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Invited Commentary
February 1998

Clinical Evaluation of Mastalgia—Invited Commentary

Arch Surg. 1998;133(2):214. doi:10.1001/archsurg.133.2.214

In this issue of the ARCHIVES, Tavaf-Motamen and associates give a wake-up call to physicians who study or treat mastodynia. They compared the recall questionnaires of 30 women with breast pain with each patient's daily visual analog scale for breast pain and found poor agreement. Only 73% of those identified as having cyclic mastalgia based on the questionnaire met the same criteria based on their daily diaries. Furthermore, the intensity of other somatic menstrual complaints was not always in accord with the severity of breast pain on the analog scales. Their data emphasize the complexity of this problem and the necessity for objective means of evaluating its course and treatment. In the United States, breast pain is almost the norm. In my surgical practice, only 2.5% of patients referred for breast-related problems are seen primarily for breast pain, but on questioning, the majority report some degree of mastodynia. Only when the pain is severe or debilitating does it become the focus of attention. In postmenopausal women, the problem is often related to hormone replacement therapy. If the cause is not obvious, the tendency is to recommend relatively harmless remedies and reserve danocrine for resistant cases. The former include caffeine and tyramine restriction, vitamin E, and evening primrose oil, each with a tenuous rationale. The subjectivity and variable course of symptoms often preclude an accurate assessment of results. The authors provide few clues about their enrollment questionnaire, and the periods evaluated with the questionnaire and the daily diary were not coincident, surely a problem when the course of a clinical problem is uneven. While it comes as no surprise that patients' histories are not always accurate, the message is clear that understanding mastodynia and its treatment requires more than hearsay.