From the Guidelines
When evaluating breast pain in females, it is crucial to ask about the timing and pattern of pain, location, severity, and duration to determine the underlying cause and appropriate management. The most recent and highest quality study 1 emphasizes the importance of a comprehensive history, including the type of pain, relationship to menses, duration, location, and impact on activities of daily living. Key questions to ask include:
- Timing and pattern of pain (cyclical or non-cyclical)
- Location (one breast or both)
- Severity and duration
- Relationship to menstrual cycle
- Associated symptoms like lumps, nipple discharge, skin changes, or fever
- Aggravating factors such as certain movements, positions, or clothing
- Medical history, including previous breast issues, family history of breast cancer, recent trauma, medications, and pregnancy status
- Impact on daily activities and sleep The NCCN Panel recommends providing reassurance to the patient and treating the pain with symptomatic management if the clinical breast exam (CBE) fails to identify any physical abnormality and screening mammograms are current and negative 1. However, if the breast pain is focal in nature, age-appropriate diagnostic imaging is recommended, such as diagnostic mammogram with or without ultrasound for those ≥30 years of age, and ultrasound for those <30 years of age 1. It is essential to note that most breast pain is not cancer-related, but persistent, severe, or changing pain, especially with other symptoms, warrants medical assessment 1. Treatment depends on the underlying cause but may include over-the-counter pain relievers, wearing a supportive bra, reducing caffeine, or hormonal treatments for cyclical pain. In terms of imaging, the ACR Appropriateness Criteria recommend no imaging beyond usual screening recommendations for women with clinically insignificant breast pain 1, while the NCCN Panel recommends age-appropriate diagnostic imaging for focal breast pain 1. Overall, a thorough evaluation and individualized approach are necessary to manage breast pain effectively and improve patient outcomes.
From the Research
Important Questions to Ask About Breast Pain in Females
When experiencing breast pain, it is essential to ask the right questions to ensure proper diagnosis and treatment. Some of these questions include:
- What are the possible causes of breast pain, and how can they be diagnosed? 2, 3, 4
- What are the differences between cyclical and noncyclical breast pain, and how are they treated? 2, 4
- What imaging tests are recommended for breast pain, and when are they necessary? 2, 3, 5
- What are the treatment options for breast pain, and when are they considered? 2, 3, 4
- How can breast pain impact quality of life, and what can be done to manage it? 2, 3, 4
- What are the risks of malignancy associated with breast pain, and how can they be assessed? 5
Classification and Assessment of Breast Pain
Breast pain can be classified into different types, including:
- Cyclical mastalgia: breast pain related to hormonal changes and the menstrual cycle 2, 4
- Noncyclical mastalgia: breast pain not associated with the menstrual cycle, which can be constant or intermittent 2, 4
- Extramammary pain: pain arising from the chest wall or other sources, interpreted as having a cause within the breast 4
Management and Treatment of Breast Pain
The management and treatment of breast pain depend on the type and severity of the pain. Some treatment options include:
- Conservative, nonpharmacologic strategies for mild to moderate pain 3
- Pharmacologic therapy for severe symptoms impacting quality of life 3, 4
- Topical nonsteroidal anti-inflammatory drugs for severe and resistant breast pain 2
- Reassurance and nonpharmacological measures for most patients with breast pain 4