Clinical Edge

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Diagnosis and Management of Benign Breast Disorders

Obstet Gynecol; ePub 2016 Jun; Pearlman, Griffin, et al

This American College of Obstetricians and Gynecologists’ (ACOG) practice bulletin outlines common benign breast disease symptoms in women who are not pregnant or lactating and discusses appropriate evaluation and management. According to the bulletin, obstetrician-gynecologists may perform diagnostic procedures when indicated or may make referrals to physicians who specialize in the diagnosis and treatment of breast disease. The following recommendations and conclusions are based on good and consistent scientific evidence (Level A):

• Women in whom atypical hyperplasia has been diagnosed have a substantially increased risk of subsequent invasive cancer in the affected breast and the contralateral breast. Risk-reduction therapy should be strongly recommended. Possible risk-reduction therapies include tamoxifen (for premenopausal and postmenopausal women), raloxifene (for postmenopausal women), and aromatase inhibitors (for postmenopausal women).

• Danazol and tamoxifen are effective for severe and refractory cases of mastalgia, but their use is limited by adverse effects.

• Women in whom LCIS has been diagnosed have a substantially increased risk of subsequent invasive cancer in the affected breast and the contralateral breast. Risk-reduction therapy should be strongly recommended. Possible risk-reduction therapies include tamoxifen (for premenopausal and postmenopausal women), raloxifene (for postmenopausal women), and aromatase inhibitors (for postmenopausal women).

Citation: Diagnosis and management of benign breast disorders. Practice Bulletin No. 164. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127:e141-56.