BMN Blog

Breast pain is one of the most common symptoms in patients undergoing breast imaging tests. Known clinically as breast mastalgia, breast pain is a frequent ailment in women regularly affecting their quality of life. In the mainstream, especially in the media and on the internet, breast pain is often associated as a symptom of cancer. However, breast pain can develop from a variety of different conditions.

Two Types of Breast Pain (Mastalgia)

• Cyclical breast pain – ranging from slight discomfort or sensation to acute pain relating to fluctuating hormone levels during a woman’s menstrual cycle. One recent study reports two-thirds of women experience cyclical breast pain during their lifetime. This pain is usually bilateral, located in the upper outer quadrant of the breast. This type of breast pain can vary within the menstrual cycle as well as increase mid cycle until usually relieved with the start of menstruation. Cyclical breast pain occurs in premenopausal women, normally in the 30-40 age range. This type of pain can present as discomfort, fullness or heaviness, and dull or constant pain (achiness).

• Noncyclic breast pain – persistent pain radiating from a precise area and separate from the menstrual cycle. Noncyclic breast pain can also present from trauma in nearby muscles and joints within the proximity of the breast. This type of pain can radiate from the mammary or chest wall or musculoskeletal area. Noncyclic breast pain occurs most commonly in the 40-50 age range, in most cases is unilateral, localizes to the inner part of the breast or outer edge of the breast or even behind the nipple. The pain associated with noncyclic breast pain can resemble a burning, stabbing or throbbing pain. A recent study reports one-third of women will experience noncyclic breast pain during their life.

Breast Pain as a Symptom of Breast Cancer

Cancer is actually an infrequent source of mastalgia or breast pain. However, it can be a symptom in some breast cancer cases. Any type of breast pain should be thoroughly assessed by a medical doctor for potential associated symptoms and management of the patient’s symptoms. In addition, it’s rare for men to develop breast mastalgia, though it can develop in some cases of gynecomastia, a benign growth in male breast glandular tissue.

Women with primary inflammatory breast cancer (IBC) may also experience breast pain. Inflammatory breast cancer characteristics may include a tender, firm and enlarged breast. Additionally, the skin over the breast may present as warm, thicker than normal and present with an orange hue. Any breast pain or change in the breast consisting of lumps or breast nodules, skin changes, peu d’orange color which is characterized by orange skin with edema and pitting, nipple retraction or discharge, as well as fever, should be seen by a medical doctor for further evaluation.

Diagnosis of Breast Pain

Breast pain in isolation with no other relevant features on history or examination is not an indication for imaging. All patients being seen by a medical doctor for breast pain within the reproductive age should be given a pregnancy test. Women with cyclical or bilateral non-focal breast pain usually do not require imaging. However, women with noncyclical, unilateral, or focal breast pain that is not extra mammary, such as chest wall pain, as determined by physical exam should undergo breast imaging to clarify the underlying etiology and exclude breast cancer. The choice of imaging modality is based on age. Women under 30 years of age should undergo an ultrasound because it is more accurate than a mammography for that particular age group.

Women between 30-39 years of age should also undergo ultrasound, and unilateral or bilateral mammography should also be performed because in this age group some small cancers are found on mammography but not ultrasound. Women age 40 and older should undergo both mammography and ultrasound. Any underlying cause of breast pain suspected should be investigated and managed as appropriate by a medical doctor.

Heather Deisher, MD is an OB/GYN in practice with Brookwood Women’s Health.