Breast pain (mastalgia), alone or in combination with breast nodularity, is reported in up to half of women attending breast clinics. Cyclical (related to menstrual cycle) pain and nodularity are so common as to be regarded as physiological. As a rule, symptoms are not severe, and resolve following menstruation. A small proportion of women experience cyclical breast pain that is clinically significant. Non-cyclical breast pain tends to occur in an older age group. The symptoms last for a shorter time and tend to resolve spontaneously. The pain is also well localized to an area of the breast and may be associated with an area on the chest wall that “triggers” the pain. Nodularity is less common than with cyclical pain. Injection of the painful area with steroid and lignocaine may relieve symptoms. Occasionally breast pain may be mistaken for inflammation of the costochondral junction (Tietze’s syndrome). Typically this pain worsens on pressure on the affected cartilage, and responds to non-steroidal anti-inflammatory drugs.
Breast pain may also be caused by infection (periductal mastitis) or abscess formation, which is particularly associated with lactation.
Treatment of Breast pain
Reassurance that the pain they are experiencing is not related to cancer, together with an explanation of the hormonal basis of the symptoms, helps in the majority of women. In about 15% of women, the pain is so severe as to affect their quality of life and to require active treatment. Some women find that stopping the oral contraceptive pill helps. Pre- and postmenopausal women who start hormone replacement therapy (hormone replacement therapy) may also experience an increase in cyclical breast pain and nodularity, and this is treated by stopping the hormone replacement therapy or changing to a low-dose, combined preparation for a short time only. Simple measures such as wearing a soft support sleep bra may help. Antibiotics should not be prescribed, unless there is evidence of infection.
Medical treatments effective in controlled studies for breast pain include:
- Danazol (200 mg once daily) is the most effective treatment, with a response in about 70% of women. However, side effects of weight gain and hirsuitism limit its usefulness.
- LHRH analogues are effective treatments, but again the side effect profiles may be unacceptable.
- Bromocriptine at a dose of 2.5 mg twice daily reduces the secretion of prolactin. It may be useful for cyclical mastalgia, but not for non-cyclical breast pain. However, 20% of women experience side effects, such as nausea, vomiting, and dizziness on bromocriptine, which are severe enough to require that treatment be stopped.
- Tamoxifen has been found to reduce mastalgia, but is not licensed for this use and its prescription is best restricted to specialist clinics.
Vitamin B6, diuretics, and progestogens are not effective in the management of breast pain.