Mastodynia and Mastalgia (Breast Pain)

Introduction

• Description: Mastalgia is the nonspecific term that is used for breast pain of any etiology. Although breast pain frequently occurs to nursing mothers, the terms are generally reserved for non–pregnancy related symptoms.

• Prevalence: Most women (70%) experience breast pain at some point in their lives (most are transient). Roughly 15% of women who experience it will require treatment.

• Predominant Age: Reproductive age.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Fibrocystic change. Rapid hormonal change (especially a change that involves an increase in estrogen levels, eg, starting birth control pills or hormone therapy or during early pregnancy). In the absence of obvious pathologic changes, mastalgia has been attributed to caffeine consumption and high-fat diets, but hard data are lacking. Nongynecologic causes include dorsal radiculitis or inflammatory changes in the costochondral junction (Tietze syndrome), sclerosing adenosis, chest wall muscle spasms, costochondritis, neuritis, fibromyalgia, and referred pain.

• Risk Factors: Pregnancy, hormone therapy. Caffeine consumption and high-fat diets have been suggested but remain unconfirmed causes.

Signs and Symptoms

• Diffuse breast pain, worse in the upper outer quadrants of the breast, often with radiation to the shoulders or upper arms, which may (two-thirds) or may not (one-third) be related to the menstrual cycle.

• When cyclic, the pain is generally worse during the week before menses. Unilateral or localized pain suggests a pathologic process.

Diagnostic Approach