Assessing and managing benign breast lesions leading to mastalgia: A review of 840 patients.

Objective: Mastalgia often raises malignancy concerns. This study explores its link to benign breast conditions, and cancer.

Material and methods: This retrospective study included 840 patients presenting to the surgical clinic with breast disease between January 2016 and January 2023.

Results: This study included 840 patients (800 female, 40 male) presenting with mastalgia, either as an isolated symptom or in combination with other complaints. In 350 cases (41.6%), pain alone was reported; in 410 cases (48.8%), pain with a lump; and in 18 cases (2.1%), pain with nipple discharge. Non-cyclic pain (51.5%) was more common than cyclic pain (42.5%), with pain most frequently localized to the right breast (53.5%), followed by bilateral (23.8%) and left breast (17.8%) pain (p<0.001). A significant association was observed between mastalgia and neck/shoulder pain (10.7%, p<0.001). A family history of breast cancer was present in 16.6% of patients. Histologic analysis revealed fibrocystic changes (42.2%), fibroadenoma (21.1%), and ductal ectasia (11%) as the most common diagnoses. Malignancy was detected in 6 cases (1.3%, including 1 male patient), with a significantly higher prevalence in the pain + lump group (p<0.001). Other findings included mastitis (9 cases), abscess (53 cases), and fat necrosis (4 cases). Patients with suspected malignancy underwent biopsy based on radiologic suspicion (BIRADS 2-4a) and physical examination.

Conclusion: Mastalgia is predominantly a benign condition, but non-cyclic pain, particularly when associated with a lump, warrants thorough evaluation to exclude malignancy. The link between mastalgia and fibrocystic changes shows that research is needed into the causes and consequences. It is not a malignancy indicator, accurate diagnosis requires histological and radiological assessments.