I. Pathophysiology

  1. Breast Pain thought to be related to Estrogen excess

II. Causes

  1. See Medication Causes of Mastalgia
  2. Cyclic Breast Pain
    1. Pain related to Menses (typically during Luteal Phase, second half of cycle)
  3. Non-cyclic Breast Pain
    1. Costochondritis
    2. Chest Trauma
    3. Sclerosing adenosis
    4. Large pendulous Breasts
    5. Breast Cancer (represents under 5% of Breast Pain)
      1. Associated with focal Breast Pain (contrast with diffuse Breast Pain in benign Mastalgia)

III. History

  1. Location: Focal or Diffuse
    1. Focal Breast Pain more concerning for malignancy than diffuse pain
  2. Duration of Breast Pain
  3. Unilateral or Bilateral
  4. Changes with Menstrual Cycle
  5. Relationship to hormonal replacement therapy
  6. Rank Breast Pain on a 10 point scale
  7. Altered life style
  8. Excessive Worry or emotional stress

V. Evaluation

  1. Breast Mass present
    1. Evaluate as Breast Mass
  2. Diffuse Breast Pain, no Breast Mass present, and no significant Breast Cancer Risk Factors
    1. Very reassuring as low risk for malignancy
    2. Routine Mammography starting at age 40 years (or age 30 years if Breast Cancer Risk Factors)
  3. Focal Breast Pain and no Breast Mass present
    1. Younger than age 30 years
      1. Consider targeted breast Ultrasound
      2. Consider repeat Breast Exam in 1-2 months
    2. Older than age 30 years
      1. Step 1: Breast Imaging
        1. Diagnostic Mammogram AND
        2. Targeted breast Ultrasound
      2. Step 2a: Negative Breast imaging
        1. Breast Cancer Risk Factors
          1. Consider subspecialist referral
          2. Routine Mammography starting at age 30 years
        2. No Breast Cancer Risk Factors
          1. Very reassuring as low risk for malignancy
          2. Routine Mammography starting at age 40 years
      3. Step 2b: Abnormal Breast imaging
        1. Breast FNA or Breast core biopsy

VI. Associated Conditions

VII. Management: Measures with best efficacy

  1. Expect spontaneous resolution in up to 80-90% of patients
  2. General measures
    1. Wear supportive Brassiere or Sports Bra
    2. Eliminate Caffeine
  3. First-line preparations
    1. NSAIDs
    2. Topical diclofenac (Solaraze)
  4. Refractory preparations
    1. Tamoxifen
    2. Danazol

VIII. Management: Other measures with less supporting evidence

  1. Vitamin E Supplementation up to 800 IU qd
  2. Herbal therapies with variable efficacy
    1. Evening Primrose Oil 1500-3000 mg orally daily
    2. Chaste Tree Berry 30 to 40 mg orally daily (PMS)
    3. References
      1. Hardy (2000) J Am Pharm Assoc 40:234-42
  3. Medroxyprogesterone
    1. Dose: 150 mg IM q3 months
    2. Very effective in pre-menopausal women
      1. Marked reduction in Mastalgia
    3. Reference
      1. Euhus (1997) J Am Coll Surg 184:596-604

Images: Related links to external sites (from Google)

Ontology: Mastodynia (C0024902)

Definition (NCI) Painful sensation in the breast region.
Definition (NCI) A disorder characterized by marked discomfort sensation in the breast region.
Definition (MSH) Pain in the breast generally classified as cyclical (associated with menstrual periods), or noncyclical, i.e. originating from the breast or nearby muscles or joints, ranging from minor discomfort to severely incapacitating.
Concepts Sign or Symptom (T184)
MSH D059373
ICD9 611.71
ICD10 N64.4
SnomedCT 53430007, 237452006, 198117005, 155959001, 266645003
English Mastodynia, BREAST PAIN, MASTALGIA, MASTODYNIA, breast pain, mastodynia, breast pain (symptom), mastodynia (diagnosis), Mastalgia (finding), Pain of breast (disorder), Ache breast, Pain breast, Sore breasts, Soreness breast, breasts soreness, breasts sores, sore breasts, ache breast, breast soreness, breasts sore, breast ache, breast painful, breast pains, acheing breasts, breasts pain, soreness breast, breast sores, breasts pains, pain breast, sore breast, pain in the breast, breast sore, painful breasts, of breast pain, pain in breast, painful breast, Mastodynias, Mastalgias, Mammalgia, Breast Pain, Mastalgia, Breast Pains, Pain, Breast, Mammalgias, Pains, Breast, Painful breasts, Breast pain, Pain in the breast, Pain of breast, Breast painful, Pain of breast (finding), breast; pain, mastalgia, pain; breast, Mastodynia - painful breast, Pain in breast
Italian Dolore mammario, Dolore alla mammella, Mastodinia, Mammelle doloranti, Dolore alle mammelle, Irritazione della mammella
Dutch pijn borst, mastalgie, pijnlijke borsten, pijnlijkheid borst, mastodynie, mamma; pijn, pijn; mamma, Mastodynie, borstpijn
French Mastodynie, Douleur au sein, Mastalgie, Endolorissement mammaire, Seins endoloris, Seins douloureux, DOULEUR MAMMAIRE, MASTALGIE, Douleur mammaire
German Schmerz Brust, schmerzhafte Brueste, Empfindlichkeit der Brueste, Schmerz in der Brust, Mastalgie, Mastodynie, empfindliche Brueste, MASTALGIE, Brustschmerz
Portuguese Mastodinia, Moinha mamária, Úlcera da mama, Mamas dolorosas, Mastalgia, Mama dorida, DOR MAMARIA, MASTALGIA, Dor mamária
Spanish Dolor en las mamas, Mastodinia, Mamas adoloridas, Mamas dolorosas, Pain of breast, Pain in breast, Mastodynia - painful breast, Mastalgia, Pain in the breast, MASTALGIA, dolor de mamas, mamas dolorosas, mastalgia, mastodinia (hallazgo), mastodinia, Dolor de mama
Japanese 乳房痛, ニュウボウツウ
Czech Bolavé prsy, Bolest prsu, Mastalgie, Pobolívání prsu, Bolestivé prsy, Bolestivost prsu, Mastodynie
Korean 유방통
Hungarian emlőfájdalom, Emlőfájdalom, Emlő fájdalom, Emlőérzékenység, Fájó emlők, Fájdalmas emlők, Mastalgia, Mastodynia