Breast pain, also known as mastalgia, is a common complaint among women and can be associated with a variety of conditions, ranging from benign to serious. The pain can be cyclic (related to the menstrual cycle) or non-cyclic, and its nature and management depend on the underlying cause.
Causes of Breast Pain in Females:
- Cyclic Breast Pain:
- Most common type, associated with menstrual cycles.
- Likely related to hormonal changes during the menstrual cycle.
- Non-Cyclic Breast Pain:
- Can be related to breast structure (e.g., cysts, fibroadenomas).
- Trauma or prior breast surgery.
- Inflammation/infection (e.g., mastitis, especially in breastfeeding women).
- Extrinsic causes like musculoskeletal pain, chest wall pain.
- Extramammary Pain:
- Pain not originating from the breast but referred to the breast area; may include conditions like costochondritis, spinal disease.
Diagnosis:
- History:
- Detailed menstrual history for cyclic patterns.
- Nature of pain: SOCRATES
- Any associated symptoms: lumps, nipple discharge, skin changes.
- Medication history, including hormone therapy and oral contraceptives.
- Personal and family history of breast disease or cancer.
- Physical Examination:
- Inspection for skin changes, nipple retraction, asymmetry.
- Palpation to detect lumps, tenderness, or changes in breast tissue.
- Examination of the axillae and cervical area for lymphadenopathy.
- Musculoskeletal examination to rule out chest wall sources of pain.
- Investigations:
- Mammography and/or Ultrasound: Especially in women over 40 or those with suspicious findings on physical examination.
- Breast MRI: Considered in special circumstances (e.g., very dense breasts, high-risk patients).
- Fine-Needle Aspiration or Biopsy: If a lump is palpable or imaging reveals suspicious findings.
- Blood Tests: If systemic disease or infection is suspected.
Differential Diagnosis (DDx):
- Benign breast conditions (fibrocystic changes, fibroadenomas).
- Breast cancer.
- Infections (mastitis, abscess).
- Rib pain, costochondritis.
- Referral pain from the spine or heart.
- Psychological causes (anxiety, depression).
Management:
- Conservative Treatment:
- Reassurance for cyclic breast pain, which is often self-limiting.
- Properly fitted bras for support.
- Application of warm or cold compresses.
- Pharmacological Treatment:
- Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief.
- Hormonal treatments (e.g., tamoxifen, danazol) in severe cases but with careful consideration due to side effects.
- Oral contraceptives adjustments.
- Treatment of Specific Conditions:
- Antibiotics for infections like mastitis.
- Surgical intervention for abscesses or suspicious lumps.
- Lifestyle Modifications:
- Regular exercise and stress reduction techniques.
- Follow-Up and Monitoring:
- Regular follow-up for reassessment, especially if symptoms persist or worsen.
- Routine breast cancer screening as per guidelines.
Conclusion:
Breast pain in females requires a careful and thorough evaluation to identify the underlying cause. While most cases of breast pain are benign and can be managed conservatively or with medications, it’s crucial to rule out serious conditions like breast cancer. Regular monitoring and follow-up are important, and women should be educated about breast self-examination and the importance of regular screening.