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Click here to read pathway for management of mastalgia (flow chart) 

For many breast problems, especially in younger patients or patients presenting with mastalgia only, reassurance and a period of watchful waiting may be suitable.

Breast pain is not usually associated with malignancy.  It is a common symptom and, if of short duration with no other clinical concern, may be managed initially in a primary care setting.  Studies show that breast pain often settles with 3-6 months.

Minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms, greater than 3 months need to be referred as non-urgent.

Cyclical breast pain in the younger patient does not need to be referred and can be managed supportively.

Assessment

Signs and Symptoms

• Minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms, greater than 3 months, need to be referred as non-urgent.

• Cyclical breast pain in the younger patient does not need to be referred and can be managed supportively.

Investigations

Investigations in patients presenting with symptoms and/or signs suggestive of breast cancer prior to referral is not recommended.

Management

• See flow chart
• Management in primary care should include: 
  • Reassurance
  • Advice on supportive, fitted bras
  • Oral or topical analgesia
  • Review of any hormonal medications the patient may be taking
  • Breast pain alone is not an indication for imaging 
• Minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with other symptoms need to be referred as non-urgent.
• Cyclical breast pain in the younger patient does not need to be referred and can be managed supportively.

Referral

Referral criteria

• Refer as non-urgent patients with minor or moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms

Referral instructions

East
Use e-Referrals to book the appointment, if no appointment available, click “defer to provider”

Priority: 2WW

Service: Surgery - Breast

Clinic type: Other symptomatic Breast

Service: Symptomatic Breast (cancer not suspected) – RD&E-RH8

 

North
Use the e-Referral Service to book the appointment, if no appointment available, click “defer to provider”

Priority: Urgent

Service: Surgery - Breast

Clinic type: Other symptomatic Breast

Service: Breast Pain & Male patients –NDHCT–NDDH-RBZ

 

West
Use the e-Referral Service to book the appointment, if no appointment available, click “defer to provider”

Priority: 2WW

Service: Surgery - Breast

Clinic type: Other symptomatic Breast

Service: DRSS-Western-Breast-(Patient will be seen within 2 weeks)-CCG-99P

 

Referral forms

Please refer using a standard referral letter

All patients whether on the 2ww pathways or symptomatic breast pathway are normally seen within 2 weeks.

Supporting Information

Further guidance

Breast Cancer Care

www.breastcancercare.org.uk/publications/benign-breast-conditions/breast-pain-bcc71

Flow chart