Mathelin C
Service de chirurgie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France; IGBMC, Institut de génétique et de biologie moléculaire et cellulaire, biologie du cancer, CNRS UMR 7104, INSERM U964, Université de Strasbourg, Illkirch, France.
Gynecol Obstet Fertil Senol. 2021 May;49(5):493-499. doi: 10.1016/j.gofs.2021.03.027. Epub 2021 Mar 20.
Breast pain is a concern in perimenopausal and postmenopausal women, quantifiable using validated tools, and may pre-exist or appear after initiation of a HRT.
A review of the literature was conducted to evaluate the frequency of breast pain, its evolution with age, its changes under HRT, its link with a possible risk of subsequent breast cancer, and the diagnostic (breast imaging) or therapeutic management modalities (pharmacological or other) in women taking HRT.
A review of the literature was carried out by consulting Medline, Cochrane Library data and international recommendations in French and English up to the end of 2019.
Published data confirm the importance of breast pain in relation to breast cancer risk. Women with breast pain prior to or related to the use of HRT have a significantly increased risk of breast cancer compared to women without breast pain. The risk is increased in cases of moderate to severe breast pain. In the presence of diffuse breast pain without abnormalities on clinical examination, it is not recommended to change the usual indications for screening, whether organized or individual. For focal breast pain, breast imaging (mammography and possibly ultrasound) is recommended. In the absence of abnormalities on breast imaging, a reassuring dialogue has to take place. With regard to HRT, doses of estrogens should be reduced until the breast pain decreases, or even stop the HRT if this symptom persists despite the use of low doses. Wearing a bra brassiere-type can also reduce breast pain.
乳房疼痛是围绝经期和绝经后女性关注的问题，可使用经过验证的工具进行量化，且可能在激素替代疗法（HRT）开始之前就已存在或在开始后出现。
对文献进行综述，以评估乳房疼痛的发生率、其随年龄的演变、在HRT作用下的变化、其与后续乳腺癌可能风险的关联，以及接受HRT治疗的女性的诊断（乳房成像）或治疗管理方式（药物治疗或其他）。
通过查阅截至2019年底的Medline、Cochrane图书馆数据以及法语和英语的国际推荐文献进行文献综述。
已发表的数据证实了乳房疼痛与乳腺癌风险的相关性。与无乳房疼痛的女性相比，在使用HRT之前或与之相关出现乳房疼痛的女性患乳腺癌的风险显著增加。中重度乳房疼痛的情况下风险会增加。对于临床检查无异常的弥漫性乳房疼痛，无论是组织性筛查还是个体筛查，均不建议改变常规筛查指征。对于局限性乳房疼痛，建议进行乳房成像（乳房X线摄影，可能还包括超声检查）。如果乳房成像无异常，必须进行安抚性对话。关于HRT，应降低雌激素剂量直至乳房疼痛减轻，若尽管使用低剂量但该症状仍持续，则甚至应停止HRT。佩戴胸罩也可减轻乳房疼痛。
