CLINICAL-EVALUATION OF MASTALGIA

Objective: To describe an accurate and reproducible method to quantify a patient's subjective experience of breast pain. Design: Prospective diary study. Setting: Military tertiary care hospital. Patients: Thir ty female military health care beneficiaries from the Waiter Reed Army Medical Center, Washington, DC, gynecology and general surgery clinic s.Main Outcome Measures: Daily mastalgia was recorded using a visual a nalog scale and menstrual symptoms were measured using a daily questio nnaire. These measures were correlated with results of a screening que stionnaire completed prior to study entry. Results: Patients identifie d as having cyclical mastalgia based on the screening questionnaire (n = 15) were found to have higher peak perimenstrual mastalgia accordin g to their daily diaries than patients who did not meet diagnostic cri teria (n = 15) (5.3 +/- 0.7 vs 3.5 +/- 0.5, P < .001). Applying the sa me criteria used in the screening questionnaire to the diary data, 17 of 30 patients met diagnostic criteria for cyclical mastalgia. The abi lity of the screening questionnaire to predict the results of the pros pective diary data was calculated, and positive and negative predictiv e values were 73 % and 60 %, respectively. Most patients with cyclical mastalgia also have other perimenstrual psychological and somatic com plaints, although a subset of patients has high levels of mastalgia wi th minimal associated symptoms. Conclusions: Accurate assessment of ma stalgia cannot be done with a retrospective questionnaire and requires prospective diary evaluation, owing to the variable and subjective na ture of symptoms and recall bias. A daily visual analog scale provides reproducible results and is easy for patients to use.