Skip to main content

Management of Breast Pain

  • Chapter
  • First Online:
Breast Disease

Abstract

Breast pain, or mastalgia, is one of the most common breast disorders in women. Initial concerns related to the association of breast pain and the risk of breast cancer often prompt patients to seek medical evaluation for breast pain. Mastalgia is further classified as cyclic (associated with the menstrual cycle) and noncyclic. Extramammary pain can often be perceived as mastalgia and awareness of extramammary causes is important in the evaluation of patients presenting with breast pain. The clinical evaluation of mastalgia entails a careful history and physical examination, often with the addition of appropriate imaging studies based upon the type and location of the pain, clinical findings, and age of the patient. A number of non-pharmacologic therapies can be recommended as first-line therapies while reserving pharmacologic treatments for more severe symptoms and complaints. Reassurance can also be an important component in the management of mastalgia, while surgical interventions have a much more limited role.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 189.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CM:

Cyclic mastalgia

EP:

Extramammary pain

NCM:

Noncyclic mastalgia

References

  1. Leinster SJ, Whitehouse GH, Walsh PV. Cyclical mastalgia: clinical and mammographic observations in a screened population. Br J Surg. 1987;74(3):220–2.

    Article  CAS  PubMed  Google Scholar 

  2. Rosolowich V, Saettler E, Szuck B, Lea RH, Levesque P, Weisberg F, et al. Mastalgia. J Obstet Gynaecol Can. 2006;28(1):49–71; quiz 58–60, 72–4.

    PubMed  Google Scholar 

  3. Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc. 2004;79(3):353–72.

    Article  PubMed  Google Scholar 

  4. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709–17.

    Article  CAS  PubMed  Google Scholar 

  5. Braunstein G. Gynecomastia. In: Harris J, Lippman M, Morrow M, Hellman S, editors. Diseases of the breast. Philadelphia: Lippincott-Raven; 1996. p. 54–60.

    Google Scholar 

  6. Barton MB, Elmore JG, Fletcher SW. Breast symptoms among women enrolled in a health maintenance organization: frequency, evaluation, and outcome. Ann Intern Med. 1999;130(8):651–7.

    Article  CAS  PubMed  Google Scholar 

  7. Ader DN, Browne MW. Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. Am J Obstet Gynecol. 1997;177(1):126–32.

    Article  CAS  PubMed  Google Scholar 

  8. Davies EL, Gateley CA, Miers M, Mansel RE. The long-term course of mastalgia. J R Soc Med. 1998;91(9):462–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Miltenburg DM, Speights Jr VO. Benign breast disease. Obstet Gynecol Clin North Am. 2008;35(2):285–300, ix.

    Article  PubMed  Google Scholar 

  10. Preece PE, Richards AR, Owen GM, Hughes LE. Mastalgia and total body water. Br Med J. 1975;4(5995):498–500.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Mansel RE. ABC of breast diseases. Breast pain. BMJ. 1994;309(6958):866–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Peters F, Diemer P, Mecks O, Behnken LL. Severity of mastalgia in relation to milk duct dilatation. Obstet Gynecol. 2003;101(1):54–60.

    Article  PubMed  Google Scholar 

  13. Dixon JM. Periductal mastitis/duct ectasia. World J Surg. 1989;13(6):715–20.

    Article  CAS  PubMed  Google Scholar 

  14. Johnson KM, Bradley KA, Bush K, Gardella C, Dobie DJ, Laya MB. Frequency of mastalgia among women veterans. Association with psychiatric conditions and unexplained pain syndromes. J Gen Intern Med. 2006;21 Suppl 3:S70–5.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Plu-Bureau G, Le MG, Sitruk-Ware R, Thalabard JC. Cyclical mastalgia and breast cancer risk: results of a French cohort study. Cancer Epidemiol Biomarkers Prev. 2006;15(6):1229–31.

    Article  PubMed  Google Scholar 

  16. Khan SA, Apkarian AV. Mastalgia and breast cancer: a protective association? Cancer Detect Prev. 2002;26(3):192–6 [Erratum in Cancer Detect Prev. 2003;27(1):82].

    Article  PubMed  Google Scholar 

  17. Olsen ML, Morton M, Stan D, Pruthi S. Is there a role for magnetic resonance imaging in diagnosing palpable breast masses when mammogram and ultrasound are negative? J Womens Health. 2012;21(11):1149–54.

    Article  Google Scholar 

  18. Leung JW, Kornguth PJ, Gotway MB. Utility of targeted sonography in the evaluation of focal breast pain. J Ultrasound Med. 2002;21(5):521–6; quiz 8–9.

    PubMed  Google Scholar 

  19. Klimberg V. Etiology and management of breast pain. In: Harris J, Lippman M, Morrow M, Hellman S, editors. Diseases of the breast. Philadelphia: Lippincott-Raven; 1996. p. 99–106.

    Google Scholar 

  20. Millet AV, Dirbas FM. Clinical management of breast pain: a review. Obstet Gynecol Surv. 2002;57(7):451–61.

    Article  PubMed  Google Scholar 

  21. Maddox PR, Mansel RE. Management of breast pain and nodularity. World J Surg. 1989;13(6):699–705.

    Article  CAS  PubMed  Google Scholar 

  22. Gateley CA, Mansel RE. Management of cyclical breast pain. Br J Hosp Med. 1990;43(5):330–2.

    CAS  PubMed  Google Scholar 

  23. BeLieu RM. Mastodynia. Obstet Gynecol Clin North Am. 1994;21(3):461–77.

    CAS  PubMed  Google Scholar 

  24. Hadi MS. Sports brassiere: is it a solution for mastalgia? Breast J. 2000;6(6):407–9.

    Article  PubMed  Google Scholar 

  25. Mason BR, Page KA, Fallon K. An analysis of movement and discomfort of the female breast during exercise and the effects of breast support in three cases. J Sci Med Sport. 1999;2(2):134–44.

    Article  CAS  PubMed  Google Scholar 

  26. Downey H, Deadman J, Davis C, Leinster S. Psychological characteristics of women with cyclical mastalgia. Breast Dis. 1993;6:99–105.

    Google Scholar 

  27. Fox H, Walker LG, Heys SD, Ah-See AK, Eremin O. Are patients with mastalgia anxious, and does relaxation therapy help? Breast. 1997;6(3):138–42.

    Article  Google Scholar 

  28. Allen SS, Froberg DG. The effect of decreased caffeine consumption on benign proliferative breast disease: a randomized clinical trial. Surgery. 1987;101(6):720–30.

    CAS  PubMed  Google Scholar 

  29. Lubin F, Ron E, Wax Y, Black M, Funaro M, Shitrit A. A case-control study of caffeine and methylxanthines in benign breast disease. JAMA. 1985;253(16):2388–92.

    Article  CAS  PubMed  Google Scholar 

  30. Ferrini RL, Barrett-Connor E. Caffeine intake and endogenous sex steroid levels in postmenopausal women. The Rancho Bernardo Study. Am J Epidemiol. 1996;144(7):642–4.

    Article  CAS  PubMed  Google Scholar 

  31. Ernster VL, Mason L, Goodson 3rd WH, Sickles EA, Sacks ST, Selvin S, et al. Effects of caffeine-free diet on benign breast disease: a randomized trial. Surgery. 1982;91(3):263–7.

    CAS  PubMed  Google Scholar 

  32. Parsay S, Olfati F, Nahidi S. Therapeutic effects of vitamin E on cyclic mastalgia. Breast J. 2009;15(5):510–4.

    Article  CAS  PubMed  Google Scholar 

  33. Meyer EC, Sommers DK, Reitz CJ, Mentis H. Vitamin E and benign breast disease. Surgery. 1990;107(5):549–51.

    CAS  PubMed  Google Scholar 

  34. Gateley CA, Maddox PR, Pritchard GA, Sheridan W, Harrison BJ, Pye JK, et al. Plasma fatty acid profiles in benign breast disorders. Br J Surg. 1992;79(5):407–9.

    Article  CAS  PubMed  Google Scholar 

  35. Srivastava A, Mansel RE, Arvind N, Prasad K, Dhar A, Chabra A. Evidence-based management of Mastalgia: a meta-analysis of randomised trials. Breast. 2007;16(5):503–12.

    Article  CAS  PubMed  Google Scholar 

  36. Pruthi S, Wahner-Roedler DL, Torkelson CJ, Cha SS, Thicke LS, Hazelton JH, et al. Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study. Altern Med Rev. 2010;15(1):59–67.

    PubMed  Google Scholar 

  37. Goss P, Li T, Theriault M, Pinto S, Thompson L. Effects of dietary flaxseed in women with cyclical mastalgia [Abstract]. Breast Cancer Res Treat. 2000;64(1):49.

    Google Scholar 

  38. Speroff L, Rowan J, Symons J, Genant H, Wilborn W. The comparative effect on bone density, endometrium, and lipids of continuous hormones as replacement therapy (CHART study). A randomized controlled trial. JAMA. 1996;276(17):1397–403.

    Article  CAS  PubMed  Google Scholar 

  39. Crandall CJ, Aragaki AK, Cauley JA, McTiernan A, Manson JE, Anderson G, et al. Breast tenderness and breast cancer risk in the estrogen plus progestin and estrogen-alone women’s health initiative clinical trials. Breast Cancer Res Treat. 2012;132(1):275–85.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Coney P, Washenik K, Langley RG, DiGiovanna JJ, Harrison DD. Weight change and adverse event incidence with a low-dose oral contraceptive: two randomized, placebo-controlled trials. Contraception. 2001;63(6):297–302.

    Article  CAS  PubMed  Google Scholar 

  41. Euhus DM, Uyehara C. Influence of parenteral progesterones on the prevalence and severity of mastalgia in premenopausal women: a multi-institutional cross-sectional study. J Am Coll Surg. 1997;184(6):596–604.

    CAS  PubMed  Google Scholar 

  42. Mansel RE, Wisbey JR, Hughes LE. Controlled trial of the antigonadotropin danazol in painful nodular benign breast disease. Lancet. 1982;1(8278):928–30.

    Article  CAS  PubMed  Google Scholar 

  43. Ramsey-Stewart G. The treatment of symptomatic benign breast disease with danazol. Aust N Z J Obstet Gynaecol. 1988;28(4):299–304.

    Article  CAS  PubMed  Google Scholar 

  44. Watts JF, Butt WR, Logan Edwards R. A clinical trial using danazol for the treatment of premenstrual tension. Br J Obstet Gynaecol. 1987;94(1):30–4.

    Article  CAS  PubMed  Google Scholar 

  45. O’Brien PM, Abukhalil IE. Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol. Am J Obstet Gynecol. 1999;180(1 Pt 1):18–23.

    Article  PubMed  Google Scholar 

  46. Gorins A, Perret F, Tournant B, Rogier C, Lipszyc J. A French double-blind crossover study (danazol versus placebo) in the treatment of severe fibrocystic breast disease. Eur J Gynaecol Oncol. 1984;5(2):85–9.

    CAS  PubMed  Google Scholar 

  47. Sutton GL, O’Malley VP. Treatment of cyclical mastalgia with low dose short term danazol. Br J Clin Pract. 1986;40(2):68–70.

    CAS  PubMed  Google Scholar 

  48. Peters F, Reck G, Zimmermann G, Breckwoldt M. The effect of danazol on the pituitary function, thyroid function, and mastodynia. Arch Gynecol. 1980;230(1):3–8.

    Article  CAS  PubMed  Google Scholar 

  49. Baker HW, Snedecor PA. Clinical trial of danazol for benign breast disease. Am Surg. 1979;45(11):727–9.

    CAS  PubMed  Google Scholar 

  50. Greenblatt B, Ben-Nun I. Danazol in the treatment of mammary dysplasia. Drugs. 1980;19(5):349–55.

    Article  CAS  PubMed  Google Scholar 

  51. Doberl A, Tobiassen T, Rasmussen T. Treatment of recurrent cyclical mastodynia in patients with fibrocystic breast disease. A double-blind placebo-controlled study–the Hjorring project. Acta Obstet Gynecol Scand Suppl. 1984;123:177–84.

    Article  CAS  PubMed  Google Scholar 

  52. Tobiassen T, Rasmussen T, Doberl A, Rannevik G. Danazol treatment of severely symptomatic fibrocystic breast disease and long-term follow-up–the Hjorring project. Acta Obstet Gynecol Scand Suppl. 1984;123:159–76.

    Article  CAS  PubMed  Google Scholar 

  53. Maddox PR, Harrison BJ, Mansel RE. Low-dose danazol for mastalgia. Br J Clin Pract Suppl. 1989;68:43–7; discussion 9–53.

    CAS  PubMed  Google Scholar 

  54. Harrison BJ, Maddox PR, Mansel RE. Maintenance therapy of cyclical mastalgia using low-dose danazol. J R Coll Surg Edinb. 1989;34(2):79–81.

    CAS  PubMed  Google Scholar 

  55. Ouimet-Oliva D, Van Campenhout J, Hebert G, Ladouceur J. Effect of danazol on the radiographic density of breast parenchyma. J Can Assoc Radiol. 1981;32(3):159–61.

    CAS  PubMed  Google Scholar 

  56. Kaleli S, Aydin Y, Erel CT, Colgar U. Symptomatic treatment of premenstrual mastalgia in premenopausal women with lisuride maleate: a double-blind placebo-controlled randomized study. Fertil Steril. 2001;75(4):718–23.

    Article  CAS  PubMed  Google Scholar 

  57. Ioannidou-Mouzaka L, Niagassas M, Galanos A, Kalovidouris A. Pilot study on the treatment of cyclical mastodynia with Quinagolide. Eur J Gynaecol Oncol. 1999;20(2):117–21.

    CAS  PubMed  Google Scholar 

  58. Kumar S, Mansel RE, Scanlon MF, Hughes LE, Edwards CA, Woodhead JS, et al. Altered responses of prolactin, luteinizing hormone and follicle stimulating hormone secretion to thyrotrophin releasing hormone/gonadotrophin releasing hormone stimulation in cyclical mastalgia. Br J Surg. 1984;71(11):870–3.

    Article  CAS  PubMed  Google Scholar 

  59. Kumar S, Mansel RE, Hughes LE, Woodhead JS, Edwards CA, Scanlon MF, et al. Prolactin response to thyrotropin-releasing hormone stimulation and dopaminergic inhibition in benign breast disease. Cancer. 1984;53(6):1311–5.

    Article  CAS  PubMed  Google Scholar 

  60. Mansel RE, Dogliotti L. European multicentre trial of bromocriptine in cyclical mastalgia. Lancet. 1990;335(8683):190–3.

    Article  CAS  PubMed  Google Scholar 

  61. Fentiman IS, Caleffi M, Brame K, Chaudary MA, Hayward JL. Double-blind controlled trial of tamoxifen therapy for mastalgia. Lancet. 1986;1(8476):287–8.

    Article  CAS  PubMed  Google Scholar 

  62. Powles TJ, Ford HT, Gazet J-C. A randomised trial to compare tamoxifen with danazol for treatment of benign mammary dysplasia. Breast Dis (Senologia). 1987;1987(2):1–5.

    Google Scholar 

  63. Messinis IE, Lolis D. Treatment of premenstrual mastalgia with tamoxifen. Acta Obstet Gynecol Scand. 1988;67(4):307–9.

    Article  CAS  PubMed  Google Scholar 

  64. Fentiman IS, Caleffi M, Hamed H, Chaudary MA. Dosage and duration of tamoxifen treatment for mastalgia: a controlled trial. Br J Surg. 1988;75(9):845–6.

    Article  CAS  PubMed  Google Scholar 

  65. GEMB Group (Grupo de Estudio de Mastopatias Benignas) Argentine. Tamoxifen therapy for cyclical mastalgia: dose randomised trial. Breast. 1997;5:212–3.

    Google Scholar 

  66. Sandrucci S, Mussa A, Festa V. Comparison of tamoxifen and bromocriptine in management of fibrocystic breast disease: a randomized blind study. Ann N Y Acad Sci. 1990;586:626–8.

    Google Scholar 

  67. Kontostolis E, Stefanidis K, Navrozoglou I, Lolis D. Comparison of tamoxifen with danazol for treatment of cyclical mastalgia. Gynecol Endocrinol. 1997;11(6):393–7.

    Article  CAS  PubMed  Google Scholar 

  68. Hamed H, Caleffi M, Chaudary MA, Fentiman IS. LHRH analogue for treatment of recurrent and refractory mastalgia. Ann R Coll Surg Engl. 1990;72(4):221–4.

    CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julia A. Files MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Files, J.A., Allen, S.V., Pruthi, S. (2015). Management of Breast Pain. In: Riker, A. (eds) Breast Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1145-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1145-5_4

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1144-8

  • Online ISBN: 978-1-4939-1145-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics