Editing Mastalgia


Not typically a sign of cancer

Can be hard to find a diagnosis, quite vague symptoms

== '''History''' ==

* Establish timeline
* Aggravating/alleviating factors
* Unilateral or both breasts
* Cyclical/related to menstrual cycle
** Cyclical is more reassuring - almost physiological
** Tender nodularity is quite reassuring (this is what used to be called fibrocystic disease)
* Aim is to differentiate between mastalgia and chest wall pain
** Chest wall pain is unilateral, brought on by activity, and can be reproduced by direct pressure
** True breast pain is often bilateral and worse before menstruation, and the cause is unknown

== '''Examination''' ==

* See separate topic for full examination
* Lie on side to let breast fall away

== '''Differential diagnosis''' ==

* Chest wall syndromes - costochondritis, bone disease, scapulothoracic bursitis
* Cyclical breast pain
* Cysts
** Can cause cyclical or non-cyclical pain
** Aspiration will resolve the pain, if this is the cause
* Fibroadenomas
* Cancer - typically incidental if found
* Fibromyalgia


== Investigation ==

* Mammogram if >40yo
* Investigate any lump

== Management ==

* Mainstay is reassurance
* May resolve on its own with no diagnosis
* Well-fitted, appropriately sized supportive bras - try wearing 24 hours a day
* Warm compress
* Dietary modifications to reduce high fat intake and lower caffeine intake
* NSAIDs
* Vitamin E, fish oil, evening primrose oil
* Topical NSAIDs
* Tamoxifen 10mg in luteal phase - abolished pain in 85% of women in one study

[[Category:Breast]]