Mastalgia

Description

• Painful breast tissue, often bilateral, which can be cyclic or noncyclic
  • 2/3 of breast pain is cyclic and usually associated with hormonal changes related to menses, external hormones, pregnancy, or menopause.
  • 1/3 is noncyclic and often is related to a breast or chest wall lesion.
• Synonym(s): mastodynia; breast pain

Epidemiology

Incidence

• Predominant sex: most common in women but occurs occasionally in men
• Predominant age: generally seen from adolescence to menopause
• Frequency of breast cancer with those reporting breast pain ranges from 1.2% to 6.7%.
• Up to 70% of women report some degree of breast pain at some point in their lives.
• Most describe mild pain, but 11% describe pain as moderate to severe.
• Higher incidence in the older population, larger breasted individuals, and those who are less fit and active (1)

Etiology and Pathophysiology

• Causative pathophysiology remains unclear but is thought to be related to hormonal or nutritional factors.
• When fibrocystic disease is the source, growth and distension of the cyst with hormonal fluctuation can cause pain.
• Hormonal factors (e.g., hormone-replacement therapy, oral contraceptives, pregnancy, menses, puberty, and menopause) may influence the diverse conditions that cause mastalgia or may themselves cause breast tenderness and pain.
• Benign breast disorders (e.g., fibrocystic changes)
• Trauma (including sexual abuse/assault)
• Diet and lifestyle (e.g., poor-fitting exercise breast support)
• Lactation problems (e.g., engorgement, mastitis, breast abscess)
• Breast masses, including breast cancer
• Hidradenitis suppurativa
• Costochondritis (Tietze syndrome)
• Postthoracotomy syndrome
• Spinal and paraspinal disorders
• Potential side effects of medications
• Postradiation effects
• Referred pain (e.g., pulmonary, cardiac, or gallbladder disease)
• Ductal ectasia

Genetics
Familial tendency

Risk Factors

• Diet high in saturated fats
• Cigarette smoking
• Recent weight gain
• Pregnancy
• Large, pendulous breasts (caused by stretching of Cooper ligaments)
• Exogenous hormones
• Caffeine has been shown not to be a risk factor (2)[A].

General Prevention

• Avoid exposure to risk factors.
• Properly fitted bra support