Persistent Breast Pain Research Articles

Persistent breast pain 5 years after treatment of invasive breast cancer is largely unexplained by factors associated with treatment

The aim of our study was to establish the prevalence of breast pain persisting 5 years after the initial treatment of breast cancer (BC) and the relationship between those persistent symptoms and general well-being. The study involved women from Victoria, Australia, who had survived at least 5 years from diagnosis, remained free from recurrence or new BC and completed the fifth annual follow-up questionnaire. Analysis involved both multivariable logistic and linear regression. Of 1,205 women, 45 % reported breast pain which persisted for at least 3 months following initial treatment, and of these, 80 % reported pain persisting for at least 5 years. The factor contributing most to the likelihood of persistent breast pain was current lymphedema; however, a full multivariable model explained <10 % of the likelihood of breast pain persisting for 5 years. The presence of breast pain at 5 years was associated with only a modest reduction in general well-being. Breast pain persisting for at least 5 years after treatment for BC is common. As the pain is largely unexplained by factors associated with the characteristics of the cancer or its treatment, the contribution of patient expectations to persistent breast pain may be considerable. Where persistent pain occurs, referral for the management of pain and, where appropriate, lymphedema is warranted.

Variations in potassium channel genes are associated with persistent severe arm pain after breast cancer surgery

Pain at the site of injury is a common symptom in women who undergo breast cancer surgery. Pain occurs in the axilla and arm ipsilateral to the affected breast. Recently, we used growth mixture modeling to identify latent classes (i.e., subgroups) of patients with distinct trajectories of worst arm pain scores using a 0-10 numeric rating scale (NRS), reported monthly for 6 months after surgery. Using GMM, patients were classified into “No” (41.6%), “Mild” (23.6%), and “Severe” (34.8%) pain groups. Given their role in nociceptive transmission and our previous finding of an association with breast pain, we hypothesized that variations in potassium (K+) channel genes would be associated with persistent arm pain after breast cancer surgery. Therefore, the purpose of this study was to test for associations between single nucleotide polymorphisms (SNPs) among 10 K+ channel genes and persistent breast pain after surgery. Differences in a number of demographic (i.e., age, ethnicity, income), clinical (i.e., body mass index, functional status, number of comorbidities), preoperative (i.e., number of breast biopsies, neoadjuvant chemotherapy, stage of disease, breast pain), intraoperative (i.e., number of lymph nodes removed, number of drains placed, type of surgery, axillary lymph node dissection, intercostobrachial nerve sacrificed), and postoperative (number of postoperative complications, severity of average and worst postoperative pain, placement of a surgical drain, received biological therapy or physical therapy during the 6 months) characteristics among the pain classes (all p<.05). Significant associations were found between variations in 5 genes [KCND2 (n=6, p<.05), KCNJ3 (n=6, all p<.05), KCNJ6 (n=4, all p<.05), KCNJ9 (n=1, p=.005) and KCNK5 (n=9, both p<.05)] and pain group membership. K+ channel gene variations and distinct demographic and clinical characteristics are associated with a novel phenotypic characterization of severe persistent arm pain after breast cancer surgery. Pain at the site of injury is a common symptom in women who undergo breast cancer surgery. Pain occurs in the axilla and arm ipsilateral to the affected breast. Recently, we used growth mixture modeling to identify latent classes (i.e., subgroups) of patients with distinct trajectories of worst arm pain scores using a 0-10 numeric rating scale (NRS), reported monthly for 6 months after surgery. Using GMM, patients were classified into “No” (41.6%), “Mild” (23.6%), and “Severe” (34.8%) pain groups. Given their role in nociceptive transmission and our previous finding of an association with breast pain, we hypothesized that variations in potassium (K+) channel genes would be associated with persistent arm pain after breast cancer surgery. Therefore, the purpose of this study was to test for associations between single nucleotide polymorphisms (SNPs) among 10 K+ channel genes and persistent breast pain after surgery. Differences in a number of demographic (i.e., age, ethnicity, income), clinical (i.e., body mass index, functional status, number of comorbidities), preoperative (i.e., number of breast biopsies, neoadjuvant chemotherapy, stage of disease, breast pain), intraoperative (i.e., number of lymph nodes removed, number of drains placed, type of surgery, axillary lymph node dissection, intercostobrachial nerve sacrificed), and postoperative (number of postoperative complications, severity of average and worst postoperative pain, placement of a surgical drain, received biological therapy or physical therapy during the 6 months) characteristics among the pain classes (all p<.05). Significant associations were found between variations in 5 genes [KCND2 (n=6, p<.05), KCNJ3 (n=6, all p<.05), KCNJ6 (n=4, all p<.05), KCNJ9 (n=1, p=.005) and KCNK5 (n=9, both p<.05)] and pain group membership. K+ channel gene variations and distinct demographic and clinical characteristics are associated with a novel phenotypic characterization of severe persistent arm pain after breast cancer surgery.

Variations in inflammatory cytokine genes are associated with persistent severe breast pain after breast cancer surgery

Variations in inflammatory cytokine genes are associated with persistent severe breast pain after breast cancer surgery

Variations in potassium channel genes are associated with persistent mild breast pain after breast cancer surgery

Variations in potassium channel genes are associated with persistent mild breast pain after breast cancer surgery

Variations in potassium channel genes are associated with severe persistent breast pain after breast cancer surgery

Persistent pain after breast cancer surgery is common with prevalence rates that range from 25% to 80%. Recently, we used growth mixture modeling to identify latent classes (i.e., subgroups) of patients with distinct trajectories of worst breast pain scores using a 0-10 numeric rating scale (NRS), reported prior to and monthly for 6 months after surgery. Four subgroups were identified: 126 patients (31.7%) with

Identification of Patient Subgroups and Risk Factors for Persistent Breast Pain Following Breast Cancer Surgery

Study purposes were to determine the prevalence of persistent pain in the breast; characterize distinct persistent pain classes using growth mixture modeling; and evaluate for differences among these pain classes in demographic, preoperative, intraoperative, and postoperative characteristics. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the pain classes, were evaluated. Patients (n = 398) were recruited prior to surgery and followed for 6 months. Using growth mixture modeling, patients were classified into no (31.7%), mild (43.4%), moderate (13.3%), and severe (11.6%) pain groups based on ratings of worst breast pain. Differences in a number of demographic, preoperative, intraoperative, and postoperative characteristics differentiated among the pain classes. In addition, patients in the moderate and severe pain classes reported higher preoperative levels of depression, anxiety, and sleep disturbance than the no pain class. Findings suggest that approximately 25% of women experience significant and persistent levels of breast pain in the first 6 months following breast cancer surgery. PerspectivePersistent pain is a significant problem for 25% of women following surgery for breast cancer. Severe breast pain is associated with clinically meaningful decrements in functional status and quality of life.

Prospective Study of Factors Predicting Adherence to Surveillance Mammography in Women Treated for Breast Cancer

This prospective study examined the factors that predicted sustained adherence to surveillance mammography in women treated for breast cancer. Breast cancer survivors (N = 204) who were undergoing surveillance mammography completed questionnaires assessing mammography-related anticipatory anxiety, persistent breast pain, mammography pain, and catastrophic thoughts about mammography pain. Adherence to mammography in the following year was assessed. In the year after study entry, 84.8% of women (n = 173) returned for a subsequent mammogram. Unadjusted associations showed that younger age, shorter period of time since surgery, and having upper extremity lymphedema were associated with lower mammography adherence. Forty percent of women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0 to 10 scale). Although mammography pain was not associated with adherence, higher levels of mammography-related anxiety and pain catastrophizing were associated with not returning for a mammogram (P < .05). The impact of anxiety on mammography use was mediated by pain catastrophizing (indirect effect, P < .05). Findings suggest that women who are younger, closer to the time of surgery, or have upper extremity lymphedema may be less likely to undergo repeated mammograms. It may be important for health professionals to remind selected patients directly that some women avoid repeat mammography and to re-emphasize the value of mammography for women with a history of breast cancer. Teaching women behavioral techniques (eg, redirecting attention) or providing medication for reducing anxiety could be considered for women with high levels of anxiety or catastrophic thoughts related to mammography.

Case Report of Methicillin-Resistant Staphylococcus aureus (MRSA) Mastitis With Abscess Formation in a Breastfeeding Woman

An afebrile woman with persistent nonhealing nipples and low-grade intermittent breast pain was diagnosed at 9 weeks postpartum with a methicillin-resistant Staphylococcus aureus infection of the left breast with abscess formation. Unilateral weaning allowed partial lactation to continue.

Optimizing breast cancer treatment efficacy with intensity-modulated radiotherapy

Purpose: To present our clinical experience using intensity-modulated radiation therapy (IMRT) to improve dose uniformity and treatment efficacy in patients with early-stage breast cancer treated with breast-conserving therapy.Methods and Materials: A total of 281 patients with Stage 0, I, and II breast cancer treated with breast-conserving therapy received whole breast RT after lumpectomy using our static, multileaf collimator (sMLC) IMRT technique. The technical and practical aspects of implementing this technique on a large scale in the clinic were analyzed. The clinical outcome of patients treated with this technique was also reviewed.Results: The median time required for three-dimensional alignment of the tangential fields and dosimetric IMRT planning was 40 and 45 min, respectively. The median number of sMLC segments required per patient to meet the predefined dose-volume constraints was 6 (range 3–12). The median percentage of the treatment given with open fields (no sMLC segments) was 83% (range 38–96%), and the median treatment time was <10 min. The median volume of breast receiving 105% of the prescribed dose was 11% (range 0–67.6%). The median breast volume receiving 110% of the prescribed dose was 0% (range 0–39%), and the median breast volume receiving 115% of the prescribed dose was also 0%. A total of 157 patients (56%) experienced Radiation Therapy Oncology Group Grade 0 or I acute skin toxicity; 102 patients (43%) developed Grade II acute skin toxicity and only 3 (1%) experienced Grade III toxicity. The cosmetic results at 12 months (95 patients analyzable) were rated as excellent/good in 94 patients (99%). No skin telengiectasias, significant fibrosis, or persistent breast pain was noted.Conclusion: The use of intensity modulation with our sMLC technique for tangential whole breast RT is an efficient method for achieving a uniform and standardized dose throughout the whole breast. Strict dose-volume constraints can be readily achieved resulting in both uniform coverage of breast tissue and a potential reduction in acute and chronic toxicities. Because the median number of sMLC segments required per patient is only 6, the treatment time is equivalent to conventional wedged-tangent treatment techniques. As a result, widespread implementation of this technology can be achieved with minimal imposition on clinic resources and time constraints.

CLINICAL EXPERIENCE OF DRUG TREATMENTS FOR MASTALGIA

Results of randomised trials and open studies in 291 patients with severe persistent breast pain in whom breast cancer had been excluded showed that drug therapy produced a good or useful result in 77% of those with cyclical mastalgia and 44% of those with non-cyclical mastalgia. In patients with cyclical mastalgia good or useful responses were obtained with danazol in 70%, with bromocriptine in 47%, and with evening-primrose oil in 45%. The equivalent response rates in patients with non-cyclical mastalgia were 31%, 20%, and 27% respectively. Progestagens were not effective in either group. Failure to respond to one drug did not preclude response to a different drug. Patients with Tietze's syndrome did not respond to drug therapy, but 7 out of 10 responded to injection of lignocaine and hydrocortisone around the affected costochondral junction.