Management of cyclical mastalgia

In order to establish the current treatment of cyclical mastalgia, a postal questionnaire was sent to 276 consultant general surgeons (over 25% of the UK total), randomly selected from the 12 UK regional health authorities. Surgeons were questioned about their choices of treatment for cyclical mastalgia, after initial resassurance, and for persistent pain. Two hundred and forty-five (89%) responded, out of whom 219 saw patients with breast disease. Twenty-three (11%) of these surgeons were identified as having a major interest in breast disease. Danazol, used by 75% of surgeons, was the drug most commonly prescribed. Initial treatments by non-specialist surgeons included danazol (31%), analgesia (19%) and diuretics (17%), and by breast surgeons evening primrose oil (30%), tamoxifen (13%) and vitamin B6 (13%). For persistent pain 46% of non-specialist surgeons prescribed danazol and 18% surgery, whereas 65% of breast surgeons prescribed danazol and 30% bromocriptine. A wide variety of therapies are used, but danazol is the most common. For persistent unresponsive pain, local excision biopsy surgery is frequently considered by non-specialist surgeons. Breast specialist tend initially to use other methods that are associated with fewer side-effects and reserve other treatments such as danazol and bromocriptine for persistent cases.