Mastalgia Flashcards
what is mastalgia?
Mastalgia refers to breast pain
how is mastalgia classified?
classified by its cause
- cyclical, to do with menstrual cycle, in both breasts and most common. If actively menstruating or on HRT.
- non cyclical, can be caused by medication e.g. hormonal contraceptives, anti-depressants (such as sertraline), or antipsychotic drugs (such as haloperidol).
- Other causes of breast pain can be extramammary pain, such as chest wall pain or shoulder pain.
what clinical features should you enquire about?
lumps, skin changes, fevers, or discharge, as well as association with menstrual cycle.
Ensure to ask about drug history, breast-feeding, pregnancies, previous medical history, and family history.
what investigations should be done for mastalgia?
Breast pain in isolation with no other relevant features on history or examination is not an indication for imaging.
All patients within reproductive age should have a pregnancy test.
how can mastalgia be managed?
most cases the mastalgia will be idiopathic so reassurance and pain control e.g paracetamol or ibuprofen is the primary form of management.
If first line management is unsuccessful, refer to a specialist. Second line treatment include Danazol, an anti-gonadotrophin agent, buy has unpleasant side-effects (such as nausea, dizziness, and weight gain)
why is single duct discharge more concerning than multi duct discharge?
single duct discharge is more likely to be malignant than multi duct discharge, which could just be physiological
what can cause mastalgia?
younger = hormonal older = usually referred pain
what self help measures can be done to help mastalgia?
- wear a well fitting, supportive bra
- reduce caffeine intake
- reduce saturated fat in diet
- topical ibuprofen/ paracetamol
what is a sclerosing lesion of the breast?
A sclerosing lesion of the breast is a benign area of hardened breast tissue
The most common types:
• sclerosing adenosis
• radial scar/complex sclerosing lesion
what is sclerosing adenosis?
may occur as a part of the normal ageing process. Sclerosing adenosis is extra growth of tissue within the breast lobules.
what are the symptoms of sclerosing adenosis?
no symptoms usually (maybe mastalgia but rare)
diagnosed on mammogram when looking for something else
may notice lump but this is rare
how can sclerosing adenosis be diagnosed?
- free hand core biopsy done under USS guidance
- Vacuum assisted biopsy, done with mammogram or USS
- excision biopsy done as a small operation
what are radial scar/complex sclerosing lesion’s?
benign areas of hardened breast tissue. They are similar to sclerosing adenosis, but they are usually larger and have features similar to a breast cancer when seen on a mammogram.
identified by size, with radial scars usually being smaller than 1cm and complex sclerosing lesions being more than 1cm.
a core biopsy can be done to confirm the diagnosis.
