Breast Pain (Mastalgia)
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
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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.
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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
