Mastalgia

 

Mastalgia (breast pain) is one of the most common breast symptoms experienced by women and management requires careful assessment and diagnosis. There is often understandable anxiety associated with the symptom, particularly about breast cancer. This worry is often the reason women seek medical evaluation. The risk of cancer in a woman presenting with breast pain as an isolated symptom is extremely low and suitable reassurance can usually be given

Breast pain is uncommon in men. Pain and tenderness may occur in men who develop gynaecomastia secondary to medication, hormonal factors, cirrhosis and other conditions. Cyclical breast pain is confined to women but both non-cyclical breast pain and extramammary pain can occur in men. The assessment of these types of pain is similar for men and women

.

Definition

Unilateral or bilateral breast pain without any associated symptoms

Cyclical breast pain is related to the menstrual cycle and is not associated with specific underlying breast disease.  It affects up to two thirds of women and one in ten experience moderate to severe symptoms

.

Exclude Red Flag Symptoms

Exclude the following red flag symptoms:

  • If associated breast lump follow breast lump pathway
  • If associated nipple discharge follow nipple discharge pathway
  • If associated nipple distortion/ retraction follow nipple distortion or retraction pathway
  • If evidence of inflammation consider the possibility of inflammatory cancer and refer on a rapid referral pathway if necessary, or the possibility of evolving abscess in which case follow breast infection/inflammation pathway

.

Management

  1. Reassurance that there is no underlying disease may be all that is required. (Studies identify no increased risk of breast cancer in women with breast pain)
  2. Check for any medication that could be a contributing cause (e.g. hormonal treatments, antidepressants, anxiolytics and antipsychotics such as sertraline, venlafaxine and haloperidol, anti hypertensive and cardiac medication such as spironolactone, methyldopa and minoxidil and antimicrobials including ketoconazole and metronidazole)
  3. Consider:
    1. a better fitting bra during the day
    2. a soft supporting bra worn at night
    3. oral paracetamol or ibuprofen as required
    4. topical NSAID as required
  4. Consider advising the patient to purchase Starflower Oil Capsules for at least 3 months and reduction of caffeine intake
  5. Ask the patient to keep a pain chart to help assess the benefits of treatment

.

NOTE In general, continue treatment for 6 months before considering a referral for second line treatments

.

Information needed from patient

How many consultations the patient has had for this condition in the last 6 months

.

Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

Have a question or query?

Get in touch