Evidence for the management of mastalgia.

Mastalgia is the commonest breast symptom presenting to general practitioners and breast surgeons alike. To make a full assessment of the cause, all patients require a full history, examination and, sometimes, investigations. Diary cards are often helpful. The commonest cause is cyclical mastalgia. Most women require reassurance only and the pain often settles spontaneously after a few months. For the remainder, simple lifestyle changes should be suggested initially, such as wearing a well-fitted sports bra, weight reduction, regular exercise and a reduction in caffeine intake. Unfortunately, there is a paucity of evidence for the usefulness of these measures. If pain is persistent or severe, a variety of pharmacological agents exist. The most effective with least side effects is a 3-6-month course of low-dose tamoxifen (10mg). Other proven agents include danazol and bromocriptine, but these have a higher side-effect profile and are rarely indicated nowadays. Newer treatments include lisuride maleate and topical non-steroidal anti-inflammatory preparations.