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)
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.
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