Mammography is not routinely used in clinical evaluation, unless a palpable breast mass is identified on palpation. In 2009, the U.S. Preventive Services Task Force recommended that all women aged 50 years and older undergo routine mammography every two years, whereas the American Cancer Society and the American College of Radiology continue to advise women to begin routine screening annually at age 40.
Mastitis, an infection in the breast, is another common cause of breast pain that often affects pregnant women. Mastitis occurs when common bacteria normally found on the skin, such as Staphylococcus aures, breech the skin through a crack or break in the nipple, causing breast tenderness, pain and swelling.
Clinicians should conduct a complete breast examination for patients complaining of breast pain. Breast exams begin with the patient in a seated position and clinicians should look for symmetry, skin changes (i.e., dimpling, retraction, or lesions), architectural distortion, and changes in upper-extremity mobility.
Palpation is usually performed with the patient in a supine position. Start with gentle palpation or a sweeping technique before moving on to deeper palpation using a vertical stripping method. Be sure to check the underlying ribs and costal cartilage.
Asymmetrical breast development is fairly common, and treatment often only requires explanation and reassurance.
If a clinician identifies abnormal breast leasions during clinical exam or mammography, a biopsy should be performed. Clinicians use stereotactic needle biopsy equipment to guide the procedure and X-ray coordinates to obtain a tissue sample for testing.
When breast cancer is ruled out, reassurance alone will result in resolution of the symptom in 86% of women with mild pain and in 52% of women with severe pain. Other recommendations include alteration of dietary factors, such as reducing caffeine, salt, and saturated fat intake.
Stimulation of breast tissue by hormone fluctuations during the menstrual cycle is the most common cause of breast pain. Hormonal changes associated with ovulation can stimulate the proliferation of glandular breast tissue, resulting in breast swelling during the luteal phase of the menstrual cycle. For most women this causes minor discomfort, and some women may even experience mastalgia, a more severe and persistent pain.
Breast pain is one of the most common problems that women seek counseling for from primary-care providers, gynecologists and breast specialists. Evaluating breast pain begins with a comprehensive health history, which should include type of pain, relationship to menses, duration, location, impact on activities of daily living, factors that aggravate and alleviate pain, and any other medical problems or comorbidities.