RESULTS Reassurance plus bra-fitting advice provides relief for most women .
There is some benefit in reducing dietary coffee and fat intake .
Dopamine agonists are useful , but less effective than endocrine treatments such as Danazol or Tamoxifen .
Of the Selective Oestrogen Receptor Modulator drugs , Ormeloxifene appears most effective , but is not licenced in the United Kingdom .
Relaxation therapy , acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness .
Subsequent drug therapy should be balanced against its side-effects ; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects .
INTRODUCTION Idiopathic mastalgia ( benign breast pain of unknown origin ) is often poorly managed because of its subjective nature and unclear aetiology .
Mastalgia is a reason for up to 50 % of breast outpatient referrals .
Existing systematic review s discuss date d treatment options that provide limited symptomatic relief .
The effect of tamoxifen on bone mineral content in premenopausal women with breast cancer
Thirty‐one of 62 consecutive premenopausal women with primary cancer of the breast completed a 1‐year investigation period , receiving either 30 mg tamoxifen daily ( 15 patients ) or placebo ( 16 patients ) . They were examined at the operation ( t0 ) and at 3‐month intervals ( t1 , t2 , t3 , and t4 ) . Bone mineral content ( BMC ) was measured at operation and after 12 months . Fifty‐six patients with benign tumors were included as healthy controls . All values of both cancer treatment groups and of the benign tumor group were comparable at the time of operation . BMC decreased significantly in both cancer patient groups when 12‐month values were compared to the initial level ( tamoxifen , −3.2 % , P < 0.001 and placebo −2.5 % , P < 0.01 ) . However , no significant difference in BMC changes was noted between tamoxifen and placebo treatment . The serum phosphate was significantly decreased in the tamoxifen treatment group at each examination . In the placebo  group , the alkaline phosphatase level increased significantly at each examination , whereas the serum magnesium fell at the 6‐ and 12‐month examinations . All other biochemical indices of calcium metabolism were basically unchanged . It is concluded that BMC is reduced in metastatic breast cancer through osteolytic metastatic bone foci . Tamoxifen also decreases the BMC . It is , however , unclear if this effect is due to a progression of the disease in spite of the treatment or if it is caused by a direct action of tamoxifen on bone
RESULTS Reassurance plus bra-fitting advice provides relief for most women .
There is some benefit in reducing dietary coffee and fat intake .
Dopamine agonists are useful , but less effective than endocrine treatments such as Danazol or Tamoxifen .
Of the Selective Oestrogen Receptor Modulator drugs , Ormeloxifene appears most effective , but is not licenced in the United Kingdom .
Relaxation therapy , acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness .
Subsequent drug therapy should be balanced against its side-effects ; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects .
INTRODUCTION Idiopathic mastalgia ( benign breast pain of unknown origin ) is often poorly managed because of its subjective nature and unclear aetiology .
Mastalgia is a reason for up to 50 % of breast outpatient referrals .
Existing systematic review s discuss date d treatment options that provide limited symptomatic relief .