Breast Pain

Question 1

Breast Pain

Answer 1

Mastalgia

Question 2

Background

Answer 2

most common breast sx prompting consultation to PCP, premenopausal > postmenopausal women; most commonly benign etiology; 0-3% pts w/isolated pain will be found to have Ca; localized pain = only presenting sx in < 15% breast CA pts

No histologic correlation; 50-90% asx women have fibrocystic changes

Question 3

Cyclic mastalgia

Answer 3

Assoc w/menstrual cycle, most severe before menses or relieved by menses onset; typically b/l, poorly localized, radiating to axilla/arm, common in younger pts; likely due to hormonal stimulation of breast lobules

Question 4

Noncyclic mastalgia

Answer 4

Unrelated to menstrual cycle or in postmenopausal pts; typically unilateral, sharp/burning, localized, most common in pts 40-50y; ddx: stretch cooper ligaments, fat necrosis, pressure from brassiere, focal/periductal mastitis, hidradenitis suppuritiva, cyst, thrombophlebitis (mondor disease), costochondritis, cervical arthritis w/radiculopathy

Question 5

History

Answer 5

Pain (type, location, relationship to menses, bi-vs unilateral, radiation, duration, resolution), exacerbating factors (irregular menses, stress, medications esp OCPs, spironolactone); note that limited, burning, or stabbing pain may localize to chest wall rather than breast.

Question 6

Exam

Answer 6

Thorough breast exam to exclude mass; costochondritis/chest wall palpation

Question 7

Red flags

Answer 7

Hx rapid onset breast erythema, edema, crusting..