4):312–23.
[14] Tahir MT, Shamsudeen S. Mastalgia. StatPearls [Internet] Treasure Isl. 2023;4–11.
[15] Salati SA, Alhumaid AA. Mastalgia: A narrative literature review of current understanding and management. East Cent African J Surg. 2018;23(1):42.
[16] Peters F, Zimmermann G, Breckwoldt M. PRL, TSH, and thyroid hormones in benign breast diseases. Klin Wochenschr. 1981;59(8):403–7.
[17] Kumar S, Mansel RE, Scanlon MF, Hughes LE, Edwards CA, Woodhead JS, et al. Altered responses of prolactin, luteinizing hormone and follicle stimulating hormone secretion to thyrotrophin releasing hormone/gonadotrophin releasing hormone stimulation in cyclical mastalgia. Br J Surg. 1984;71(11):870–3.
[18] Sánchez JC, Rocha JEB, Piña VB, Sánchez GC, Erazo Valle-Solís AA, Balcázar CHF, et al. Consenso Mexicano sobre diagnòstico y tratamiento del cancer mamario. Gac Mex Oncol. 2017;16(Suppl 2):7–78.
[19] Preece PE, Richards AR, Owen GM, Hughes LE. Mastalgia and total body water. Br Med J. 1975;4(5995):498–500.
[20] Chase C, Wells J, Eley S. Caffeine and breast pain: Revisiting the connection. Nurs Womens Health. 2011;15(4):286–94.
[21] José D, Ardila A. Mastalgia : diagnóstico y manejo clínico.
[22] Minton J, Foecking M, Webster D, Matthews R. Response of fibrocystic disease to caffeine withdrawal and correlation of cyclic nucleotides with breast disease. Am J Obs Gynecol. 1979;135(1):157–8.
[23] Eren T, Aslan A, Ozemir IA, Baysal H, Sagiroglu J, Ekinci O, et al. Factors effecting mastalgia. Breast Care. 2016;11(3):188–93.
[24] Jokich PM, Bailey L, D’Orsi C, Green ED, Holbrook AI, Lee SJ, et al. ACR Appropriateness Criteria® Breast Pain. J Am Coll Radiol. 2017;14(5):S25–33.
[25] Pearlman M, Jeudy M, Chelmow D. Breast Cancer Risk Assessment and Screening in Average-Risk Women. Obstet Gynecol. 2017;130(1):241–3.
[26] Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, et al. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. J Am Coll Radiol [Internet]. 2021;18(9):1280–8. Available from: https://doi.org/10.1016/j.jacr.2021.04.021
[27] Schünemann HJ, Lerda D, Quinn C, Follmann M, Alonso-Coello P, Rossi PG, et al. Breast cancer screening and diagnosis: A synopsis of the european breast guidelines. Ann Intern Med. 2020;172(1):46–56.
[28] Helvie MA, Bevers TB. Screening mammography for average-risk women: The controversy and NCCN’s position. JNCCN J Natl Compr Cancer Netw. 2018;16(11):1398–404.
[29] Mema E, Cho E, Ryu YK, Jadeja P, Wynn R, Taback B, et al. In the Setting of Negative Mammogram, Is Additional Breast Ultrasound Necessary for Evaluation of Breast Pain? Curr Probl Diagn Radiol [Internet]. 2019;48(2):117–20. Available from: https://doi.org/10.1067/j.cpradiol.2017.12.007
[30] Owen WA, Brazeal HA, Shaw HL, Lee M V., Appleton CM, Holley SO. Focal breast pain: imaging evaluation and outcomes. Clin Imaging [Internet]. 2019;55(January):148–55. Available from: https://doi.org/10.1016/j.clinimag.2019.02.008
[31] Kalantari BN, Dauphine CE, Khalkhali I. The role of imaging in the evaluation of focal mastalgia. Breast J. 2013;19(6):569–70.
[32] Olcucuoglu E, Yilmaz G. Mastodynia: Is imaging necessary in young patients? Turkish J Surg. 2013;29(1):17–9.
[33] Marinero Ratchelous FE, López Valle MÁ, Iturralde Rosas P, Tena Alavez G. Mastalgia. Guía de práctica clínica. Col Mex Espec en Ginecol y Obstet. 2017;101–15.
[34] Genç A, Çelebi MM, Çelik SU, Atman ED, Kocaay AF, Zergeroğlu AM, et al. The effects of exercise on mastalgia. Phys Sportsmed [Internet]. 2017;45(1):17–21. Available from: http://dx.doi.org/10.1080/00913847.2017.1252702
[35] Mohammed AA. Evaluation of mastalgia in patients presented to the breast clinic in Duhok city, Iraq: Cross sectional study. Ann Med Surg [Internet]. 2020;52(December 2019):31–5. Available from: https://doi.org/10.1016/j.amsu.2020.02.012
[36] ElSherif A, Valente SA. Management of Mastalgia. Surg Clin North Am. 2022;102(6):929–46.
[37] Hafiz SP, Barnes NLP, Kirwan CC. Clinical management of idiopathic mastalgia: A systematic review. J Prim Health Care. 2018;10(4):312–23.
[38] Balci FL, Uras C, Feldman S. Clinical Factors Affecting the Therapeutic Efficacy of Evening Primrose Oil on Mastalgia. Ann Surg Oncol [Internet]. 2020;27(12):4844–52. Available from: https://doi.org/10.1245/s10434-020-08949-x
[39] Mirzaee F, Fakari FR, Babakhanian M, Roozbeh N, Ghazanfarpour M. The Effectiveness of Herbal Medicines on Cyclic Mastalgia: A Systematic Review on Meta-Analysis. Rev Bras Ginecol e Obstet. 2022;44(10):972–85.
[40] Cancelo Hidalgo M. Isoflavonas y salud ósea. Rev Osteoporos y Metab Miner. 2018;10(4):139–45.
[41] Espitia FJ, Hoz D La. Utilidad de los fitoestrógenos en ginecología. Médicas UIS [Internet]. 2010;23(3):1–5. Available from: https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/2396
[42] Brkic M, Vujovic S, Ivanisevic MF, Ivovic M, Gajic MT, Marina L, et al. The Influence of Progesterone Gel Therapy in the Treatment of Fibrocystic Breast Disease. Open J Obstet Gynecol. 2016;06(05):334–41.
[43] Nappi C, Affinito P, Di Carlo C, Esposito G, Montemagno U. Double-blind controlled trial of progesterone vaginal cream treatment for cyclical mastodynia in women with benign breast disease. J Endocrinol Investig Off J Ital Scociety Endocrinol. 1992;15(11):801–6.
[44] Regidor PA, Colli E. The progestin-only pills drospirenone 4 mg and desogestrel 0.075 mg as an option for the management of dysmenorrhea and mastodynia. Gynecol Endocrinol [Internet]. 2022;38(11):978–82. Available from: https://doi.org/10.1080/09513590.2022.2134339
[45] Song Y, Xu W, Chatooah ND, Chen J, Huang Y, Chen P, et al. Comparison of low dose versus ultra-low dose hormone therapy in menopausal symptoms and quality of life in perimenopause women. Gynecol Endocrinol [Internet]. 2020;36(3):252–6. Available from: https://doi.org/10.1080/09513590.2019.1666815
[46] Gara R, Sundram V, Chauhan S, Jaggi M. Anti-Cancer Potential of a Novel SERM Ormeloxifene. Curr Med Chem. 2013;20(33):4177–84.
[47] Ghassab-Abdollahi N, Mirghafourvand M, Osouli Tabrizi S. The effect of centchroman on mastalgia: a systematic review. Eur J Contracept Reprod Heal Care [Internet]. 2019;24(1):71–9. Available from: https://doi.org/10.1080/13625187.2018.1564816
[48] S L, A S, Dv S, Bs R, R S, Sharaf S, et al. Comparative differential cytotoxicity of clinically used SERMs in human cancer lines of different origin and its predictive molecular docking studies of key target genes involved in cancer progression and treatment responses. Curr Res Pharmacol Drug Discov [Internet]. 2022;3(August 2021):100080. Available from: https://doi.org/10.1016/j.crphar.2021.100080
[49] Brahmachari S, Bhagat V, Vasuniya V. Evaluating the Effect of Ormeloxifene on Multiple Fibroadenomas and Mastalgia. J Pharm Bioallied Sci. 2021;13(2):1–22.
[50] Behzadmehr R, Bojnordı TE. The comparison of the therapeutic effects of piroxicam gel and oral vitamin E in cyclic mastalgia. J Exp Clin Med. 2022;39(4):954–7.
[51] Tejwani PL, Srivastava A, Nerkar H, Dhar A, Hari S, Thulkar S, et al. Centchroman Regresses Mastalgia: A Randomized Comparison with Danazol. Indian J Surg. 2011;73(3):199–205.
[52] Gupta P, Verma V, Gupta R, Kumar A, Singh S, Gupta U, et al. Role of tamoxifen and danazol in mastalgia: prospective controlled trial. Int Surg J. 2016;3(2):553–6.
[53] Ariza Márquez YV, Briceño Balcázar I, Ancízar Aristizábal F. Tratamiento de cáncer de seno y farmacogenética. Rev Colomb Biotecnol. 2016;18(1).
[54] Singh DD, Dharanipragada K, Shanmugam D, Manikandan S. Oral versus topical tamoxifen in cyclical mastalgia—A randomized controlled trial. Breast J. 2020;26(4):743–7.
[55] Sinha M, Barman A, Sahu S, Jha A, Asharaf A. Tamoxifen in Mastalgia: A Meta-Analysis. J Obs Gynaecol Can. 2022;44(10):1084–94.
[56] Aristizabal P, Uzan C. Mastodinias. EMC - Tratado Med. 2014;18(4):1–6.
[57] Goyal A. Breast pain. BMJ Clin Evid . 2010;17(08):133–7.
[58] Sivarajah R, Welkie J, Mack J, Casas RS, Paulishak M, Chetlen AL. A review of breast pain: Causes, imaging recommendations, and treatment. J Breast Imaging. 2020;2(1):101–11.
[59] Mandıroğlu S, Yüksel UM, Delialioğlu SÜ, Doğan L. Is it mastalgia or myofascial pain? A clinical confusion. Arch Rheumatol. 2021;36(1):114–9.
[60] Cornell LF, Sandhu NP, Pruthi S, Mussallem DM. Current Management and Treatment Options for Breast Pain. Mayo Clin Proc [Internet]. 2020;95(3):574–80. Available from: https://doi.org/10.1016/j.mayocp.2019.12.014
[61] Yildirim AC, Yildiz P, Yildiz M, Kahramanca S, Kargici H. Mastalgia-Cancer Relationship: A Prospective Study. J Breast Heal. 2015;11(2):88–91.
[62] Amin AL, Purdy AC, Mattingly JD, Kong AL, Termuhlen PM. Benign Breast Disease. Surg Clin North Am. 2013;93(2):299–308.
[63] Davies EL, Cochrane RA, Stansfield K, Sweetland HM, Mansel RE. Is there a role for surgery in the treatment of mastalgia? Breast. 1999;8(5):285–8.
[64] Jacobs L, Bevers TB, Helvie M, Lehman CD, Bonaccio E, Monsees B, et al. Breast cancer screening and diagnosis, version 3.2018. JNCCN J Natl Compr Cancer Netw. 2018;16(11):1362–89.
[65] American College of Obstetricians and Gynecologists. Breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017;130(122):1–16.
[66] American Cancer Society. Breast Cancer Early Detection and Diagnosis American Cancer Society Recommendations for the Early Detection of Breast Cancer. Am Cancer Soc [Internet]. 2016;1–55. Available from: https://www.cancer.org/content/dam/CRC/PDF/Public/8579.00.pdf
[67] Wilt TJ, Harris RP, Qaseem A, Biebelhausen J, Desai S, Feinberg L, et al. Screening for cancer: Advice for high-value care from the American College of Physicians. Ann Intern Med. 2015;162(10):718–25.
[68] Siu AL. Screening for breast cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2016;164(4):279–96.
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