|Year : 2015 | Volume
| Issue : 3 | Page : 108-111
Prevalence of mastalgia in young Indian females
Sukanya Raghunath1, Nagarathna Raghuram1, Sandhya Ravi2, Nidhi C Ram1, Amritanshu Ram1
1 Department of Research Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
2 Prameya Wellness, Bengaluru, Karnataka, India
|Date of Web Publication||27-Oct-2015|
324, 5th Cross, 1st Block Jayanagar, Bangalore - 560 011, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Mastalgia is a common breast disorder with highly variable prevalence estimates ranging 41–79%. The prevalence in Indian young females is not much studied. Materials and Methods: The study was carried out on young female students aged 18–29 years from four different nursing colleges at Ramanagaram District, South India. After signing the informed consent, students filled up the basic details demographic data and specific breast history checklist. Results: The prevalence of mastalgia was 47.33% (354 out of 748), of which 88.70% (314) had cyclical mastalgia (CM) and 9.89% (35) had acyclic mastalgia (ACM). Students who had low body mass index (BMI) had higher risk for mastalgia as compared to those with normal BMI [relative risk (RR) = 1.063] or high BMI (RR = 1.685). Moderately stressed students were at higher (RR = 0.771) risk of mastalgia compared to those with low stress. Students with high stress levels were also at a higher (RR = 0.787) risk compared to those with low stress. Conclusions: The prevalence of mastalgia was 47.33% among 748 young females from four nursing colleges in Karnataka, India.
Keywords: Mastalgia, prevalence, young Indian women
|How to cite this article:|
Raghunath S, Raghuram N, Ravi S, Ram NC, Ram A. Prevalence of mastalgia in young Indian females. J Health Res Rev 2015;2:108-11
|How to cite this URL:|
Raghunath S, Raghuram N, Ravi S, Ram NC, Ram A. Prevalence of mastalgia in young Indian females. J Health Res Rev [serial online] 2015 [cited 2020 Mar 31];2:108-11. Available from: http://www.jhrr.org/text.asp?2015/2/3/108/168368
| Introduction|| |
Prevalence of mastalgia is highly variable ranging 41–79%. Approximately, 40–70% of cases of breast pain (BP) are caused by cyclical mastalgia (CM) and are related to hormonal cycling of estrogen, progestin, and prolactin, while acyclical mastalgia (ACM) is more frequent or severe and interferes with daily activities and accounts for about 30% of BP.
The prevalence seems to vary widely in different countries. In the US, two studies on adult population documented prevalence rates of 68% and 11% for CM  while in Canada and UK; it is reported to be 51.5% and 32%, repectively. The prevalence in India appears to be similar with a reported prevalence of 51–54% in adult urban population.
Purpose of the study
The manifestation of benign breast disorders may develop during adolescence but may not be diagnosed till adulthood. The prevalence in young women is unknown, but it is more than 50% in women of reproductive age. Clinical follow-up studies have reported varied risk ratios of benign breast diseases developing into breast cancer.,,,, Therefore, identifying and treating young women with mastalgia are of prime importance. To the best of our knowledge, there are no published studies on the prevalence of mastalgia with or without fibrocystic disease in young Indian women.
Aim of the study
The present study was undertaken to estimate the prevalence of mastalgia among young Indian women.
| Materials and Methods|| |
The study was carried out on young women aged 18–29 years from four residential private nursing colleges and one State Government Nursing and Degree College in South Karnataka, India. All subjects included in the survey were volunteers hailing from semiurban and rural areas.
The study was approved by the Institutional Ethics Committee of Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA) University (IEC no is RES/IEC-SVYASA/16/201). This study was registered with Clinical Trial Registry of India (CTRI/2014/08/004911).
Permission and written approval were obtained from the administrative heads of the four participating colleges. Prior to data collection, the staff and students of the colleges were apprised about the need for this study. This included an introductory address by the researcher, followed by a talk by a breast surgeon discussing breast diseases in general and the importance of self-examination.
After obtaining the signed informed consent, women were requested to fill up a checklist for mastalgia suitable to Indian population developed as part of the study. The checklist included a numerical pain analogue scale (PAS) marked from 0 to 10, based on Cleeland's Breast Pain Inventory (BPI) along with other information described in the ensuing pages. Clinical and demographic features of subjects including age, marital and educational status, history of hypothyroidism, their stress level, shifts at work, lifestyle pattern along with anthropometric and demographic data were obtained.
Weight was measured using a research grade electronic weighing scale and height was measured using a simple tape measure. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters.
The checklist, developed for the study, included questions about age of menarche, pattern of the menstrual cycle, family history of breast cancer, BP [CM (pain before/during/after the menstrual cycle) or ACM (pain throughout the month)], nodularity, past diagnosis or treatment of mastalgia, and details of any other illnesses based on conventional risk factors.
Numeric PAS are valid and reliable measures of pain intensity. We used Cleeland's BPI  after obtaining written permission, which is a validated tool  with a Cronbach's alpha between 0.77 and 0.91. The 5th question of BPI is a numerical PAS from 0 (no pain) to 10 (pain as bad as you imagine) to measure the pain intensity. The PAS from Cleeland's BPI has been vastly used for mastalgia studies. We also measured self-rated stress on a Likert scale of 0–4 (nil, low, moderate, high).
Data were analyzed using R' software version 3.1.0 (https://www.r.project.org/ Developer R Development Core Team). Mean and standard deviations are reported for continuous variables and frequencies and percentages are reported for categorical variables. Relative risk (RR) was calculated as a ratio between the proportion of cases with two cases without mastalgia for BMI and stress categories.
| Results|| |
Seven hundred and fifty four students attended the introductory lecture. Of these 748 women (99.2%) responded and agreed to participate. Their age ranged between 18 years and 29 years with a mean age of 19.96 years. Average BMI was 20.8 kg/m 2 while average age of menarche was 12.5 years. Out of these 748 women, 711 were unmarried while 34 were married. Most of these women reported low stress levels (73.73%) and had regular menstrual cycles (85.2%). The sociodemographic details are recorded in [Table 1].
Of these 354 (47.33%) women who were diagnosed with mastalgia, 314 (88.70%) had CM and 35 (9.89%) had ACM. Five women (1.41%) suffering from mastalgia missed reporting, they had either CM or ACM. Out of 354 women with mastalgia, 13 (3.67%) missed reporting their stress levels, of which 10 were from the CM group while 3 were from the ACM group. One woman with CM (0.28%) missed her height assessment. The average pain score for the CM group was 3.03 ± 1.57 while it was 3.71 ± 1.45 for the ACM group. Average pain duration was more than 9.6 ± 8.8 months for mastalgia group, on the other hand it was 12.06 ± 9.31 for the ACM group. Majority of the women from the CM group reported low stress levels (70.70%) while those from the ACM group reported moderate stress levels (45.71%).
Association between mastalgia and other variables was estimated by RR and is recorded in [Table 2].
Women who had low BMI had higher risk for mastalgia as compared to those with normal BMI (RR = 1.063) or high BMI (RR = 1.685). Moderately stressed students had a higher risk for mastalgia compared to those with low stress (RR = 0.771). Women with high stress levels had a higher risk for mastalgia as compared to those with low stress (RR = 0.787).
Thus, those with medium and high stress levels and low BMI had higher risk of developing mastalgia than those who had low stress and normal or high BMI.
| Discussion|| |
This study was done on nursing college students from four colleges in South India. The present study estimated the prevalence of mastalgia (both CM and ACM) as 47.33%, where 88.7% had CM and only 9.89% had ACM. Women with medium and high stress levels and low BMI had higher risk of developing mastalgia than those with low or normal stress levels and high BMI.
In the present study, prevalence of mastalgia is less (47.33%) as compared to a clinical study on CM from the US (68%) with a sample size of 874 within the age range of 18–44 years, while it is closer to Canadian online survey (51.5%) with a sample size of 1,659 with the mean age of 34 years. Studies on urban Indian population also reported similar prevalence rates for the women (N = 1,693) in the third decade of their life (62.5%) and women (50.5%) within the age range of 30–50 years (N = 107) (Joshi et al. 2010). Till date there has been no studies reporting the prevelance in the younger age groups.
There are several studies that have shown moderate-to-high levles of stress in nursing students  that could be due to academic pressure, health-related issues, and difficulties in adjusting to the new environment. There are strong evidence which suggests that, severe mastalgia is leading to high level of psychological distress. Studies also point out that emotional abuse and anxiety are independently associated with BP. Many studies have shown that there is a relationship between high BMI and stress. Although in our study, very few women with mastalgia were with high BMI (N = 67) and high stress levels (N = 11). There is a need for mechanistic studies to explore this subgroup of women with mastalgia.
It could be hypothesized that BMI and stress have a nonlinear association with development of mastalgia.
Recent studies provides strong evidence that both low BMI and high BMI have a strong association with psychological distress.,, The relationship between BMI and psychological distress is so independent in direction, that the more one moves away from the normal weight the worst the psychological status. The present study is the first to explore the prevalence of mastalgia in young women and its association with stress and BMI. There is a need for early recognition and treatment.
Hence, the present study estimated the prevelance of mastalgia as 47.33% of the 748 young females from 4 nursing colleges in Karnataka, India.
The present study focussed on women in the age group of 18–29 years to determine the prevalence of mastalgia among young women population as there is a need to educate them and bring awareness about the importance of breast self-examination (BSE).
Association of mastalgia with benign breast conditions such as fibroadenosis, adenomas, and cysts has not been explored as ultrasound scanning of the breast was not planned for. Data related to endocrine abnormalities such as hypothyroidism and polycystic ovarian disease, which are commonly seen in this age group, have not been collected.
The present study has the following limitations: The association of stress level and BMI may simply be a chance finding and needs to be confirmed in other population-based studies. Nursing students constitute a very selected group of the "Universe of population of young women in India." Hence, information gathered may not be extrapolated to or generalizable to all the young women. Future studies on adolescent and young women can be planned for diffenret ethinic groups. Assessments may include psychological scales to measure stresses specific to nursing professionals and ultrasound scanning can also be documented to explore the association of mastalgia with benign breast conditions.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
| References|| |
Murshid KR. A review of mastalgia in patients with fibrocystic breast changes and the non-surgical treatment options. JTU Med Sc 2011;6:1-18.
American Cancer Society. Non-cancerous Breast Conditions. 2012.
Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: Prevalence and associated health and behavioral factors. J Psychosom Obstet Gynaecol 2001;22:71-6.
Ader DN, Browne MW. Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Am J Obstet Gynecol 1997;177:126-32.
Brown N, White J, Brasher A, Scurr J. The experience of breast pain (mastalgia) in female runners of the 2012 London Marathon and its effect on exercise behaviour. Br J Sports Med 2014;48:320-5.
Joshi JV, Pandey SN, Galvankar P, Gogate JA. Prevalence of premenstrual symptoms: Preliminary analysis and brief review of management strategies. J Midlife Health 2010;1:30-4.
Wang J, Costantino JP, Tan-Chiu E, Wickerham DL, Paik S, Wolmark N. Lower-category benign breast disease and the risk of invasive breast cancer. J Natl Cancer Inst 2004;96:616-20.
Schnitt SJ. Benign breast disease and breast cancer risk: Morphology and beyond. Am J Surg Pathol 2003;27:836-41.
Hill DA, Preston-Martin S, Ross RK, Bernstein L. Medical radiation, family history of cancer, and benign breast disease in relation to breast cancer risk in young women, USA. Cancer Causes Control 2002;13:711-8.
Webb PM, Byrne C, Schnitt SJ, Connolly JL, Jacobs T, Peiro G, et al
. Family history of breast cancer, age and benign breast disease. Int J Cancer 2002;100:375-8.
Cleeland CS, Ryan KM. Pain assessment: Global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994;23:129-38.
Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain 2004;20:309-18.
Scurr J, Hedger W, Morris P, Brown N. The prevalence, severity, and impact of breast pain in the general population. Breast J 2014;20:508-13.
van der Riet P, Rossiter R, Kirby D, Dluzewska T, Harmon C. Piloting a stress management and mindfulness program for undergraduate nursing students: Student feedback and lessons learned. Nurse Educ Today 2015;35:44-9.
Singh A, Chopra M, Adiba S, Mithra P, Bhardwaj A, Arya R, et al
. A descriptive study of perceived stress among the North Indian nursing undergraduate students. Iran J Nurs Midwifery Res 2013;18:340-2.
Ramirez AJ, Jarrett SR, Hamed H, Smith P, Fentiman IS. Psychological distress associated with severe mastalgia. In: Mansel RE, editor. Recent Developments in the Study of Benign Breast Disease: The Proceedings of the 5th
Intenational Symposioum on Benign. CRC Press; 1993. p. 280.
Colegrave S, Holcombe C, Salmon P. Psychological characteristics of women presenting with breast pain. J Psychosom Res 2001;50:303-7.
Jokela M, Elovainio M, Keltikangas-Järvinen L, Batty GD, Hintsanen M, Seppälä I, et al
. Body mass index and depressive symptoms: Instrumental-variables regression with genetic risk score. Genes Brain Behav 2012;11:942-8.
Gaysina D, Hotopf M, Richards M, Colman I, Kuh D, Hardy R. Symptoms of depression and anxiety, and change in body mass index from adolescence to adulthood: Results from a British birth cohort. Psychol Med 2011;41:175-84.
Lanza HI, Echols L, Graham S. Deviating from the norm: Body mass index (BMI) differences and psychosocial adjustment among early adolescent girls. J Pediatr Psychol 2013;38:376-86.
[Table 1], [Table 2]