Work-up and management of breast pain

Abstract

Breast pain, or mastalgia, is a common symptom and a frequent reason for breast center referrals. It can be categorized as cyclical or non-cyclical pain. Cyclical breast pain is more common and varies with the menstrual cycle. Non-cyclical breast pain includes true breast pain and extramammary causes. Categorizing breast pain helps to guide the work-up and management. A thorough history and physical exam should be performed in all patients presenting with breast pain. Though breast pain alone is rarely a sign of breast cancer, breast imaging may be still be appropriate. If there are no concerning findings on the physical exam, the imaging work-up is determined by patient age and the type of breast pain. Management of breast pain without suspicious findings on physical exam or breast imaging is driven by the severity of the pain. Reassurance of the negative findings and that the patient does not have breast cancer is often all that is required. Breast pain frequently resolves spontaneously and no further treatments are necessary. If pain is persistent or impacting quality of life, initial management is centered on conservative therapies such as physical support. Medications can be considered for severe and persistent pain, but the side effects of these therapies need to be considered.