Low-Fat Diet for Breast Mastalgia
There is no convincing scientific evidence that a low-fat diet significantly improves breast mastalgia, despite this being a commonly recommended intervention. 1
Types of Breast Pain and Their Causes
Breast mastalgia affects 70-80% of women at some point in their lives and is categorized into three main types 1, 2:
- Cyclical mastalgia (70% of cases): Related to hormonal fluctuations, waxes and wanes with menstrual cycle
- Noncyclical mastalgia (25% of cases): Usually unilateral, more focal, often inflammatory rather than hormonal
- Extramammary pain (10-15% of cases): Pain originating outside the breast but perceived as breast pain
The etiology of breast pain is multifactorial and may include 1:
- Hormonal fluctuations
- Disorders of lipid metabolism or fatty acid levels
- Medications (hormonal treatments, SSRIs)
- Psychological factors
- Breast size and inadequate support
Evidence Regarding Low-Fat Diet
A small study of 16 women with cystic breast disease and cyclic mastalgia found that reducing dietary fat intake from 35% to 21% of total calories resulted in significant reductions in luteal-phase serum estrogens, but did not report on pain outcomes 3
Despite widespread belief in dietary interventions, the American College of Radiology notes there is no convincing scientific evidence that dietary modifications significantly affect breast pain 1, 2
The evidence for dietary fat affecting breast cancer recurrence and survival is not strongly or consistently supportive, especially when total calories and obesity are considered 1
First-Line Management Approaches
Reassurance alone resolves symptoms in 86% of mild cases and 52% of severe cases of breast mastalgia 2, 4
Non-pharmacological measures should be tried first 2, 5:
- Wearing a well-fitted supportive bra, especially during exercise
- Application of ice packs or heating pads for comfort
- Regular physical exercise
- Over-the-counter NSAIDs for pain relief
Special Considerations
For women with large breasts, pain may be related to breast size and can be associated with neck, shoulder, and back pain 1, 2
Smoking cessation should be advised for patients with periductal inflammation and burning pain behind the nipple, as this is often associated with heavy smoking 1, 2
Stress management may be beneficial as stressful lifestyle has been associated with mastalgia 6
Common Pitfalls to Avoid
Dismissing breast pain without proper evaluation, as some cancers (especially invasive lobular and anaplastic carcinomas) can present with pain 1, 2
Ordering unnecessary imaging for diffuse, non-focal breast pain when clinical exam is normal 2, 7
Focusing solely on dietary interventions when other approaches may be more effective 2, 5
Failing to consider extramammary causes when breast exam and imaging are normal 1, 2