The level of evidence (I-III) and classification of recommendations (A-E) are defined at the end of the "Major Recommendations" field.
Mastalgia and Breast Cancer
Psychological Factors
- Education and reassurance is an integral part of the management of mastalgia and should be the first-line treatment. (II-1 A)
Well-Fitting Support Bra
- The use of a well-fitting bra that provides good support should be considered for the relief of cyclical and noncyclical mastalgia. (II-3 B)
Hormones
Hormone Replacement Therapy (HRT)
- A change in dose, formulation, or scheduling should be considered for women on HRT. HRT may be discontinued if appropriate. (III C)
Caffeine
- Women with breast pain should not be advised to reduce caffeine intake. (1 E)
Vitamins
Vitamin E
- Vitamin E should not be considered for the treatment of mastalgia. (1 E)
Fat
Evening Primrose Oil (EPO)
- There is presently insufficient evidence to recommend the use of EPO in the treatment of breast pain. (II-2 C)
Phytoestrogens
Flaxseed
- Flaxseed should be considered as a first-line treatment for cyclical mastalgia. (I A)
Medications
Topical Non-Steroidal Anti-inflammatory Drugs
- Topical, non-steroidal anti-inflammatory gel, such as diclofenac 2% in pluronic lethicin organogel (PLO), should be considered for pain control for localized treatment of mastalgia. (I A)
Tamoxifen and Danazol
- Tamoxifen 10 mg daily or danazol 200 mg daily should be considered when first-line treatments are ineffective. (I A)
Mastectomy
- Mastectomy or partial mastectomy should not be considered an effective treatment for mastalgia. (III E)
Definitions:
Level of Evidence*
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence from well-designed controlled trials without randomization.
II-2: Evidence from well-designed cohort (prospective or retrospective) or case–control analytic studies, preferably from more than one centre or research group.
II-3: Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Classification of Recommendations**
- There is good evidence to support the recommendation that the condition be specifically considered in a periodic health examination.
- There is fair evidence to support the recommendation that the condition be specifically considered in a periodic health examination.
- There is poor evidence regarding the inclusion or exclusion of the condition in a periodic health examination.
- There is fair evidence to support the recommendation that the condition not be considered in a periodic health examination.
- There is good evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.
*The quality of evidence reported in these guidelines has been adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on the Periodic Health Exam.
**Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on the Periodic Health Exam.