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