- Mehra Golshan, MD
Mehra Golshan, MD
- Associate Professor of Surgery
- Harvard Medical School
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
Breast pain (mastalgia) is common in women and occasionally occurs in men. Evaluation of breast pain is important to determine whether the pain is due to normal physiological changes related to hormonal fluctuation or to a pathologic process such as breast cancer. Breast pain is usually mild, although approximately 11 percent of affected women will describe their pain as moderate to severe .
This topic will discuss the etiology, evaluation, and treatment of breast pain in women. Evaluation of a breast mass is discussed separately. (See "Clinical manifestations and diagnosis of a palpable breast mass".)
Although not completely characterized, the prevalence of breast pain appears to depend on the population studied. As examples:
●In one series of 10,000 consecutively seen female patients (mean age, 46 years) referred for breast evaluation, 5 percent had a chief complaint of breast pain .
●In a separate study of almost 1700 women (mean age, 34 years) surveyed by online questionnaire, over half (51.5 percent) had experienced breast pain . Pain was more commonly reported among older women, those with larger breast sizes, and those less fit and/or physically active. In addition, of those who reported symptoms, 41 and 35 percent reported negative impacts from breast pain on their sexual health and sleep, respectively. Of interest, 10 percent of those symptomatic had reported breast pain as an issue for over half of their lives.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Ader DN, Shriver CD. Cyclical mastalgia: prevalence and impact in an outpatient breast clinic sample. J Am Coll Surg 1997; 185:466.
- Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J 2004; 10:111.
- Scurr J, Hedger W, Morris P, Brown N. The prevalence, severity, and impact of breast pain in the general population. Breast J 2014; 20:508.
- Davies EL, Gateley CA, Miers M, Mansel RE. The long-term course of mastalgia. J R Soc Med 1998; 91:462.
- Ader DN, Browne MW. Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Am J Obstet Gynecol 1997; 177:126.
- Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: prevalence and associated health and behavioral factors. J Psychosom Obstet Gynaecol 2001; 22:71.
- Levinson W, Dunn PM. Nonassociation of caffeine and fibrocystic breast disease. Arch Intern Med 1986; 146:1773.
- Jacobson MF, Liebman BF. Caffeine and benign breast disease. JAMA 1986; 255:1438.
- Heyden S, Muhlbaier LH. Prospective study of "fibrocystic breast disease" and caffeine consumption. Surgery 1984; 96:479.
- Minton JP, Foecking MK, Webster DJ, Matthews RH. Caffeine, cyclic nucleotides, and breast disease. Surgery 1979; 86:105.
- Abraham GE. Nutritional factors in the etiology of the premenstrual tension syndromes. J Reprod Med 1983; 28:446.
- Archer DR, Fischer LA, Rich D, et al. Estrace vs Premarin for treatment of menopausal symptoms: dosage comparison study. Advances in Therapy 1992; 9:21.
- Bech P, Munk-Jensen N, Obel EB, et al. Combined versus sequential hormonal replacement therapy: a double-blind, placebo-controlled study on quality of life-related outcome measures. Psychother Psychosom 1998; 67:259.
- Greendale GA, Reboussin BA, Hogan P, et al. Symptom relief and side effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin Interventions Trial. Obstet Gynecol 1998; 92:982.
- Peters F, Diemer P, Mecks O, Behnken L LJ. Severity of mastalgia in relation to milk duct dilatation. Obstet Gynecol 2003; 101:54.
- Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc 2004; 79:353.
- Morley JE, Dawson M, Hodgkinson H, Kalk WJ. Galactorrhea and hyperprolactinemia associated with chest wall injury. J Clin Endocrinol Metab 1977; 45:931.
- Love SM, Gelman RS, Silen W. Sounding board. Fibrocystic "disease" of the breast--a nondisease? N Engl J Med 1982; 307:1010.
- Devitt JE. Abandoning fibrocystic disease of the breast: timely end of an era. CMAJ 1986; 134:217.
- Hutter RV. Goodbye to "fibrocystic disease". N Engl J Med 1985; 312:179.
- Morrow M. The evaluation of common breast problems. Am Fam Physician 2000; 61:2371.
- Leddy R, Irshad A, Zerwas E, et al. Role of breast ultrasound and mammography in evaluating patients presenting with focal breast pain in the absence of a palpable lump. Breast J 2013; 19:582.
- Boyd NF, McGuire V, Shannon P, et al. Effect of a low-fat high-carbohydrate diet on symptoms of cyclical mastopathy. Lancet 1988; 2:128.
- Goodwin PJ, Miller A, Del Giudice ME, et al. Elevated high-density lipoprotein cholesterol and dietary fat intake in women with cyclic mastopathy. Am J Obstet Gynecol 1998; 179:430.
- Ernster VL, Goodson WH 3rd, Hunt TK, et al. Vitamin E and benign breast "disease": a double-blind, randomized clinical trial. Surgery 1985; 97:490.
- Blommers J, de Lange-De Klerk ES, Kuik DJ, et al. Evening primrose oil and fish oil for severe chronic mastalgia: a randomized, double-blind, controlled trial. Am J Obstet Gynecol 2002; 187:1389.
- Wilson MC, Sellwood RA. Therapeutic value of a supporting brassière in mastodynia. Br Med J 1976; 2:90.
- Hadi MS. Sports Brassiere: Is It a Solution for Mastalgia? Breast J 2000; 6:407.
- Mason BR, Page KA, Fallon K. An analysis of movement and discomfort of the female breast during exercise and the effects of breast support in three cases. J Sci Med Sport 1999; 2:134.
- Colak T, Ipek T, Kanik A, et al. Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia treatment. J Am Coll Surg 2003; 196:525.
- Diclofenac gel for osteoarthritis. Med Lett Drugs Ther 2008; 50:31.
- A diclofenac patch (Flector) for pain. Med Lett Drugs Ther 2008; 50:1.
- Dixon JM. Hormone replacement therapy and the breast. BMJ 2001; 323:1381.
- Graham CA, Sherwin BB. A prospective treatment study of premenstrual symptoms using a triphasic oral contraceptive. J Psychosom Res 1992; 36:257.
- Bancroft J, Rennie D. The impact of oral contraceptives on the experience of perimenstrual mood, clumsiness, food craving and other symptoms. J Psychosom Res 1993; 37:195.
- Euhus DM, Uyehara C. Influence of parenteral progesterones on the prevalence and severity of mastalgia in premenopausal women: a multi-institutional cross-sectional study. J Am Coll Surg 1997; 184:596.
- Uzan S, Denis C, Pomi V, Varin C. Double-blind trial of promegestone (R 5020) and lynestrenol in the treatment of benign breast disease. Eur J Obstet Gynecol Reprod Biol 1992; 43:219.
- O'Brien PM, Abukhalil IE. Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol. Am J Obstet Gynecol 1999; 180:18.
- Gateley CA, Miers M, Mansel RE, Hughes LE. Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic. J R Soc Med 1992; 85:12.
- Srivastava A, Mansel RE, Arvind N, et al. Evidence-based management of Mastalgia: a meta-analysis of randomised trials. Breast 2007; 16:503.
- Fentiman IS, Caleffi M, Hamed H, Chaudary MA. Dosage and duration of tamoxifen treatment for mastalgia: a controlled trial. Br J Surg 1988; 75:845.
- Parlati E, Polinari U, Salvi G, et al. Bromocriptine for treatment of benign breast disease. A double-blind clinical trial versus placebo. Acta Obstet Gynecol Scand 1987; 66:483.
- Sismondi P, Biglia N, Giai M, Defabiani E. GnRH analogs in benign breast disease and breast cancer chemoprevention. A challenge for the year 2000. Eur J Gynaecol Oncol 1994; 15:108.
- Wisbey JR, Kumar S, Mansel RE, et al. Natural history of breast pain. Lancet 1983; 2:672.
- Kumar S, Mansel RE, Scanlon MF, et al. Altered responses of prolactin, luteinizing hormone and follicle stimulating hormone secretion to thyrotrophin releasing hormone/gonadotrophin releasing hormone stimulation in cyclical mastalgia. Br J Surg 1984; 71:870.
- Gateley CA, Mansel RE. Management of the painful and nodular breast. Br Med Bull 1991; 47:284.
- Duijm LE, Guit GL, Hendriks JH, et al. Value of breast imaging in women with painful breasts: observational follow up study. BMJ 1998; 317:1492.
- Goodwin PJ, DeBoer G, Clark RM, et al. Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study. Breast Cancer Res Treat 1995; 33:63.
- Plu-Bureau G, Thalabard JC, Sitruk-Ware R, et al. Cyclical mastalgia as a marker of breast cancer susceptibility: results of a case-control study among French women. Br J Cancer 1992; 65:945.
- Aiello EJ, Buist DS, White E, et al. Rate of breast cancer diagnoses among postmenopausal women with self-reported breast symptoms. J Am Board Fam Pract 2004; 17:408.
- Cyclical breast pain
- Noncyclical breast pain
- Extramammary pain
- PHYSICAL EXAMINATION
- Role of diet and lifestyle
- Symptomatic relief
- Medical therapy
- Association with breast cancer
- MALE BREAST PAIN
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS