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Table of Content - Volume 19 Issue 2- August 2021


 

Mastalgia and associated factors: A case control study

 

Y Satish Reddy

 

Assistant Professor, Department of General Surgery, Viswabharathi Medical College and General Hospital, Kurnool, INDIA.

Email: satish.yeddula@gmail.com

 

Abstract              Background: patients with breast pain are often referred to surgery department. The present study was conducted to determine the factors associated with Mastalgia among women attending a tertiary care hospital Methods: This case control study was conducted on 120 women between the age 18 to 65 in the department of General surgery. The study included case subjects (n = 50) with Mastalgia and the control subjects (n = 50) without Mastalgia. The severity of breast pain was calculated with visual analog scale. questionnaire was given to all the participants and data is collected. Data was analysed by SPSS version 16 and P value of < 0.05 was considered statistically significant value. Results: Among those who had experienced mastalgia, 76% (46) had cyclical mastalgia and 24% (14) had non-cyclical mastalgia. The mean of pain score was 4.72 ± 2.28 and most of the women(18%) had pain score of “6” which is moderate pain The mean age and Body mass index were higher in the case group than control group (p<0.005). Stressful lifestyle, caffeine consumption, smoking, higher BMI and higher breast-fed infants were significantly associated with mastalgia (p < 0.001). postmenopausal women have decreased frequency of mastalgia which is significantly associated with mastalgia (p < 0.001). Conclusion: age, BMI, Stress, caffeine, smoking, lactation frequency, menopause state were found to be related with mastalgia.

Keywords: Mastalgia, Breast pain, Cyclical mastalgia, visual analogue scale(VAS)

 

INTRODUCTION

70% of women in their lifetime are affected with Mastalgia and it is a very common symptom that makes women to visit physicians. Mastalgia is the pain that arises from the breast tissue.1,2 This trend may be due to increased perception towards breast cancer and fear of assuming mastalgia as a disease.3 The usual age of women with Mastalgia is around 30–50 years.4 Mastalgia is a chief complaint in women5 which is caused by benign or malignant diseases. Depending on the connection with menstruation, mastalgia can be divided as cyclic or non-cyclic and the breast pain is mainly mild, however moderate or severe pain is reported by some patients.6 The complete Causes of breast pain were not identified; but in this connection, increased estrogen levels, estrogen-progesterone ratio imbalances, decreased progesterone, hormonal and non-hormonal causes are examined.7,8 It is believed that intensity of breast pain can be effected by physical activities9 and breast pain is also caused by impaired lipid metabolism [10]. Some researchers believe that physical activities can affect mastalgia intensity [9]. Due to impaired metabolism breast pain can be noticed in obese people. Increased aldosterone levels caused due to raised oestrogen concentration leads to breast pain by water and salt accumulation in the body.11 Breast cyclic pain can be reduced by exercise as it decreases serum estradiol.12 and lifestyle modification is considered as one of the principles of treatment in reducing the breast pain.13 The present study was conducted to determine the factors associated with mastalgia among women attending a tertiary care hospital.

 

Method

This case–control study was carried out on 120 women aged 18–65 years in the department of general surgery at Viswabharathi Medical College and General Hospital over a period of 6 months from 01/06/20 to 30/11/2020. The study included case subjects (n = 60) who were selected from women admitted to the breast surgery outpatient clinic with mastalgia, and the control subjects (n = 60) who were selected from the women who were admitted to the general surgery outpatients without breast pain The inclusion criteria were 18–65-years-old and willing to participate. Exclusion criteria included women with age below 18 and above 65 years, pregnancy, breastfeeding, no previous history of breast malignancies, the absence of wound or lesions in breast and abnormal breast examinations, not using anti-depressant drugs. The study was approved by institutional ethics committee and written consent was obtained from each participant. All relevant information was collected by interviewing and using a questionnaire. The questionnaire was in two parts; the first part asked about the subjects age and BMI. Body mass index (BMI) was calculated as kg / m2. The second part was about information regarding emotional stress level, smoking, consumption of caffeine, Menopause status and number of infants that they had breast feeding. Study group consisting of patients with mastalgia were asked about the severity of pain and its relationship to the menstrual cycle. The severity of pain was noted on a visual analogue scale (VAS) that scored between 0 and 10..

Score 0: no pain,

Score 1 – 3: mild pain,

Score 4 – 6: moderate pain,

Score 7 – 10: severe pain.

Statistical analysis: quantitative variables were reported as mean ± SD and categorical variables were reported as percentages. The groups were compared by using the student's t-test for the continuous variables and the Chi-square test for the categorical variables.

 

RESULT

A total of 120 women aged between 18–65 were enrolled. The case subject group with mastalgia comprised 60 patients and the control group without mastalgia comprised 60 patients.

The type of breast pain in the case group are summarized in table ​1

Table 1: Distribution of the patients with breast pain in the case group

Breast pain

n

%

Relation with menstruation

cyclic

46

76

noncyclic

14

24

The mean score of mastalgia in study group was 4.72 ± 2.28. most of the women (18%) had mastalgia “6” which is moderate pain according to visual analog scaling.

Mean age was significantly higher in the mastalgia group (p <0.05). BMI was significantly higher in the case group (p <0.05). Emotional stress level, Caffeine intake, and smoking were significantly related with mastalgia (p < 0.001). Lactation frequency (number of breastfed infants) was significantly higher in the case group (p < 0.001).) Premenopausal state was related with increased incidence of mastalgia (p < 0.001). The comparisons of the factors between the case group and the control group are summarized in table 2. A summary of women characteristics with or without mastalgia is shown in Table 2.

Table 2: Comparison of factors between the Case and control groups

Character

Case (n=60)

Control(n=60)

p

Age mean ± SD, years

46.19±10.51

42.73±11.06

t test p<0.05

BMI mean ± SD, kg/m2

26.80 ± 5.33

22.50 ± 5.85

t test p<0.05

Stress, n (%)

None

10 (16)

23 (38)

Pearson's chi-squared test

P<0.001

stressful

50 (84)

37 (62)

Coffee n(%) consumption

no

37 (62)

45 (75)

Pearson's chi-squared test

P<0.001

yes

23 (38)

15 (25)

Smoking (cigarettes), n (%)

no

38 (64)

46 (76)

Pearson's chi-squared test

P<0.001

yes

22 (36)

14 (24)

Lactation (breast-fed infants), n (%)

0

2 (4)

14 (23)

Pearson's chi-squared test

P<0.001

1

7 (12)

12 (20)

2

18 (30)

18 (30)

3

20 (33)

7 (12)

≥ 4

13 (21)

9 (15)

Menopause, n (%)

premenopausal

52 (86)

48 (80)

Pearson's chi-squared test

P<0.001

postmenopausal

8 (14)

78 (20)

 

DISCUSSION

The present study was done to determine the factors associated with mastalgia. Johnson et al.14 in their study reported that the age of women complaining of breast pain was between 35 and 55 years. In the present study, the mean age of the total study group was 46.19±10.51years (range 18–65) revealing that breast pain often takes place the perimenopausal period when hormonal and menstrual irregularity takes place (p < 0.01). Koçoğlu et al. in their study reported that mastalgia was common in obese women.15 In the present study increased BMI was associated with Mastalgia. the relationship between mastalgia and psychological stress was explained by many studies.16–18 Ader et al.19 in their study reported that increased stress was associated with mastalgia. In our study, ‘stressful lifestyle’ was significantly higher in the mastalgia group (p < 0.01). The relationship of caffeine consumption and smoking with breast pain is controversial.20,21 Ader et al.19 in their study observed that increased caffeine consumption and smoking were associated with mastalgia. In the present study coffee and smoking are significantly associated with breast pain (p < 0.001) In our study increased incidence of lactation was associated with mastalgia (p<0.001) it highlights the association of mastalgia with the increased incidences of lactation which causes an increased exposure to high estrogen and prolactin levels and also 3 or more periods of lactation leads to anatomical changes in the breast tissue chiefly in the ductal system which may also lead to breast pain [22]

 

CONCLUSION

women at 35–50 years of age, higher BMI, Consumption of coffee, smoking, premenopausal period, stress and increased lactation frequency were detected to be associated with mastalgia, With the help of this study, we have identified risk factors for mastalgia

 

REFERENCES

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