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Most breast pain is associated with benign conditions, such as cyclical pain and fibrocystic changes and gross cysts. It is uncommon for a breast cancer to specifically cause breast pain.

  • Breast pain is common in premenstrual women. Elements from the history can help distinguish pain that is cyclical versus noncyclical, and that which is breast related versus extramammary.
  • We initiate the evaluation of breast pain with a thorough history and physical examination. Clinical judgment is used when deciding if imaging tests are necessary. For women of any age with a suspicious clinical examination and/or history, a mammogram and targeted ultrasound are performed.
  • For young women (under age 30) with cyclical breast pain, an ultrasound is the optimal imaging study. However, unless there are pertinent high-risk factors (eg, family history of premenopausal breast cancer), diagnostic studies are not necessary for most young women.
  • For women with a focal finding on the clinical examination (eg, discrete mass or focal tenderness), and/or a history not consistent with classic cyclical pain (eg, sudden onset of focal pain), a mammogram and a targeted ultrasound are performed.
  • Treatment with analgesics and a supportive brassiere can be helpful for many women with mastalgia.

Breast cysts, which can present as a solitary mass or multiple masses, usually prompt women to seek medical attention because of the palpable mass or associated pain or discomfort. A breast cyst may be first identified on a clinical or self-breast examination, or as a mammographic density. Breast cysts may fluctuate in size, number, and magnitude of symptoms.