What is the workup for mastodynia (breast pain)?

From the Guidelines

Mastodynia workup should begin with a thorough clinical history and physical examination to identify potential causes of breast pain, and for women with clinically insignificant breast pain, no imaging beyond usual screening recommendations is indicated. The initial assessment should include details about pain characteristics (cyclical vs. non-cyclical), location, duration, and relationship to menstrual cycle. Physical examination should evaluate for breast masses, skin changes, nipple discharge, and lymphadenopathy.

• For women less than 30 years of age with clinically significant breast pain (focal and noncyclical), ultrasound (US) is the appropriate initial imaging modality 1.
• For women 30 to 39 years of age with clinically significant breast pain (focal and noncyclical), mammography, including digital breast tomosynthesis (DBT), and US are appropriate and equivalent alternatives 1.
• For women 40 years of age and older with clinically significant breast pain (focal and noncyclical), mammography and DBT are appropriate equivalent alternatives, and are complementary to US 1. The workup should also consider non-breast etiologies such as chest wall pain, which may require different diagnostic approaches.
• Basic management strategies for cyclical mastodynia include wearing a supportive bra, reducing caffeine and salt intake, and using NSAIDs like ibuprofen 400-600mg every 6-8 hours during painful periods.
• If these measures fail, hormonal treatments such as oral contraceptives or danazol 100-400mg daily may be considered.
• For non-cyclical pain, further investigation with MRI might be warranted if initial imaging is inconclusive.
• Biopsy should be performed if there are suspicious findings on imaging or examination.

From the Research

Mastodynia Workup

• A thorough history and physical examination are essential in evaluating mastodynia, as they can help determine the underlying cause and guide treatment options 2, 3, 4, 5
• The physical examination can help reassure the patient that they do not have breast cancer, and can also identify any palpable masses or other abnormalities 2, 3, 4, 5
• Imaging studies, such as ultrasound, may be necessary in some cases to rule out malignancy, especially in patients with a family history of breast cancer or abnormal physical examination findings 6
• However, in young patients (less than 30 years old) with normal physical examination and no family history, imaging may not be necessary, and medical therapy can be started directly after informing the patient 6
• The workup for mastodynia should also consider other potential causes, such as:
  • Hormonal fluctuations 2, 4
  • Dietary factors, such as high fat intake 4
  • Medications, such as oral contraceptives or hormone replacement therapy 4
  • Stress and anxiety 2
  • Ill-fitting bra 2, 4
• A targeted approach to diagnosis and treatment can help improve patient outcomes and reduce unnecessary testing and treatment 2, 3, 4, 5