Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0006142 (breast cancer)
 160,383 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most important factors in the evaluation and treatment of breast pain consist of a thorough history, physical, and radiologic evaluation. These can be used to reassure the patient that she does not have breast cancer. In the 15% of mastalgia patients who have life-altering pain and still request treatment, therapy may consist of a well-fitting bra, a decrease in dietary fat intake, and discontinuance of oral contraceptives or hormone replacement therapy. Those women still resistant to therapy may experience relief from evening primrose oil supplements, bromocriptine, tamoxifen, or GnRH analogues. Predicting which treatment will be most useful for any particular woman may be challenging. No differences in success rates were found to be associated with factors such as reproductive history, presenting complaint, personal or family history of breast disease, or subsequent need for breast surgery. The peak (but not basal) serum prolactin levels in response to thyrotropin releasing hormone stimulus has been predictive of success for hormonal treatment but is relatively invasive. A survey of treatments actually used was obtained from 276 consultant surgeons in Britain in 1990. Of those, 75% prescribed danazol. Others used analgesia (21%), diuretics (18%), local excision (18%), bromocriptine (15%), evening primrose oil (13%), tamoxifen (9%), a well-fitting bra (3%), and no treatment (10%). Breast specialists were more likely to begin treatment with primrose oil, tamoxifen, vitamin B6, and analgesia, reserving other hormonal therapies for more difficult cases. To further evaluate the women who have severe mastalgia but do not complete treatment regimens, a questionnaire was sent to 79 patients who failed to return to the Longmore Breast Unit of Western General Hospital, Edinburgh. Seventy-one women responded. Of these, 36 said they felt better, 19 said they felt no more could be done, 18 learned to live with it, 14 were not worried even if the pain recurred, 2 were pregnant, 10 were postmenopausal, and 5 were still taking the medications previously prescribed. The prognosis for women with breast pain is not always predictable. Women with cyclic breast pain often are relieved by events that alter their hormonal milieu, whereas noncyclic breast pain may last only 1 to 2 years. Sitruk-Ware and colleagues conducted a study of French women with fibroadenomas. They found an association between fibroadenomas and cyclic mastalgia occurring more than 1 year prior to the first full-term pregnancy. A retrospective, case-control study to determine if cyclic mastalgia was a risk factor for breast cancer was conducted on 210 newly diagnosed women with breast cancer.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Mastodynia. 781 7

Mammary duct ectasia is a benign disease of the mammary gland, characterized by a frequently long history of tumour formation, nipple discharge, nipple retraction and mastalgia. Non-puerperal mammary abscess, which may be the presenting symptom, is also part of the syndrome. Diagnosis can often be made on the basis of the history and the clinical findings of nipple discharge, nipple retraction, tenderness on palpation, fistula formation and subareolar tumour/abscess formation. Mammography may guide diagnosis. Breast cancer is the most important differential diagnosis. If the clinical picture resembles cancer, it is necessary to perform diagnostic biopsy. Causal therapy of mammary duct ectasia is not available. Until now excision of the central mammary tissue and larger ducts has been used as treatment for the clinical manifestations of abscess, fistula and nipple discharge, apparently with good results.
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PMID:[The duct ectasia syndrome--an overlooked disease entity]. 839 Nov 77

Breast cancer is infrequently associated with pregnancy. However, such cases often pose diagnostic and treatment problems. The infarction of breast lesions is likewise uncommon, and generally hinders intraoperative morphologic diagnosis. A 33-year-old woman in the 37th week of pregnancy presented with a breast tumoration of progressively increasing size and associating mastalgia. Following fine-needle aspiration and trut-cut biopsy with posterior amplified tumorectomy and axillary dissection, a ductal neoplasm was identified with an infarction affecting 90% of the tumoral surface. The where no axillary adenopathies, and the patient was estrogen receptor-negative. An analysis is made of this rare association of pregnancy and infarcted breast cancer, with an evaluation of the role of fine-needle aspiration and/or gestation may play in the occurrence of tumor infarction.
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PMID:[Pregnancy, breast cancer and tumor infarction]. 867 21

The association between the clinical manifestations of benign breast disease (BBD) and mammographic patterns was investigated among 1394 women (923 pre-menopausal and 471 post-menopausal) participating to the Canadian National Breast Screening Study in Vancouver, who completed a questionnaire designed to collect detailed information on the symptoms and signs of BBD, hormonal, reproductive and dietary factors. Mastalgia was present in 637 (46%) women and was cyclical in 505 (79%). Breast swelling was noted in 331 women (23%) and mammary dysplasia involving 50% or more of the breast parenchyma in 733 (43%). Mastalgia was highly associated with breast swelling (odds ratios [OR] = 29.9, 95% confidence interval [CI] = 21.3-41.8), particularly when cyclical and characterized by tenderness with pain (OR = 58.4, 95% CI = 39.1-87.0). The relative risk for mammary dysplasia involving 50% or over of the breast parenchyma was significant in pre-menopausal women having breast swelling (OR = 2.96, 95% CI = 1.81-4.83), being highest in women with cyclical mastalgia associated with tenderness and pain (OR = 3.43, 95% CI = 1.49-7.92); similar associations were noted in post-menopausal women. This study indicates that mastalgia is strongly related to breast swelling, especially when tenderness is associated with pain. Furthermore, mastalgia associated with breast swelling is highly related to the presence of mammary dysplasia involving 50% or more of the breast parenchyma in both pre- and post-menopausal women, suggesting that cyclical tenderness and breast swelling may carry an increased breast cancer risk.
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PMID:Clinical determinants of mammographic dysplasia patterns. 893 47

This descriptive study evaluates a newly established national breast cancer information service in Iran and reports data on the impact of contacting the service. Two instruments were used to collect data: a "call record form" and a "user survey" questionnaire. The call record was filled in after each inquiry, and during 1 year 1,000 forms were completed. The questionnaire was filled in 1 week after each inquiry and was completed for a random sample of 400 callers. Thus, the results are presented in two parts. Analysis of the call record forms (part one) showed that 95% of the callers were female, mostly married (82%) and with secondary or higher education (80%). Most callers reported that they had heard about the service through the mass media (69%). Benign breast diseases, mastalgia and breast masses were the most common subjects of the inquiries (28%, 27%, and 18%, respectively). The majority of callers (77%) said that the main reason for contacting the service was that they wanted more information about breast diseases. Examination of the questionnaires (part two) revealed that 97% of respondents described the service as "useful" or "very useful". The vast majority (80%) perceived the information given as "easy" or "very easy" to understand. When respondents were asked to compare their feelings before and after contacting the service, 86% said that they felt "much more" or "a little more cheerful" and 81% said that they felt "much less" or "a little less worried". Practically all (99%) were satisfied with the overall service provided. The findings indicate that the service is effective in providing information and support for patients, relatives and the general public. The real challenge is how to make the service more widely available, especially to breast cancer patients.
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PMID:Evaluation of a national breast cancer information service: the Iranian experience. 1033 34

Breast lesions, including mastalgia; benign proliferative changes; and benign masses, including fibroadenomas, are common in adolescents and young adult women. Breast cancer is rare in women less than 20 years old and uncommon in women less than 30 years old. Discrete masses in women less than 30 years old that do not feel suspicious on examination can be observed for 1 or 2 months. If they persist, than an FNA can differentiate those that are benign and can be observed versus those that need either an excisional biopsy or definitive surgery. Mammography has little role in the diagnosis of women less than 30 years old except in those individuals with highly suspicious lesions on examination.
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PMID:Breast disease in adolescents and young women. 1038 10

Percutaneous progesterone topically applied on the breast has been proposed and widely used in the relief of mastalgia and benign breast disease by numerous gynecologists and general practitioners. However, its chronic use has never been evaluated in relation to breast cancer risk. The association between percutaneous progesterone use and the risk of breast cancer was evaluated in a cohort study of 1150 premenopausal French women with benign breast disease diagnosed in two breast clinics between 1976 and 1979. The follow-up accumulated 12,462 person-years. Percutaneous progesterone had been prescribed to 58% of the women. There was no association between breast cancer risk and the use of percutaneous progesterone (RR = 0.8; 95% confidence interval 0.4-1.6). Although the combined treatment of oral progestogens with percutaneous progesterone significantly decreased the risk of breast cancer (RR = 0.5; 95% confidence interval 0.2-0.9) as compared with nonusers, there was no significant difference in the risk of breast cancer in percutaneous progesterone users versus nonusers among oral progestogen users. Taken together, these results suggest at least an absence of deleterious effects caused by percutaneous progesterone use in women with benign breast disease.
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PMID:Percutaneous progesterone use and risk of breast cancer: results from a French cohort study of premenopausal women with benign breast disease. 1040

Cyclical mastopathy (CM) (ie, fibrocystic disease) is a commonly occurring condition with severe breast pain reportedly affecting up to 70% of women. DIAC is a new, non-hormonal treatment for CM that is administered as a capsule taken orally once each day. Earlier trials of DIAC have yielded promising results with resolution of the signs and symptoms of CM. We report the largest randomized clinical trial published to date on therapy for CM.Objective: To evaluate the safety and efficacy of different doses of DIAC compared to placebo given for 6 months to women with CM.Methods: A double-blind, randomized, dose-response, parallel-group clinical trial design was used. All enrolled women had moderate or severe cyclical mastalgia for at least 12 of the prior 24 months associated with nodularity and/or fibrosis on clinical exam. After obtaining informed consent, women were examined to exclude breast cancer or suspicious breast masses, thyroid disease, or other cancers. No one had recent breast surgery nor change in the use of hormones or adjuvant medication for breast pain for at least 3 months. A randomly generated number sequence was used to create a block randomization scheme. Women were assigned to receive either one of 5 daily doses of DIAC or placebo. One of the doses of DIAC was expected to be too low to provide relief of mastalgia. Women kept diary data daily. Clinical examinations and quality-of-life questionnaires were completed during the luteal phase of the menstrual cycle before and after 1, 2, 4, and 6 months of study therapy. Women were contacted by phone during the luteal phase in months 3 and 5 for additional data retrieval.Endpoints of the study included breast examination graded by quadrant for tenderness, size/amount of nodularity, and fibrosis. These data were converted to a standardized score for tenderness (TS) and nodularity (NS). Daily pain assessment from the diary was converted to a standardized pain score (PS). A total CM score represented the sum of these three measures. Changes in quality of life during and after DIAC therapy were also evaluated. The study had the power to detect at least a 30% improvement in the total CM score with beta = 0.80 and alpha = 0.05.Results: Twenty-six sites in 16 states within the United States randomized a total of 385 women with CM. The mean age of women enrolled was 42 years (range 21-73). Over two-thirds of the women had completed study drug intervention as of September 1997. All study drug therapy was to be completed by December 1997 with unblinding in January 1998. No serious or life-threatening side effects had been observed in the trial as of September 1997.Conclusions: DIAC is a promising new therapeutic for CM. The unblinded data from the completed trial assessing safety, efficacy, and quality of life will be presented.
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PMID:A multicenter randomized trial of DIAC for cyclical mastopathy. 1083 98

Raloxifene is marketed in France for prevention of nontraumatic vertebral fracture in postmenopausal women. In animal pharmacology studies, it was found to both agonize and antagonize estrogen. The assessment file is methodologically sound but fails to answer many practical questions. A placebo-controlled trial showed that raloxifene reduced the risk of vertebral collapse after 2 years of treatment, in both primary and secondary prevention, but demonstrated no effect on nonvertebral fractures. In this trial, raloxifene also reduced the risk of breast cancer. Two trials versus combined hormone replacement therapy (HRT) showed HRT had a more favourable effect on surrogate end points reflecting the risk of fracture and cardiovascular risk (changes in bone mineral density and lipid profile). Compared with combined HRT, raloxifene reduced the incidence of menorrhagia and mastodynia, but did not relieve symptoms linked to menopause. Results of animal studies call for close clinical monitoring to detect a possible increase in the incidence of ovarian cancer.
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PMID:Raloxifene. Not better than estrogen. 1121 27

Mastalgia, defined as breast pain, is a common, often distressing complaint among women. It is the most common breast-related complaint in primary care clinics, with a prevalence in working women of approximately 66%. An underlying fear of breast cancer is what prompts these patients to seek health care. A comprehensive history and thorough clinical breast exam is essential to evaluation. Once significant breast disease is ruled out, the majority of these patients respond to simple reassurance.
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PMID:Mastalgia: evaluation and management. 1122 18


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