Breast pain: assessment, management, and referral criteria.

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Breast pain (mastalgia) is experienced by ≤70% of women during their lifetime1 and may be considered a physiological symptom rather like painful menses, but remains a common presentation in primary care. Despite an absence of evidence suggesting that mastalgia alone is associated with breast cancer, it is still commonly referred to secondary care breast units — in one study it accounted for 41% of referrals.2 This article reviews the management of breast pain within primary care and criteria for referral. Cyclical breast pain is the condition experienced by two-thirds of patients with true mastalgia. It is influenced by hormonal changes over the menstrual cycle, usually worsening in the last week of a cycle and relieved at the onset of menses. Pharmacological hormonal agents can exacerbate symptoms. Contributing factors such as caffeine, iodine deficiency, and dietary fat intake have been suggested, but no link definitively proven.3 Non–cyclical breast pain accounts for around one-third of patients with true mastalgia.4 It does not follow a menstrual pattern. Causes could be large pendulous breasts, breast cysts, pregnancy, thrombophlebitis, trauma, and previous breast surgery.3 Inflammatory conditions such as mastitis (both lactational and non-lactational) and breast abscess are painful, and …