Cyclical mastalgia as a marker of breast cancer susceptibility: results of a case-control study among French women

Can breast ultrasound reduce patient's level of anxiety and pain?

BACKGROUND

Breast pain is one of the most common complaints of women attending a gynecology clinic and general practitioners. This pain can cause anxiety and, consequently, reduce the woman's quality of life. The objective of this study was to assess the severity of pain and anxiety in patients with breast pain and normal examination, before and after breast sonography.

MATERIALS AND METHODS

Among the patients with breast pain and normal examination who came for breast sonography in three centers in Shiraz during 2011-2012, 51 patients agreed to cooperate in this project. These patients filled out the questionnaire for evaluation of pain and anxiety before and after breast sonography.

RESULTS

Sonography findings indicated that 88% of patients have normal sonography without any finding. The average amounts of pain severity before and after sonography were 3.3 and 2.4, respectively (p < 0.005). The average amounts of anxiety severity in patients before and after sonography were 51.9 and 37.9, respectively (p < 0.005).

CONCLUSION

This study shows the severity of pain and anxiety after ultrasonography decreased significantly. It can be concluded that ultrasound findings, which reassure the patients that they do not have specific pathology, can reduce the pain and anxiety by its impact on psychological status of the patient.

Factors Effecting Mastalgia

BACKGROUND

Breast pain is one of the leading complaints that ends up with referral to breast surgery clinics. The purpose of the present study was to investigate the factors that cause mastalgia, and its relation with benign or malignant breast disease.

METHODS

The study was performed in 700 patients. Data obtained from surveys, and imaging findings were prospectively recorded, and analyzed.

RESULTS

The mean age was 45.20 ± 10.78 years. The mastalgia group included 500 cases; the asymptomatic group comprised 200 individuals. Stressful lifestyle, caffeine consumption, and smoking were associated with mastalgia (p < 0.05). Rates of women who had breast fed 3 times or more were higher in the mastalgia group (p < 0.05). Increased breast density, and breast imaging-reporting and data system (BI-RADS) 2 mammography findings were related with mastalgia (p < 0.05). Cysts and fibroadenomas were more common in the mastalgia group (p < 0.05). The incidence of a past history of malignant breast disease was significantly higher in the mastalgia group (p < 0.05).

CONCLUSIONS

Stress, caffeine, smoking, lactation frequency, and benign disorders were factors detected to be related with mastalgia. Although a significant relation between mastalgia and malignant breast disease was detected in our study, more controlled studies are still required to investigate this issue further.

[Breast pain: Recommendations]

OBJECTIVES

To evaluate the diagnostic value of clinical examination and additional tests in the exploration of breast pain, to evaluate the strategy of their care and to provide recommendations.

METHODS

A literature search in English and French carried out by consulting the databases PubMed, Cochrane Library and international recommendations.

RESULTS

Clinical examination and interrogation, with the use of visual analog scale used to differentiate non-cyclical breast pain from mastodynia (LE2). A calendar can be used to characterize the cyclical breast pain (LE3). Using a questionnaire can help to characterize the pain (LE3). In the absence of palpable abnormality, it is not recommended to modify systematic or individual screening modalities (LE2). MRI is not recommended in case of normal mammography and sonography. Explorations biopsy is guided by imaging. The therapeutic management includes reassurance after a normal clinical evaluation and/or normal radiological findings (LE2), and precise fitting of a brassière. In case of failure of this first approach, NSAIDs gel can be proposed (LE1-2).

Mastodynia: is imaging necessary in young patients?

OBJECTIVE

Mastalgia is the most frequent symptom seen in patients who undergo breast imaging. There are various medical treatment methods in the literature. However, malignancy should be excluded before starting treatment. This is a prospective study, evaluating the necessity of imaging in patients who have applied for cyclic or non-cyclic breast pain, with normal physical examination, and without a family history.

MATERIAL AND METHODS

Two hundred women, younger than 30 years of age, who applied to Iğdır State Hospital general surgery department with complaint of cyclic or non-cyclic breast pain, were prospectively studied. Patients with nipple discharge, complaint of lump in their breast, who were pregnant or lactating, who had breast cancer history in their family and those who were found to have lumps on examination were excluded from the study. All patients underwent ultrasound imaging and the same radiologist evaluated them.

RESULTS

The breast examination was normal in all patients. Ultrasound imaging results were completely normal in 98 (48%) patients. 47 (23.5%) patients were found to have fibroadenoma, with a mean diameter of 9.6 mm (5 mm-14 mm). 45 (22.5%) patients had simple cysts with a mean diameter of 7.8 mm (3 mm-11 mm). 6 (3%) patients were found to have intraductal papillomas and 4 (2%) to have lipomas. All patients were classified as either BI-RADS 1 or BI-RADS 2.

CONCLUSION

It is recommended that malignancy should be eliminated before starting treatment in patients with breast pain. In this study, the necessity of imaging in patients younger than 30 years and who applied to the general surgery department for only breast pain, was investigated. None of the patients with a normal breast examination were found to have any lesions considered suspicious for malignancy. We believe that if breast examination is normal, the patient is equal to or younger than 30 years of age and there is no family history, imaging is not necessary and that medical therapy can be started directly after the patient is informed.

Cyclical mastalgia and breast cancer risk: results of a French cohort study

Cyclical mastalgia is a common complaint, with a potentially important relationship to breast cancer risk. In the last decade, case-control studies have reported that cyclical mastalgia could be considered as an independent risk factor for breast cancer. The subjectivity of a retrospectively collected symptom questioned the validity of this finding. We have examined the association between cyclical mastalgia and breast cancer risk in the French cohort study of women with benign breast disease diagnosed in two breast clinics between 1976 and 1979 and followed-up until 1997. The present study was restricted to the women free of any hormonal treatment (n = 247). The mean follow-up was 16 +/- 5 years, and a total of 22 breast cancers occurred during the follow-up. Using a Cox model with duration of cyclical mastalgia as a time-varying variable, the adjusted relative risk of breast cancer increased with the duration of cyclical mastalgia (P = 0.006). The corresponding relative risk for 37 months of cyclical mastalgia was 5.31 (95% confidence interval, 1.92-14.72). We show here that the conclusion still holds when the symptom cyclical mastalgia was collected prospectively in a cohort study, bringing additional evidence that cyclical mastalgia may represent an independent and useful clinical marker of increased breast cancer risk. It might be a confounding factor when assessing the effects of hormonal treatments on breast cancer risk such as hormonal replacement therapy or oral contraceptives.

Le profil clinique des femmes qui utilisent la tibolone est-il le même que celui des femmes utilisant un traitement hormonal classique ? Données d'une enquête nationale en France

OBJECTIVES

To compare the pre-existing risk profiles for breast or endometrial cancer of menopaused women receiving tibolone or another hormone replacement therapy in France, with a view to examining the possibility of biases of selection of patients and of detection of these cancers in the Million Women Study.

PATIENTS AND METHODS

Nationwide survey conducted in France among a representative sample of 153 gynaecologists. The particulars of the last two consulting menopaused women treated with tibolone (N = 306) and of the last two treated with a classical estrogen-progestogen therapy (N = 306) were collated then analysed.

RESULTS

Compared to those treated with a classical estrogen-progestogen therapy, more women receiving tibolone were aged 60 years or over (40 vs 31%; P < 0.01). More of them had risk factors for breast cancer (history of mastodynia or mastopathy, elevated mammographic breast density) (6 vs 50%; P < 0.01). More of them had a history of uterine investigation or exploration or of irregular bleeding (61 vs 53% of women with a history of irregular bleeding; P < 0.05). Overall, 84% of women treated with tibolone had at least one risk factor for breast or endometrial cancer vs 75% of those receiving a classical estrogen-progestogen therapy (P < 0.01).

DISCUSSION AND CONCLUSION

Owing to its specific properties, tibolone is generally prescribed to women with a higher risk profile for breast or endometrial cancer than those receiving a classical estrogen-progestogen therapy, which may entail patient selection and cancer detection biases in non-randomised, open-label, observational studies.

Mastalgia

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Benign breast diseases

Benign breast diseases have always been neglected in comparison to cancer, despite the fact that there are many more patients with such diseases than patients presenting to a breast clinic for cancer. Like normal breast tissues, benign breast diseases are under a complex system of controls by both systemic hormonal and local factors. In this review, we attempt to present an overview of the latest knowledge concerning the epidemiology, classification, clinical presentation, management, and physiopathology of these disorders.

[Actions of a 19-norprogesterone derivative on mammary gland: nomegestrol acetate]

As the biological effects of progestins vary according to their molecular structure, it becomes essential to differentiate the various types of progestins, particularly with regard to the breast.

OBJECTIVE

The purpose of this review was to gather published data on the effects of a 19-norprogesterone derivative, nomegestrol acetate, on the breast. Materials and methods. All experimental and clinical published studies reporting data in the literature on nomegestrol acetate and breast were reviewed.

RESULTS

In experiments on steroid receptors, it was shown that nomegestrol acetate presents a high binding specificity and affinity for progesterone receptors, notably in normal and cancerous human breast tissues. It sharply inhibits synthesis of progesterone receptors in hormone-dependent T-47D human breast cancer cells grown in an estrogenic culture medium, thereby demonstrating its strong progestational activity. On the other hand, it does not bind to estrogen receptors and lacks any estrogenic potential, confirmed by the lack of induction of alkaline phosphatase activity of endometrial Ishikawa cells. Estrogen-induced synthesis of estrogen receptors is also inhibited by nomegestrol acetate, a major determinant of its strong intrinsic anti-estrogenic activity. Unlike androgenic progestins (e.g. 19-nortestosterone derivatives and medroxyprogesterone acetate) which may act indirectly on the breast by inducing modifications of sex hormone binding globulin (SHBG) and insulin-like growth factor-I (IGF-I), nomegestrol acetate is devoid of any androgenic activity. In studies carried out on the effects of progestins on enzyme activities involved in estradiol (E2) formation in breast tissue, nomegestrol acetate can control E2 levels in breast cancer tissue in vitro: it inhibits estrone sulfatase activity that converts estrone sulfate (E1S) to estrone (E1) and inhibits 17beta-hydroxysteroid dehydrogenase type 1 activity that converts E1 to E2, resulting in blockade of E2 bioformation in MCF-7 and T-47D human breast cancer cells. It also stimulates sulfotransferase activity and subsequently the transformation of non conjugated estrogens E1 and E2 into biologically inactive estrogen sulfates. In vitro studies on cell proliferation have demonstrated that nomegestrol acetate, on the one hand, is unable to stimulate proliferation of MCF-7 cells cultured in a medium devoid of estrogens and, on the other hand, can exert antiproliferative effects on T-47D cells grown in an estrogenic environment. Furthermore, studies on mammary apoptosis have shown that the withdrawal of nomegestrol acetate induces apoptosis peak of normal human breast epithelial cells in vitro and in vivo. In clinical trials carried out with premenopausal women, nomegestrol acetate administered in antigonadotropic sequence has demonstrated its efficacy in the treatment of cyclical mastodynia and early onset benign breast diseases. With postmenopausal hormone replacement therapy (HRT) combining estrogen and nomegestrol acetate, clinical trial results showed low incidence of mastodynia while under treatment as well as moderate increase in mammographic density, particularly with continuous combined regimens, however rapidly reversed by a short-term suspension of HRT. Noclinical data with this progestagen is available on breast cancer risk.

CONCLUSION

In addition to efficacy on mastodynia, in vitro and in vivo study results support the good tolerance of nomegestrol acetate on breast, in the short and medium term.

French hormones: progestins and therapeutic variation in France

Western medicine is seen as universally valid, but in reality it displays a wide range of national and local variability. Our paper focuses on one such case of local variation: the widespread use of progestins in France to treat various pre-menopausal conditions as well as for contraception. The case of progestins allows us to explore how specific styles of research may come to dominate a particular local medical culture, and how they are influenced by changing criteria of scientific validity and wider social relations. We argue that in the 1980s and 1990s a single prestigious research-oriented Parisian hospital service played a dominant role in the transformation of progestins into scientifically validated medical practice. This status was not called seriously into question until recently when foreign research on a different form of hormone therapy suggested that risk was associated with their use. We also propose that both the research around and medical use of progestins in France was shaped by the positive attitude of many French women, including feminists, to hormonal therapies and to the non-surgical specialty most closely associated with hormones, medical gynaecology.

Evaluation and management of breast pain

Pain is one of the most common breast symptoms experienced by women. It can be severe enough to interfere with usual daily activities, but the etiology and optimal treatment remain undefined. Breast pain is typically approached according to its classification as cyclic mastalgia, noncyclic mastalgia, and extramammary (nonbreast) pain. Cyclic mastalgia is breast pain that has a clear relationship to the menstrual cycle. Noncyclic mastalgia may be constant or intermittent but is not associated with the menstrual cycle and often occurs after menopause. Extramammary pain arises from the chest wall or other sources and is interpreted as having a cause within the breast. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low. After appropriate clinical evaluation, most patients with breast pain respond favorably to a combination of reassurance and nonpharmacological measures. The medications danazol, tamoxifen, and bromocriptine are effective; however, the potentially serious adverse effects of these medications limit their use to selected patients with severe, sustained breast pain. The status of other therapeutic strategies and directions for future research are discussed.

The characteristics of cyclical and non-cyclical mastalgia: a prospective study using a modified McGill Pain Questionnaire

Breast pain (mastalgia) is a common condition (usually classified as cyclical or non-cyclical) the characteristics of which have never been studied using a standardized pain instrument. We have modified the short form of the McGill Pain Questionnaire (SF-MPQ) for the measurement of mastalgia, and have administered it to 271 women with breast pain and without breast cancer. The mean pain-rating index (sum of 15 descriptors of SF-MPQ) was similar between cyclical and non-cyclical pain, and was 12.0 (of 45) for the entire group. When compared to similar studies of pain at other sites, this falls in the same range as chronic cancer pain, and just below the pain of rheumatoid arthritis. Mean %VAS (visual analog scale) was 45.12 and mean %PPI (present pain index) was 39.9. Most women described their pain as 'heavy, aching and tender,' and these descriptors were given significantly higher ratings by women with cyclical pain. In women with non-cyclical mastalgia, the overall pain severity was related to the size of the painful area, and the steadiness of the pain, and the affective components were more prominent than in women with cyclical mastalgia. Thus, cyclical and non-cyclical mastalgia show some differences in their characteristics with substantial overlap. The total breast pain score was most efficiently estimated by a combination of the VAS, the PPI, and the quality of life questions (R2 = 0.96). Studies of breast pain should include both groups to better understand and characterize these differences, particularly with regard to a possible connection with breast cancer risk.

Expression of interleukin-6 and tumor necrosis factor alpha and histopathologic findings in painful and nonpainful breast tissue

Mastalgia is a common condition that is thought to be hormonally related, but the mechanisms of pain causation are unknown. Inflammatory cytokines are implicated in pain modulation, but have not been studied with regard to mastalgia. We compared the relationship of mastalgia to the expression of the cytokines interleukin (IL)-6, IL-1beta, and tumor necrosis factor (TNF)-alpha and the degree of tissue infiltration with inflammatory cells in breast tissue from 29 premenopausal women with breast pain and 29 age-matched pain-free controls. Paraffin sections from breast biopsy samples were scored for the presence of inflammatory infiltrate and were evaluated for the expression of IL-6, IL-1beta, and TNF-alpha using standard immunohistochemical procedures. TNF-alpha and IL-6 expression displayed a trend toward slightly lower values in patients with pain (median TNF-alpha score, 3 versus 5; median IL-6 score, 3 versus 4). In the luteal phase, patients with mastalgia showed a trend toward lower expression of IL-6 (p = 0.4) in comparison to those without pain. A similar trend was also seen with TNF-alpha expression (p = 0.4). IL-1beta expression was extremely scant in the first 30 samples and was not investigated further. The degree of inflammatory infiltrate in the tissue was unrelated to the presence of breast pain. These data suggest that the three cytokines tested in this study do not play a significant role in the causation of mastalgia and lend weight to the previous finding that there are no identifiable histologic correlates of this troubling condition. Further investigation of the role of cytokines in breast pain is warranted, especially in view of the possible association between mastalgia and breast cancer risk.

Mastalgia and breast cancer: a protective association?

Breast pain (mastalgia) is a common complaint, with a potentially important relationship to breast cancer risk. We have examined the association between mastalgia and breast cancer in the patient population of the Breast Care Center of University Hospital, Syracuse, New York. Of 5463 women with complete breast cancer risk factor information, 1532 (28%) reported breast pain as an incidental complaint at their initial visit, and 861 were diagnosed with breast cancer. Forward stepwise logistic regression was used to analyze the association between breast pain and a diagnosis of breast cancer. The age-adjusted OR for breast cancer was 0.60 (95% CI 0.50-0.74). Adjustment for additional risk factors (early menarche, late first birth, late menopause, exogenous hormone use, positive family history) yielded an OR of 0.63, 95% CI 0.49-0.79. Thus, women who experienced breast pain in our patient population were less likely to be diagnosed with breast cancer than women who did not complain of breast pain, regardless of age, and of other breast cancer risk factors. Further investigation of this possible protective association is warranted.

Clinical management of breast pain: a review

Breast pain (mastalgia) is a common cause of anxiety among women and frequently leads to a primary care clinic for consultation. Fortunately, mild premenstrual breast discomfort lasting for 1 to 4 days can be considered "normal." However, moderate-to-severe breast pain lasting over 5 days can interfere with usual activities, lead to unnecessary medical tests, and potentially invite the use of ineffective, occasionally harmful medications. Despite the severity of some patients' symptoms, mastalgia is still considered a trivial complaint by many physicians; often it is felt to be psychological in nature. Careful evaluation to rule out breast cancer and reassure the patient is enough to make the pain resolve in most cases. In a few patients, however, mastalgia is severe enough to deserve further evaluation and treatment. Overall, 92% of patients with cyclical mastalgia (CM) and 64% with noncyclical mastalgia (NCM) can obtain relief of their pain with the judicious use of several available therapies.

Gonadotropin level abnormalities in women with cyclic mastalgia

OBJECTIVES

Women with cyclic mastalgia seem to be at risk of fibrocystic breast disease and/or breast cancer. We studied the relationships between mastalgia and hormone levels throughout the menstrual cycle.

STUDY DESIGN

Ostensibly healthy women were monitored during a sum of 326 cycles. A case-control study compared personal and hormonal variables of 30 women experiencing cyclic mastalgia with those of 77 women without this symptom.

RESULTS

Except sleeping times, no significant differences were found in personal variables. Cyclic mastalgia and symptoms of fluid retention were slightly associated. Menses and the luteal phase were significantly longer in cases than in controls. Gonadotropin but not ovarian hormone levels were also significantly higher in cases throughout the cycle.

CONCLUSION

Cyclic mastalgia is less related to symptoms of fluid retention or to ovarian hormone levels than to regularly high gonadotropin levels, specific inhibitors might thus be used to alleviate the symptom.

Percutaneous progesterone use and risk of breast cancer: results from a French cohort study of premenopausal women with benign breast disease

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.

Elevated high-density lipoprotein cholesterol and dietary fat intake in women with cyclic mastopathy

OBJECTIVE

This study was designed to examine the contribution of plasma lipids to the pathophysiology of cyclic mastopathy, before and after consideration of diet and sex hormones.

STUDY DESIGN

Thirty-four women with severe cyclic mastopathy (case patients) and 29 women without cyclic mastopathy (control subjects) recorded their breast symptoms daily during 1 menstrual cycle. During each menstrual phase (follicular, early luteal, late luteal, and menstrual) they prospectively completed 2 24-hour dietary diaries, provided blood for lipid and hormone assays, and underwent anthropometric measurements.

RESULTS

Mean age was 34 years. Premenstrual breast swelling and tenderness were significantly more severe in case patients (P < .0001). Cyclic change (late luteal vs follicular) of high-density lipoprotein cholesterol differed between case patients and control subjects, with case patients having a relative excess of high-density lipoprotein cholesterol in the premenstrual phase (P = .01). Dietary fat intake was greater throughout the cycle in case patients (37.5 vs 33.7% of calories, P = .02), and case patients reported increased appetite in the premenstrual phase (P = .01). In multivariate analyses the contributions of mean dietary fat intake and of cyclic change in high-density lipoprotein cholesterol were independently significant, with odds ratios for upper versus lower quintiles being slightly >5.

CONCLUSIONS

Women with cyclic mastopathy had a relative excess of high-density lipoprotein cholesterol during the symptomatic late luteal phase of the menstrual cycle and a higher fat intake throughout the cycle than did control subjects. These observations support the hypothesis that lipids (notably high-density lipoprotein cholesterol) and a high-fat diet play a role in the pathophysiologic characteristics of cyclic mastopathy.

Mastalgia. Tailoring treatment to type of breast pain

Breast pain is a common, often distressing problem among women. After significant disease is ruled out, most patients respond to simple reassurance. Others, however, require treatment because symptoms interfere with their lifestyle. The authors offer practical suggestions for tailoring treatment for these patients according to type of pain--cyclical mastalgia, non-cyclical mastalgia, or chest wall pain.

Prevalence and impact of cyclic mastalgia in a United States clinic-based sample

OBJECTIVES

A descriptive study was conducted to examine the prevalence of premenstrual breast symptoms, the impact of cyclic mastalgia on various activities, and associated patterns of health care utilization.

STUDY DESIGN

Patients at an obstetrics and gynecology clinic (n = 1171) completed a questionnaire.

RESULTS

Sixty-nine percent of women reported regular premenstrual discomfort; 36% had consulted a health care provider about the symptoms. Current moderate-to-severe cyclic mastalgia was found in 11%. Women <36 years old with cyclic mastalgia were 4.7 times as likely as asymptomatic young women to have had a mammogram. Mastalgia interferes with usual sexual activity in 48% of women and with physical (37%), social (12%), and work or school (8%) activity.

CONCLUSIONS

Cyclic mastalgia is a common problem, sometimes severe enough to interfere with usual activities, and it is associated with high use of mammography among young women. Largely ignored both scientifically and clinically in the United States, this disorder merits further biopsychosocial investigation.

Breast health and associated premenstrual symptoms in women with severe cyclic mastopathy

OBJECTIVES

A case-control study was undertaken to examine the association of cyclic mastopathy with premenstrual syndrome and prior breast health.

STUDY DESIGN

A total of 34 women with severe cyclic mastopathy (cases) and 29 women with no significant breast symptoms (controls) prospectively recorded breast pain and swelling and symptoms of premenstrual syndrome during one menstrual cycle. They also provided information on past breast health. The two study groups were compared by use of standard statistical methods.

RESULTS

Women with cyclic mastopathy reported more frequent consultations with physicians for specific breast lumpiness (p = 0.02) or generalized lumpiness (p = 0.004) and for all breast problems (p = 0.0001) and more frequent mammograms (p = 0.04), surgical breast biopsies (p = 0.06), and breast needle aspirations (p = 0.05). Premenstrual symptoms were more severe in women with cyclic mastopathy; this was most pronounced for physical symptoms (water retention and breast symptoms, p < 0.001) but also present for negative affect, behavior change, and impaired concentration (p < 0.05).

CONCLUSIONS

Women with cyclic mastopathy have a spectrum of breast concerns and they undergo more frequent breast investigations than do women without the disorder. Most symptoms of premenstrual syndrome are also more severe in women with cyclic mastopathy.

Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study

Cyclical mastopathy (CM) is a common clinical syndrome of premenstrual breast swelling and tenderness. Its symptoms are relieved by reduction in dietary fat intake and, because fat intake may be associated with breast cancer risk, it was hypothesized that CM may also be related to breast cancer risk. This case-control study included 192 premenopausal women with a recent history of axillary node-negative breast cancer and 192 age-matched premenopausal controls. Subjects provided information on diet and risk factors, and they recorded breast symptoms prospectively during one menstrual cycle. Symptoms in the noncancerous breast of cases and the matched (right or left) breast of controls were examined. A cyclical pattern of symptoms was identified in both groups; breast tenderness scores were similar postmenstrually (p = 0.31) but were significantly higher premenstrually in the case group (p = 0.03). Cases also had a greater premenstrual increase in breast tenderness than controls (p = 0.03). When the effects of other risk factors for breast cancer were included in multivariate analyses, the association of cyclical tenderness with breast cancer persisted (p = 0.05), the odds ratio for severe tenderness being 3.32. Thus, we have identified an association of cyclical breast tenderness with breast cancer risk in premenopausal women. The association persists after consideration of diet and the effects of other breast cancer risk factors.

Progestogen use and decreased risk of breast cancer in a cohort study of premenopausal women with benign breast disease

A cohort study of 1,150 premenopausal French women with benign breast disease diagnosed in two breast clinics between 1976 and 1979 was carried out to analyse the relationship between progestogen use and the risk of breast cancer. The follow-up accumulated 12,462 person-years. The risk of breast cancer was estimated using a Poisson regression analysis on person-time data and the proportional hazards model. In the latter analysis, cumulated progestogen use and age were considered as time-varying covariables and adjustment was performed on the main risk factors for breast cancer. Neither overall progestogen use nor the duration of use was found to be significantly associated with the risk of breast cancer. When progestogens were classified into two categories according to their hormonal potency (19-nortestosterone derivatives vs other progestogens), 19-nortestosterone derivative use was found to be significantly associated with a lower risk of breast cancer. In the adjusted model, the corresponding risk of breast cancer was 0.48 (95% confidence interval 0.25-0.90). In addition, there was a linear trend in the decrease of the relative risk of breast cancer with the duration of use (P = 0.02). These results do not support the hypothesis that progestogens might increase the breast cancer risk. They suggest, instead, that treatment with 19-nortestosterone derivatives might have a beneficial effect on the risk of breast cancer in women with benign breast disease.