Diagnostic and therapeutic approach to mastalgia. A daily challenge in the gynecological visit.
[Diagnostic and therapeutic approach to mastalgia. A daily challenge in the gynecological visit.]Luz del Carmen Sanabria Villegas1, Leopoldo Santiago Sanabria2, Mario Villafán Athié3, Ximena van Tienhoven3, Renata Fernanda Rodríguez Castro3, Ariel Zoilo De la Puente Gómez3
1. Departamento Ginecología y Obstetricia, Hospital Ángeles, Villahermosa, México; 2. Departamento Ginecología Oncológica, Unidad Médica de Alta Especialidad 4 - Luis Castelazo Ayala, Ciudad de México, México; 3. Departamento Ginecología y Obstetricia. Universidad Panamericana, Ciudad de México, México.
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Abstract
La mastalgia es uno de los principales motivos de consulta diaria para el ginecólogo. Se estima que alrededor del 70% de las mujeres experimentará mastalgia en algún momento de su vida, además que es un síntoma que puede presentarse de manera reincidente. Es un cuadro que suele representar gran angustia en la paciente dada la posible asociación con algún proceso maligno, lo cual se ha demostrado que tan solo ocurre hasta en el 3% de los casos, por lo que se debe tranquilizarla durante la consulta de primer contacto. Se trata de un síntoma con múltiples etiologías, que en la mayoría de los casos se deben a patologías benignas de la glándula mamaria. La evaluación por estudios de imagen debe apegarse a las recomendaciones emitidas por las diferentes guías internacionales y no solicitar estudios innecesarios que lleven a un sobrediagnóstico y sobretratamiento. El abordaje en el tratamiento puede representar un gran reto para el ginecólogo, ya que existen diversas opciones que abarcan desde terapéuticas no farmacológicas, como son modificaciones en el estilo de vida y múltiples terapéuticas farmacológicas, sin embargo, existen pocos ensayos clínicos aleatorizados que permitan demostrar la superioridad de uno. En objetivo del presente es revisar las diversas recomendaciones en el abordaje diagnóstico y tratamiento que sustentan el manejo clínico de la mastalgia.
Abstract
Mastalgia is one of the main reasons for daily consultation with the gynecologist. It is estimated that approximately 70% of women will experience mastalgia at some point in their lives, and it is also a symptom that can occur recurrently. It is a condition that usually represents great distress in the patient given the possible association with some malignant process, which has been shown to only occur in up to 3% of cases, so she should be reassured during the first contact consultation. It is a symptom with multiple etiologies, which in most cases are due to benign pathologies of the mammary gland. Evaluation by imaging studies should adhere to the recommendations issued by the different international guidelines and not request unnecessary studies that lead to overdiagnosis and overtreatment. The treatment approach can represent a great challenge for the gynecologist, since there are various options that range from non-pharmacological therapies, such as lifestyle modifications and multiple pharmacological therapies, however, there are few randomized clinical trials that allow demonstrating one's superiority. The objective of the present is to review the various recommendations in the diagnostic approach and treatment that support the clinical management of mastalgia.
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