Mastalgia

Question 1

What is the nerve supply to the breast?

Answer 1

Anterolateral and anteromedial branches of intercostal nerves T3-5

Question 2

What are non-breast causes of non-cyclical mastalgia?

Answer 2

Cervical and thoracic spondylosis
Lung disease
Gall stones
Exogenous oestrogens
Thoracic outlet syndrome

Question 3

What is true breast pain?

Answer 3

Diffuse breast pain

Trigger spots

Question 4

What in the history would suggest chest wall breast pain?

Answer 4

Unilateral
Brought on by activity
Lateral or medial
Reproduced by pressure on a specific area of chest

Question 5

How should cancer be excluded in mastalgia?

Answer 5

Clinical exam
Mammography in women >40
USS if localised area of pain

Question 6

Describe true mastalgia

Answer 6

Cyclical swelling
Nodularity
Week before menstruation and relived by onset

Question 7

What are some non-specific measures to help with mastalgia?

Answer 7

Wearing a soft, supportive bra at night
Chest wall pain; gentle exercise and stretching
Lifestyle changes

Question 8

Tx for mastalgia with an MSK origin for pain

Answer 8

Consider tx with NSAIDs or LA + depot steroid

Question 9

Tx for mastalgia that is part of a generalised premenstrual syndrome

Answer 9

Consider SSRI

Question 10

What is the endocrine treatment available for true mastalgia?

Answer 10

Tamoxifen 10mg daily in luteal phase (days 15-25 of cycle)