Breast Pain Research Articles

Effectiveness of Aloe Vera and Cabbage Leaf Compress on Breast Swelling Pain in Post-Partners in Bogor Barat District, Bogor City

ASEAN data in 2022 stated that 76,543 postpartum mothers experienced breast engorgement. 17.2 million postpartum mothers worldwide experience breast pain problems while breastfeeding. In Indonesia, the incidence of breastfeeding mothers experiencing breast engorgement reached the highest figure of 37.2% and 16% of working breastfeeding mothers experienced breast engorgement. Breast engorgement is interpreted as increased venous and lymph flow in the breasts to prepare for lactation. This is due to overdistension of the lactation ducts, causing breast swelling pain, and breast engorgement accompanied by an increase in body temperature. The study used a quasi-experimental design with a pretest-posttest two-group design. The sample consisted of 30 postpartum mothers who experienced breast engorgement pain and were divided into 2 intervention groups, namely aloe vera compresses and cabbage compresses, the intervention was carried out for 14 days. The instrument used was the Visual Analogue Scale (VAS). Data were analyzed using the Paired T-Test and Independent T-Test. In the Independent Sample T-Test, the p-value of the VAS scale for the aloe vera group was 0.019 <0.05 with an average score of 2.0 and the VAS scale for the cabbage group was 0.037 <0.05 with an average score of 1.87.

A systematic review on the techniques, long-term outcomes, and complications of partial breast irradiation after breast-conserving surgery for early-stage breast cancer.

To evaluate the efficacy and safety of four techniques of partial breast irradiation (PBI) including interstitial brachytherapy (ISBT), balloon-based brachytherapy (BBT), Intraoperative radiotherapy (IORT) and three-dimensional conformal radiotherapy (3DCRT) in the treatment for early-stage breast cancer patients after breast-conserving surgery. A systematic search was performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed, Embase, Cochrane Library and Web of Science databases. The inclusion criteria were clinical trials and observational studies that reported on outcome measures of principal PBI techniques. The methodological quality of the included research data was assessed using bias risk assessment tool with the Methodological Index for Non-Randomized Studies (MINORS), and the research information were analyzed using data analysis software. Clinical studies were collected from the earliest available date until September 2023. Fifty-one studies were included, with a total sample size of 7708. The results of network meta-analysis (NMA) showed that ISBT can lower the local recurrence (SUCRA: 73.8%). In terms of reducing distant metastasis, 3DCRT may be the best choice (SUCRA: 52.5%). And IORT has the highest 5-year overall survival (SUCRA: 90%). Furthermore, ISBT also has the advantages of lowest risk with fat necrosis (SUCRA: 72.5%), infection (SUCRA: 78.3%) and breast pain (SUCRA: 86.2%). BBT may be the optimal solution for fibrosis (SUCRA: 76.9%) and hyperpigmentation (SUCRA: 66.7%). 3DCRT has lower incidence of telangiectasia (SUCRA: 56.7%) and better cosmetic result (SUCRA: 85%). Postoperative PBI treatment using ISBT after breast-conserving surgery in patients with early-stage breast cancer may be a more valuable choice based on the treatment efficacy and is associated with fewer late side-effects. Large-scale, prospective, long-term studies are warranted to clarify the role of different PBI techniques in selected patients.

Mastalgia and Why It Should Be Evaluated With Imaging in Areas Where Use of Breast Cancer Screening Services are Unsatisfactory.

Mastalgia or breast pain is a very common symptom in women attending breast clinic. The aim of this study was to evaluate whether imaging for mastalgia leads to cancer detection in an area where routine breast cancer screening services are underutilized. This prospective study was performed between 1st March 2021 to 31st January 2023 at a tertiary care academic institution of central India. All patients underwent through clinical examination by a surgeon. Then patients were referred for ultrasound and/or X-ray mammography (MMG) depending on age. Cancer detection rate was calculated. The final cohort consisted of 176 patients with mastalgia and without any abnormality on clinical breast examination. Sixteen patients had mass lesion on radiology and core needle biopsy resulted as infiltrating duct carcinoma in 7 patients and benign phylloides tumor in one patient. Overall case detection rate for cancer was 4%. The breast cancer detection rate in patients presenting with mastalgia was low. However, in the absence of routine mammographic screening in the Indian general population, these would have been missed. Hence, diagnostic assessment for mastalgia is an appropriate strategy in countries where routine screening MMG is lacking.

Effect of Flaxseed on Pain Relief and Quality of Life in Patients With Mastalgia: A Single Arm Interventional Study.

Mastalgia, a common complaint among women, denotes breast discomfort that can manifest as cyclical or non-cyclical. Reassurance, mechanical support and various non-pharmacological treatments, like flaxseeds, have been seen to have a good effect in treating mastalgia. Thus, the aim of this study was to investigates the efficacy of flaxseed in alleviating pain associated with mastalgia and its impact on the overall health-related quality of life among female patients. Conducted at a tertiary care center in Northern India over 18 months, it employed a single-arm interventional design. The participants included females aged 18 years and older presenting with breast pain at the Department of General Surgery. The intervention involved daily consumption of 30 g of milled flaxseed for each participant, administered over a period of six months. Pain severity was assessed using the visual analogue scale (VAS) before supplementation and at follow-up intervals up to six months. Concurrently, the Short Form-12 (SF-12) items Health Survey measured health-related quality of life, encompassing both physical and mental health domains. Statistical analysis employed parametric (paired t-test) and non-parametric tests (chi-square, McNemar) where appropriate, with statistical significance set at p<0.05. Two hundred women with mastalgia were included with a significant reduction in mean VAS scores from 6.03±0.83 at baseline to 2.19±0.66 at six months post-intervention (p = 0.0001). This reduction in pain intensity demonstrated a positive correlation with duration of flaxseed supplementation, notably declining after the initial three months. The mean difference in physical and mental SF-12 score at first visit and at 6 months after intervention was significant (p = 0.0001). This study underscores the potential of flaxseed as a therapeutic option for managing mastalgia and enhancing health-related quality of life among affected individuals.

Time to revisit the enigma of mastalgia management

Mastalgia (breast pain) also known as mastodynia, is one of the most common causes of breast issues for which a female visits a medical practitioner. It is divided into cyclical mastalgia, which is associated with menstruation, or can be noncyclical mastalgia which can present premenopausal or postmenopausal. The incidence of breast cancer associated with mastalgia is extremely low and reassurance plays a major role in the treatment of patients. Hormonal changes have been associated with the pathogenesis of cyclical mastalgia. Outdated treatment modalities are still being followed even though newer and more effective treatment options have been established. Objective assessment of breast pain should be done with the visual analog scale. Non-pharmacological therapy should be encouraged in every patient of mastalgia such as counseling and reassurance, sports bra, yoga, and relaxation therapy. Tamoxifen and ormeloxifene are now the drug of choice in severe mastalgia and care should be taken to counsel the patients about use and common and detrimental side effects. The available treatment modalities and their directions to use are discussed in this review.

Risk Factors for Low Quality of Life among Women Using Different Types of Contraceptives in Saudi Arabia: A Questionnaire-Based Study.

This study aimed to assess and identify the risks for poor quality of life among female Saudi contraceptive users by administering an online questionnaire. The validity of the Arabic version of the Spanish Society of Contraception Quality of Life (SEC-QOL) questionnaire was assessed by incorporating the relevant items into an exploratory factor analysis and a subsequent confirmatory factor analysis. Internal consistency was assessed using Cronbach's alpha coefficient. p < 0.05 was statistically significant. Questionnaires completed by 652 eligible women were analyzed. The most common contraception method was oral pills (51.5% of respondents). Analysis of the internal consistency of the questionnaire revealed that overall reliability was >0.7, which is considered adequate (Cronbach's alpha = 0.845). Analysis of risk factors associated with higher overall SEC-QOL scores (worse overall quality of life) revealed several statistically significant variables. A "not good" relationship with their husbands, "heavy" menstrual flow, and premenstrual breast symptoms (breast pain, hypersensitivity, and increased size) were identified as risk factors for poor quality of life due to their association with the highest scores (poor quality of life). The Arabic version of the modified SEC-QOL is a valid and reliable tool to measure the quality of life of Saudi contraceptive users.

>Efficacy of disease-modifying antirheumatic drugs in the treatment of granulomatous mastitis: a systematic review.

Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disorder of unknown etiology. This benign condition can mimic the clinical presentation of breast cancer and is characterized by symptoms such as breast pain, erythema, and swelling. Over the past few years, Disease-Modifying Antirheumatic Drugs (DMARDs) have been increasingly used to manage this condition. However, strong evidence to support their use is lacking. This systematic review aimed to summarize the evidence and evaluate the efficacy of DMARDs in the management of IGM. A systematic literature review, adhering to PRISMA guidelines, was conducted across electronic databases, including PubMed, EMBASE, SCOPUS, directory of open access journals (DOAJ) and Cochrane Library from their inception until May 2024. We included retrospective and prospective studies while excluding case reports and case series of less than 10 patients. Eighteen studies met our eligibility criteria. Fifteen studies were retrospective, while 2 were prospective. No randomized controlled trials were identified. Of these, 16 papers examined the effect of methotrexate on IGM, revealing significant disease improvement in most cases. Several of the studies indicated that patients treated with azathioprine and mycophenolate mofetil also achieved favorable responses. Given the rarity of IGM, only a limited number of studies have explored the use of DMARDs as a pharmacological treatment option. A significant barrier to advancing our understanding is the substantial heterogeneity in the quality and volume of data provided by these studies. Therefore, there is a need for well-designed, randomized, placebo-controlled trials to rigorously assess the efficacy of DMARDs in the treatment of IGM.

Characteristics of primary tuberculous mastitis in tuberculosis endemic country: A case series

Tuberculous mastitis (TM) is a rare form of tuberculosis, occurring as a primary disease when there is no evidence of tuberculosis in other locations. There are no clear clinical features of TM, especially in the absence of a previous tuberculosis infection. Due to its unclear clinical picture, diagnosis is difficult, and it is often confused with breast carcinoma or pyogenic abscesses. The aim of this study was to report our experience and discuss the characteristics and diagnostic modalities in cases of primary TM in a tuberculosis-endemic area. Method A case series study was conducted at the Arifin Achmad Regional Hospital, reporting four cases of primary tuberculous mastitis in January 2024. The patients were women aged 24-41 years. Case presentation All patients presented with complaints of breast pain for the last 2 weeks to 2 months and complained of symptoms in the form of a lump in the breast that was reddish in colour and mastalgia. One patient was diagnosed during pregnancy, and one had a history of prior breastfeeding. One patient presented with FNAB results for breast carcinoma. The other patient complained of an ulcer on her breast. Physical examination revealed axillary lymphadenopathy in all patients. Histopathological examination revealed tuberculous mastitis in all patients and 1 with tuberculous mastitis, fibrocystic changes, and Atypical Ductal Hyperplasia (ADH). Conclusion Patients with tuberculous mastitis who visited our institution had symptoms similar to those of abscesses and breast cancer. The FNAC test is the most reliable, but false-negative results can occur. Diagnosis requires teamwork between the patient’s doctor, anatomical pathologist, and radiologist. This research requires a larger scale to describe actual conditions.

Effectiveness and safety of finerenone in diabetic kidney disease patients: a real-world observational study from China

Aims Finerenone has been approved for treating diabetic kidney disease (DKD) with reducing cardiorenal risk. Real-world data on finerenone treatment for the management of DKD are presently lacking. This study aimed to investigate the effect of finerenone on the renal parameters of the Chinese DKD population in the real-world medical setting for the first time, especially in combination with renin–angiotensin system inhibitors (RASi) and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Methods Forty-two DKD patients were selected and completed a 6-month finerenone treatment. Renal parameters and adverse effects were collected at every visit. Results The median urine albumin-to-creatinine ratio (UACR) was 1426.11 (755.42, 3638.23) mg/g. Among them, the proportion of patients with a UACR of 300–5000 mg/g was 76.2%, and the proportion of patients with a UACR of >5000 mg/g was 14.3%. The median estimated glomerular filtration rate (eGFR) was 54.50 (34.16, 81.73) mL/min/1.73 m2. Finerenone decreased the UACR significantly throughout the study period (p < .05). The maximal decline of UACR at month 6 was 73%. Moreover, the proportion of patients with a 30% or greater reduction in UACR was 68.42% in month 6. There was a smaller decline (9–11%) in the eGFR after initiating finerenone (p > .05). One patient each discontinued finerenone due to hyperkalemia (2.4%) and acute kidney injury (2.4%). No patient reported hypotension, breast pain, and gynecomastia. Conclusions This study from China first demonstrated finerenone decreased UACR with manageable safety in real-world DKD treatment. A triple regimen of RASi, SGLT2i, and finerenone may be a promising treatment strategy for lowering albuminuria and reducing hyperkalemia risk in advanced DKD patients.

EP4 - Beyond the Surface: A Comprehensive Clinical Audit of Radiological Studies in Mastalgia

Abstract Aims Breast pain is a common symptom in women, frequently presenting to primary care physicians and breast specialists. Despite its prevalence, the causes and optimal treatment of mastalgia often remain unclear (1). Methods We established predefined inclusion and exclusion criteria to create a patient cohort comprising individuals who underwent radiological investigations for mastalgia between January 2021 and December 2021. Results The choice of initial investigation varied based on the patient's age and clinical examination findings. Mammography was the initial investigation for 91 patients (55.49%), while 73 patients (44.51%) underwent ultrasound examinations. No patients required histological investigations due to the absence of significant findings suitable for biopsy. Conclusions Our results suggest that diagnostic imaging for breast pain does not significantly contribute to increased cancer detection. This observation held true when we stratified the data by patient status, age, gender, and imaging modality. Notably, the rate of cancer diagnoses in our audit population was 0%, which contrasts with international literature reporting rates within the range of 0-3% (9)(10). Our findings highlight the concern of overutilization of diagnostic imaging in healthcare settings. Furthermore, it underscores that normal test results do not necessarily offer reassurance to patients and can sometimes increase their anxiety levels (10)(11).

Single preoperative radiation therapy with delayed surgery for low-risk breast cancer: Oncologic outcome, toxicity and cosmesis of the SPORT-DS phase I trial

BackgroundA novel approach using single-fraction preoperative partial breast irradiation (PBI) for low-risk breast cancer is under study. We sought to investigate the rate of pathologic response (pR), toxicities and cosmetic results related to this new treatment strategy. MethodsWomen of 65 years or older with stage I unifocal luminal A breast cancer were eligible for inclusion in this phase I prospective trial. Patients received a single 20 Gy dose of PBI followed by breast-conserving surgery (BCS) 3 months later. The primary endpoint was the pR rate, and the secondary endpoints were radiation therapy-related toxicity and cosmetic results. ResultsThirteen patients were treated, with a median age of 71. Eleven patients (84.6 %) had pR with a median residual cellularity of 1 % (range: 0–10 %). At median follow-up of 48.5 months, no recurrences or cancer-related deaths were recorded. Acute radiation therapy-related toxicity were limited to grade 1 dermatitis and breast pain. At the 1-year follow-up, there were one grade 2 fat necrosis and two grade 3 toxicities (wound infection and hematoma). Only grade 1 toxicities remained at 2 years, but one grade 2 toxicity (fibrosis/induration) developed by the 3-year follow-up. Three-year patient-reported cosmetic outcomes were good or excellent in 60 % of patients. ConclusionsSingle-fraction preoperative PBI preceding BCS for low-risk breast cancer is feasible, relatively well tolerated and leads to a high level of pR. The 3-month interval after PBI seems to place surgery in a post-radiation inflammatory phase. Further delay between PBI and surgery could improve pR and cosmetic outcome. NCT03917498.

Reasons for premature removal of progestogen implant among women in a community in Pretoria

Background: Implanon is widely used in South Africa and around the world. However, a significant number of users discontinue it prematurely. The current study aims to explore the reasons for women’s early removal of the progestogen implant, known as Implanon, in a Pretoria community.Methods: This was a qualitative study applying a descriptive phenomenological design, with nine one-on-one interviews done at Temba Community Health Centre among women who had their Implanon implants removed sooner than the intended length of time.Results: Four major themes emerged from the data collection: reasons for choosing Implanon, side effects of Implanon, the social impact of Implanon and public attitudes towards Implanon. These four themes were further explored through 13 subthemes.Conclusion: The participants acknowledged and valued the benefits of Implanon, but they also encountered undesirable side effects such headaches, bleeding, breast pain and enlargement, decreased libido, and mood swings. The primary causes of the implant’s early removal were these side effects, among which bleeding was the most frequently reported problem.Contribution: Implanon-induced bleeding has an impact on the economics of households and the sexual lives of women, as it requires the purchasing of sanitary products and other medications.

Breast gel based on Boswellia serrata, Betaine and myo-Inositol improves cyclic mastodynia in fertile women: A retrospective clinical study.

The management of mastodynia plays a central role in improving women quality of life. Despite its high occurrence, specific therapeutic guidelines for mastalgia are still lacking. Available therapies include unspecific anti-inflammatories, even though they may often expose to undesirable effects and low compliance. The aim of this study was to highlight the efficacy of the topical application of combined natural molecules including Boswellia serrata, Betaine and myo-Inositol in improving cyclic mastalgia. In this retrospective pilot clinical study, patients with cyclic mastalgia applied a specific breast gel for three months. The severity of the pain was measured through the Visual Analogue Score (VAS) in the treated group compared to untreated one. Treated patients also filled in a questionnaire evaluating acceptance and safety of the breast gel. This pilot clinical study demonstrated for the first time the efficacy of the topical application of a breast gel based on Betaine, Boswellia serrata, and myo-Inositol in improving cyclic mastodynia. The completed questionnaires also revealed high levels of acceptance, as both safety and compliance. Besides confirming the positive effects of these natural molecules in the management of conditions affecting breast physiology - so far evaluated as oral supplementation - the obtained results pave the way for further studies supporting the use of such molecules as a tailored medical device in the management of breast pain, thus also opening toward a combined oral and topical approach.

Efficacy of Tedizolid Phosphate in Treating Mastitis: A Clinical Outcome Analysis

Background: Mastitis is a common inflammatory condition of the breast, often requiring effective antibiotic treatment. This study evaluates the efficacy of tedizolid phosphate in treating mastitis among patients in an outpatient setting. Methods: A total of 100 patients diagnosed with mastitis at the OPD of Prime Hospital, Maijdee, Noakhali, were enrolled in this study between July 1, 2023, and June 30, 2024. Patients received tedizolid phosphate, and outcomes were assessed through clinical examination and follow-up. The study focused on symptom resolution, duration of antibiotic course, and adjunctive treatments. Result: The majority of patients (45.0%) were aged 21-30 years. The most common symptoms were breast pain (60.0%), breast lump (40.0%), and nipple discharge (25.0%). All participants underwent imaging, with 45.0% showing mastitis in the right breast and 30.0% in the left. Tedizolid phosphate was prescribed to 100% of patients, with completing a 6-day course. Symptom improvement was observed in 85.0% of cases, with partial improvement in 15.0%. No cases of non-improvement or worsening were recorded. Conclusion: Tedizolid phosphate demonstrated high efficacy in treating mastitis, with a significant proportion of patients achieving full symptom resolution. The findings support its use as a reliable treatment option, though further studies with longer follow-up and microbiological analyses are recommended to confirm these results.

Health Care Problems of Unmarried Women in Rural Areas: A Study in Chidambaram Area, Cuddalore District, Tamil Nadu

Rural women are among the most marginalized groups in Indian society. Many welfare policies are being launched and executed in favour of rural women, who have historically been marginalized. Despite these efforts, rural women continue to be affected by various issues, particularly poor health, which is linked to their productivity and human capital. In this regard, the WHO states that "better health is central to human happiness and well-being. It also makes an important contribution to economic progress, as a healthy population lives longer, is more productive, and saves more." Rural women have limited access to and opportunities to utilize health care policies. Through our study, we intended to assess the perceptions of unmarried women regarding health-care-seeking behaviour related to problems during menstruation. In this study, 300 unmarried women aged 15–35 were selected as the sample. Although the schedules were administered to all 300 women selected in the sample villages for this study, the data were collected from the respondents using a well-structured interview schedule. The association between the health problems at various levels reported by the women in the study area and their socio-economic and demographic variables was analysed using the chi-square test. The major health problems reported by respondents in the study area were analysed with regard to the socio-economic and demographic characteristics of the women. Abdominal pain, profuse bleeding, irregular periods, breast tenderness, painful menstruation, leg pain/backache, headache/vomiting sensation, and white discharge were the major problems reported by the women in the study area. To assess the health problems of women during menstruation, unmarried women were considered for further analysis.

The efficacy of levonorgestrel intrauterine device, medroxyprogesterone acetate, and norethisterone acetate in the treatment of endometrial hyperplasia without atypia

Objectives: Pregestational treatments, which trigger apoptosis and suppress endometrium, are the gold standard therapy for endometrial hyperplasia without atypia. The levonorgestrel-intrauterine device is the first choice in current guidelines due to its low dose. Still, oral progestins have no clear evidence due to their lower regression rates and side effects. Here, we aimed to compare the regression rates, hysterectomy requirement, and the occurrence of side effects in the sixth month between the levonorgestrel-intrauterine device, norethisterone acetate, and medroxyprogesterone acetate treatment. Methods: A total of 60 patients were included. The study group was divided into three groups: levonorgestrel-intrauterine device group (n=20), norethisterone acetate group (n=20), and medroxyprogesterone acetate group (n=20). Demographic findings, body mass index, gravida, parity, comorbid diseases, regression, hysterectomy requirement, patient desire to continue treatment, and side effects such as amenorrhea, headache, weight gain, intermenstrual spotting, nausea, and breast tenderness were compared between three groups. Results: There was no statistically significant difference between the three groups regarding headache, weight gain, intermenstrual spotting, and breast tenderness. Regression rates were significantly higher in the levonorgestrel intrauterine device group compared to medroxyprogesterone acetate (p=0.044) and norethisterone acetate group (p=0.020). Similarly, hysterectomy rates were significantly lower in the levonorgestrel intrauterine device group compared to medroxyprogesterone acetate (p=0.031) and norethisterone acetate group (p=0.028). Amenorrhea was significantly more common in the levonorgestrel intrauterine device group than in other groups (p=0.020 for both), whereas nausea was rarer in the levonorgestrel intrauterine device group (p=0.047 for both). According to the patient’s satisfaction, the levonorgestrel intrauterine device was the most satisfactory treatment compared to medroxyprogesterone acetate and norethisterone acetate (p=0.028 and p=0.031). No significant difference was found between the medroxyprogesterone acetate and norethisterone acetate groups in terms of regression rates, hysterectomy requirements, amenorrhea, nausea, and patient satisfaction. Conclusion: Considering low hysterectomy requirement, high regression rates, and patient satisfaction, the levonorgestrel intrauterine device should be the first choice for endometrial hyperplasia without atypia as compared to oral progestins. Thus, patients must be informed about side effects and offered levonorgestrel intrauterine devices before oral progestins for endometrial hyperplasia without atypia.

Imaging Enigma in Mastitis: A Comprehensive study of Multifaceted Causes, Clinical and Radiological Presentations

Mastitis is an inflammatory condition of the breast which represents an array of underlying etiologies encompassing both infectious and non-infectious causes. Exacerbating factors include endemic infections, lack of awareness and suboptimal breastfeeding practices. Neglected cases lead to prolonged morbidity, recurrent episodes, and complications such as abscess or sinus formation, resulting in permanent breast disfigurement. Its overlapping clinical presentation with breast cancer necessitates an integrated multidisciplinary approach for diagnosis and treatment. The primary aim was to investigate demographic, radiological, and histopathological characteristics of mastitis. Objectives included correlating radiological and histopathological findings, classifying mastitis by etiology, identifying the clinical and imaging patterns across diverse clinical settings to enhance the understanding of mastitis. This is a retrospective observational study, analysing the clinical, radiological, and histopathological data from 65 patients with mastitis between February 2023 and February 2024. The study included 65 patients, aged 18 to 65 years, with breast pain as the most prevalent clinical presentation. Cases were classified as infectious (47.6%) and non-infectious (52%). Acute puerperal mastitis (26.15%) and granulomatous mastitis (30%) were the most common subtypes. The commonest mammographic finding was focal asymmetry. On ultrasound, infectious mastitis showed oedema with other inflammatory changes, including diffuse skin thickening and collections; while non-infectious mastitis typically presented as solitary or multiple breast masses (p < 0.001). Surprisingly, idiopathic granulomatous mastitis constituted the largest percentage amongst various histopathological causes of mastitis in our study. An integrated multidisciplinary approach with understanding of the pathogenesis is imperative for prompt diagnosis and optimizing treatment strategies, thereby improving patient outcome. Radiological imaging is critical for diagnosis, evaluating disease extent, conducting guided interventions, and monitoring treatment response.

Imaging for breast pain: A useful paradigm to promote breast cancer screening and reduce unnecessary breast imaging

ObjectiveIdentify the proportion of patients presenting for diagnostic breast imaging with clinically insignificant breast pain who are eligible for screening mammography and analyze the impact of routing these patients to screening on resource utilization, healthcare spending and cancer detection. MethodsWe retrospectively reviewed 100 consecutive women ≥40 years old without a history of breast cancer who underwent diagnostic mammogram and breast ultrasound for clinically insignificant breast pain from 1/2022 to 4/2022. Patients were screen-eligible if their last bilateral mammogram was over 12 months prior to presentation. Patients with only screening views during diagnostic mammography were assumed to have a negative/benign screening mammogram. Costs were calculated using the Centers for Medicare & Medicaid Services Physician Fee Schedule. Results68 of 100 patients with breast pain were screen-eligible at time of diagnostic imaging. With a screen first approach, 47/68 would have had negative/benign screening mammograms, allowing for the availability of 47 diagnostic breast imaging appointments. The current workflow led to 100 diagnostic mammograms and ultrasounds, 29 follow-up ultrasounds, and 10 image-guided biopsies, with a total cost of $42,872.41. With a screen first approach, there would have been 68 screening mammograms, 53 diagnostic mammograms and ultrasounds, 10 follow-up ultrasounds, and 9 image-guided biopsies, with a total cost of $34,231.60. Two cancers were identified, both associated with suspicious mammographic findings. None would have been missed in a screen-first approach. DiscussionIdentifying screen-eligible patients with clinically insignificant breast pain and routing them to screening mammogram improves radiology resource allocation and decreases healthcare spending without missing any cancers.

The clinical efficacy of Lou's Wentong method in the treatment of lactational mastitis: A retrospective self-control study with 158 cases

BackgroundAs a common breast disease in lactating women, lactational mastitis is clinically manifested as painful breast lumps and systemic symptoms. To a certain extent, this disease may affect the physical and mental health of lactating women and even the breastfeeding of infants. ObjectiveThis study was conducted to evaluate the clinical efficacy of Lou's Wentong Method in the comprehensive treatment of lactational mastitis and its effects on relevant symptoms. MethodsA total of 158 patients who were diagnosed with lactational mastitis in The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2022 to January 2024 were included in this study to conduct a retrospective analysis. The treatment method comprised oral administration of traditional Chinese medicine prescriptions guided by the concept of “Wentong zhi yong” (warming and dispersing therapy for treating abscesses), puncture and pus extraction for patients with abscess formation, and milk drainage for patients with milk stagnation. The clinical symptoms of these patients were collected according to the seven indexes in Lou's quantitative scorecard for evaluating the condition of canker sores before and after treatment. Additionally, the improvement of each symptom after treatment, the total effective rate of the clinical treatment, and the total symptom evaluation score before and after treatment were also analyzed. ResultsIt was demonstrated that there were significant differences in the overall distribution of different severity symptoms (skin erythema, breast pain, number of lumps, size of lumps, breast abscesses, and body temperature) at three time points (P < 0.01). The evaluation of these symptoms at different time points revealed that all symptoms were effectively mitigated over time. Meanwhile, the efficacy was assessed according to the efficacy index to evaluate the efficacy of Lou's Wentong Method in the comprehensive treatment of lactational mastitis. The results corroborated the pronounced efficacy of Lou's Wentong Method in treating lactational mastitis, exhibiting statistical significance (P < 0.01). ConclusionLou's Wentong Method has significant therapeutic effects in the comprehensive treatment of lactational mastitis. Furthermore, this method is conducive to alleviating the clinical symptoms of these patients as soon as possible and can reduce the pain of patients, thus promoting their recovery.

Clinical efficacy of gamma-oryzanol combined with Femoston for perimenopausal syndrome.

Perimenopausal syndrome (PMS) is a chronic disease associated with estrogen deficiency. Because of the unsatisfactory outcomes of current conventional treatments for this condition, its treatment must be continuously explored and optimized. To assess the clinical effectiveness of γ-oryzanol in combination with Femoston for PMS. A total of 119 patients with PMS were selected from June 2023 to December 2023, which included 59 and 60 patients in the control and observation group, respectively. The control and observation groups were treated with Femoston and γ-oryzanol + Femoston, respectively. Comparative analyses were performed in terms of clinical effectiveness, safety (dizziness and headache, nausea and vomiting, and breast tenderness), sex hormones [estradiol (E2), luteinizing hormone (LH), and follicle-stimulating hormone (FSH)], lumbar spine (L1-4) and bilateral femoral bone mineral density (BMD), and sleep quality (sleeping time and frequency of awakenings from sleep). Compared with the control group, the observation group had statistically higher total effective rates of treatment; lower overall incidence of adverse events; higher post-treatment E2 levels and L1-4 and bilateral femoral BMD; and lower LH and FSH levels, sleeping time, and frequency of awakenings from sleep after treatment. Therefore, for the treatment of PMS, γ-oryzanol combined with Femoston is significantly better than Femoston alone in terms of clinical effectiveness, exhibiting more pronounced clinical advantages in improving safety, sex hormone levels, BMD, and sleep quality.