Mastodini (Meme Ağrısı)
Özet
Mastodini (meme ağrısı), kadınların yaşamlarının herhangi bir döneminde en sık karşılaştıkları meme yakınmalarından biri olup, yaşam kalitesini önemli ölçüde etkileyen ancak çoğu zaman benign nedenlere bağlı gelişen klinik bir durumdur. Mastodini; döngüsel, döngüsel olmayan ve meme dışı ağrı olmak üzere üç temel grupta değerlendirilir. Etkin yönetim, ayrıntılı anamnez ve fizik muayene ile malignite riskinin doğru değerlendirilmesini, uygun hastalarda yaşa ve klinik bulgulara göre görüntüleme yöntemlerinin seçilmesini gerektirir. Klinik muayenesi normal olan ve ek risk faktörü bulunmayan olgularda ileri görüntüleme çoğu zaman gerekli değildir. Tedavinin temelini hasta eğitimi, güven verme, uygun sütyen kullanımı, yaşam tarzı düzenlemeleri ve topikal nonsteroid antiinflamatuvar ilaçlar oluşturur. Dirençli veya yaşam kalitesini belirgin etkileyen olgularda tamoksifen, danazol veya diğer hormonal tedavi seçenekleri dikkatle değerlendirilebilir. Mastodini nadiren meme kanseri ile ilişkili olsa da, hastaların en önemli kaygısı malignite olasılığıdır. Bu nedenle kanıta dayalı tanısal algoritmaların uygulanması, gereksiz girişimlerin önlenmesi ve multidisipliner yaklaşımın benimsenmesi büyük önem taşır. Bu bölümde mastodininin güncel epidemiyolojisi, etiyopatogenezi, tanısal değerlendirmesi ve kanıta dayalı tedavi seçenekleri kapsamlı olarak gözden geçirilmektedir.
Mastalgia, also referred to as mastodynia or breast pain, is one of the most common breast-related complaints encountered in clinical practice, affecting up to 70% of women during their lifetime. Although breast pain is a frequent cause of anxiety because of concerns about breast cancer, it is rarely associated with malignancy. Mastalgia is generally classified as cyclic, non-cyclic, or extramammary pain, each with distinct etiologies, clinical characteristics, and management strategies. A comprehensive clinical assessment, including detailed history-taking and physical examination, remains the cornerstone of evaluation and helps identify patients who require further imaging or tissue diagnosis. Diagnostic imaging should be guided by patient age, clinical findings, and current evidence-based recommendations, while unnecessary investigations should be avoided in patients with typical benign presentations. Initial management primarily consists of reassurance, patient education, appropriate breast support, lifestyle modifications, and topical nonsteroidal anti-inflammatory drugs. Hormonal therapies such as tamoxifen or danazol may be considered in carefully selected patients with severe or persistent symptoms but require careful assessment because of their potential adverse effects. Most patients experience spontaneous improvement over time, particularly those with cyclic mastalgia. A multidisciplinary, patient-centered approach involving surgeons, radiologists, primary care physicians, nurses, and other healthcare professionals optimizes diagnostic accuracy, reduces patient anxiety, and improves quality of life. This chapter summarizes the current evidence regarding the epidemiology, pathophysiology, diagnostic evaluation, differential diagnosis, imaging strategies, treatment options, prognosis, and multidisciplinary management of mastalgia.
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