Education And Debate

ABC of Breast Diseases: Breast Pain

BMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6958.866 (Published 01 October 1994) Cite this as: BMJ 1994;309:866
  1. R E Mansel

    Breast pain (mastalgia) alone or in association with lumpiness is reported in up to a half of all women attending breast clinics. Two thirds of a group of working women and 77% of a screening population admitted to having had recent breast pain when directly questioned. Most mastalgia is of minor or moderate severity and is accepted as part of the normal changes that occur in relation to the menstrual cycle. Studies have clearly shown that women who complain of mastalgia are psychologically no different from women attending hospital outpatient clinics for other conditions.

    Classification

    Breast pain can be separated into two main groups, cyclical and non- cyclical. The best way to assess whether pain is cyclical is to ask a patient to complete a breast pain record chart. Two thirds of women have cyclical pain, and the remaining third have non-cyclical pain.

    Daily breast pain chart.

    Breast pain chart of patient with severe cyclical mastalgia. (P indicates menstrual period.)

    Breast pain chart of patient with moderate continuous non-cyclical mastalgia.

    Cyclical mastalgia

    Patients with cyclical pain are by definition premenopausal, and their average age is 34. Normal changes in relation to menstrual cycle are heightened awareness, discomfort, fullness, and heaviness of the breast during the three to seven days before each period. Women often report areas of tender lumpiness in their breasts and increased breast size at this time. Patients with cyclical mastalgia typically suffer increasing severity of pain from mid-cycle onwards, with the pain improving at menstruation. The pain is usually described as heavy with the breast being tender to touch, and it classically affects the outer half of the breast. The pain varies in severity from cycle to cycle but can persist for many years.

    Cyclical mastalgia is relieved by the …

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