Breast Pain Diagnosis

Characteristics of Cyclical Breast Pain

The American College of Radiology notes that cyclical breast pain represents 70% of cases, is bilateral or diffuse, related to hormonal fluctuations, and worsens in the luteal phase 1
The pain follows a predictable pattern with the menstrual cycle, worsening during the luteal phase and improving with menstruation 1, 2
The pain is typically bilateral or diffuse, without a precise reproducible point on examination 1, 3
The pain is directly related to hormonal fluctuations of the menstrual cycle 2, 3
The age of presentation can be before 20 years, with a generally prolonged course in this group 1, 2

The American College of Radiology states that non-cyclical breast pain is typically unilateral, focal, and localizable with precision, of inflammatory rather than hormonal origin 1
The pain has no predictable relationship with the menstrual cycle, although it may be worse in cold weather 1
The pain is often located in the subareolar region, nipple, or infero-interne quadrant of the breast 1, 3
The site of the pain is precisely localizable and reproducible by the patient and physician 1
The pain has a predominantly inflammatory origin rather than hormonal 1, 3

Mastitis or breast abscess can present with focal pain preceding induration, redness, heat, and fever 1
Mondor's disease is a thrombophlebitis, usually of the thoraco-epigastric vein 1
Ectatic ducts may be visible on mammography with secretory calcifications at the site of pain 1

Neurological mechanisms, such as irritation of the anterior lateral and anterior medial branches of the intercostal nerves from T3 to T5, can cause breast or nipple pain 1
Musculoskeletal causes, including Tietze's syndrome (costochondritis), can cause referred pain 1, 3
Visceral causes, such as cardiac ischemia, esophageal disorders, pulmonary conditions, and gastrointestinal pathology, can also cause breast pain 1

For cyclical breast pain, imaging is not necessary beyond routine age-appropriate screening, as cyclical pain alone does not require imaging 2, 4
The risk of cancer is extremely low in the absence of other signs or symptoms 2, 4
For non-cyclical breast pain, evaluation is necessary even without additional signs or symptoms of breast disease to exclude underlying benign or malignant breast lesions 1
Consideration of extra-mammary causes is essential when the breast examination is normal 2, 3