Mastalgia

Mastalgia is a topic covered in the 5-Minute Clinical Consult.

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Basics

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

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