Mastalgia (breast pain) is common and can be localized or diffuse and unilateral or bilateral.
Etiology
Localized breast pain is usually caused by a focal disorder that causes a mass, such as a breast cyst, or an infection (eg, mastitis, abscess). Most breast cancers do not cause pain.
Diffuse bilateral pain may be caused by fibrocystic changes or, uncommonly, diffuse bilateral mastitis. However, diffuse bilateral pain is very common in women without breast abnormalities. The most common causes in these women are
Evaluation
History
History of present illness should address the temporal pattern of pain and its nature (focal or diffuse, unilateral or bilateral). The relation between chronic or recurrent pain and menstrual cycle phase should be ascertained.
Review of systems should seek other symptoms suggesting pregnancy (eg, abdominal enlargement, amenorrhea, morning nausea) or fibrocystic changes (eg, presence of many masses).
Past medical history should cover disorders that could cause diffuse pain (eg, fibrocystic changes) and use of estrogens and progestins.
Physical examination
Red flags
Interpretation of findings
Testing
Treatment
For menstrual-related mastalgia, acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) is usually effective. If pain is severe, a brief course of danazol or tamoxifen may be given. These drugs inhibit estrogen and progesterone. If estrogen or a progestin is being taken, stopping may be necessary.
For pregnancy-related breast pain, wearing a firm, supportive brassiere, taking acetaminophen, or both, can help.
Recent evidence suggests that evening primrose oil may reduce the severity of mastalgia.
