Benign Breast Diseases: Mastalgia (Breast Pain)

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Mastalgia may affect up to 70 per cent of women during their lifetime. The causes are largely unknown and there are probably many, including hormone levels in the body, fat in the diet, the menstrual cycle and fluid retention. Breast pain may be cyclical, non-cyclical or musculoskeletal.

Cyclical mastalgia is most commonly observed in women in their 30s. The pain, which lasts for a variable length of time, is frequently worse in the pre-menstrual phase of the cycle and resolves with menstruation. It is most often bilateral but may be unilateral or localized. The extent of pain severity may differ with each menstrual cycle.

Non-cyclical mastalgia is often later in onset and is unrelated to the menstrual cycle. It may be constant, intermittent or sporadic. The pain may be diffuse or localized to one area of one breast with radiation to the axilla or arm.

Both cyclical and non-cyclical mastalgia are often associated with breast nodularity or lumpiness. Spontaneous resolution, after a variable period of time, usually occurs.

Diagnosis

No test is required unless an abnormality is found on clinical breast examination.
Breast self-examination is an important skill to acquire.

Treatment

No treatment is required in the majority of cases of mastalgia. The following may be helpful:

Dietary modifications including a reduction of caffeine, fat and salt.
A comfortable, well-fitting supportive bra.
Discontinuation of oral contraceptive or hormone.
Drug therapy:
- In mild cases, simple analgesics such as aspirin and Tylenol may help.
- More severe cases are aided by evening primrose oil (Efamol), Danazol and Bromocriptine. Other investigational agents, such as flaxseed, have proven effective.

Risk of Breast Cancer