Distinguish normal, nonfocal, physiologic discomfort from that which may warrant diagnostic evaluation
Pain is physiologic for 1-2 days prior to onset of menses
Visual analog scale (VAS): 10-cm scale; 0 (no pain) to 10 (pain as bad as it could be)
Mark intensity of pain and record measurement in cm
Cyclic mastalgia: Pain severity ≥ 4 cm on VAS for ≥ 7 days per month
Starts during luteal phase, ↑ until onset of menses then resolves
Does not merit imaging work-up
Noncyclic mastalgia: Not related to menstrual cycle; focal (1 finger can point to area of concern), persistent, merits diagnostic work-up
Extramammary causes of pain: Outside breast
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Kushwaha AC et al: Overutilization of health care resources for breast pain. AJR Am J Roentgenol. 211(1):217-223, 2018
Mema E et al: In the setting of negative mammogram, is additional breast ultrasound necessary for evaluation of breast Pain? Curr Probl Diagn Radiol. ePub, 2018
Nijs J et al: Explaining pain following cancer: a practical guide for clinicians. Braz J Phys Ther. ePub, 2018
Agasthya GA et al: Can breast compression be reduced in digital mammography and breast tomosynthesis? AJR Am J Roentgenol. 209(5):W322-W332, 2017
Chetlen AL et al: Mastalgia: imaging work-up appropriateness. Acad Radiol. 24(3):345-349, 2017
Cho MW et al: Focal breast pain: does breast density affect the need for ultrasound? Acad Radiol. 24(1):53-59, 2017
Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast pain. J Am Coll Radiol. 14(5S):S25-S33, 2017
Feder K et al: Is Individualizing breast compression during mammography useful? - investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Rofo. 189(1):39-48, 2017
Arslan M et al: Retrospective analysis of women with only mastalgia. J Breast Health. 12(4):151-154, 2016
Cooney MA et al: Current knowledge of pain after breast cancer treatment: a systematic review. Pain Manag Nurs. 14(2):110-23, 2013
Hawker GA et al: Measures of adult pain: visual analog scale for pain (VAS Pain), Numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 63 Suppl 11:S240-52, 2011
Bundred NJ: Breast pain. Clin Evid (Online), 2007
Tumyan L et al: Negative predictive value of sonography and mammography in patients with focal breast pain. Breast J. 11(5):333-7, 2005
Smith RL et al: Evaluation and management of breast pain. Mayo Clin Proc. 79(3):353-72, 2004
Leung JW et al: Utility of targeted sonography in the evaluation of focal breast pain. J Ultrasound Med. 21(5):521-6; quiz 528-9, 2002
Duijm LE et al: Value of breast imaging in women with painful breasts: observational follow up study. BMJ. 317(7171):1492-5, 1998
Fox H. Are patients with mastalgia anxious, and does relaxation therapy help? Breast. 6:138-42, 1997
Goodwin PJ et al: Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study. Breast Cancer Res Treat. 33(1):63-73, 1995
McNicholas MM et al: Pain and increased mammographic density in women receiving hormone replacement therapy: a prospective study. AJR Am J Roentgenol. 163(2):311-5, 1994
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Synonyms
Mastodynia, mastalgia, mammalgia
Definitions
Distinguish normal, nonfocal, physiologic discomfort from that which may warrant diagnostic evaluation
Pain is physiologic for 1-2 days prior to onset of menses
Visual analog scale (VAS): 10-cm scale; 0 (no pain) to 10 (pain as bad as it could be)
Mark intensity of pain and record measurement in cm
Cyclic mastalgia: Pain severity ≥ 4 cm on VAS for ≥ 7 days per month
Starts during luteal phase, ↑ until onset of menses then resolves
Does not merit imaging work-up
Noncyclic mastalgia: Not related to menstrual cycle; focal (1 finger can point to area of concern), persistent, merits diagnostic work-up
Extramammary causes of pain: Outside breast
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Kushwaha AC et al: Overutilization of health care resources for breast pain. AJR Am J Roentgenol. 211(1):217-223, 2018
Mema E et al: In the setting of negative mammogram, is additional breast ultrasound necessary for evaluation of breast Pain? Curr Probl Diagn Radiol. ePub, 2018
Nijs J et al: Explaining pain following cancer: a practical guide for clinicians. Braz J Phys Ther. ePub, 2018
Agasthya GA et al: Can breast compression be reduced in digital mammography and breast tomosynthesis? AJR Am J Roentgenol. 209(5):W322-W332, 2017
Chetlen AL et al: Mastalgia: imaging work-up appropriateness. Acad Radiol. 24(3):345-349, 2017
Cho MW et al: Focal breast pain: does breast density affect the need for ultrasound? Acad Radiol. 24(1):53-59, 2017
Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast pain. J Am Coll Radiol. 14(5S):S25-S33, 2017
Feder K et al: Is Individualizing breast compression during mammography useful? - investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Rofo. 189(1):39-48, 2017
Arslan M et al: Retrospective analysis of women with only mastalgia. J Breast Health. 12(4):151-154, 2016
Cooney MA et al: Current knowledge of pain after breast cancer treatment: a systematic review. Pain Manag Nurs. 14(2):110-23, 2013
Hawker GA et al: Measures of adult pain: visual analog scale for pain (VAS Pain), Numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 63 Suppl 11:S240-52, 2011
Bundred NJ: Breast pain. Clin Evid (Online), 2007
Tumyan L et al: Negative predictive value of sonography and mammography in patients with focal breast pain. Breast J. 11(5):333-7, 2005
Smith RL et al: Evaluation and management of breast pain. Mayo Clin Proc. 79(3):353-72, 2004
Leung JW et al: Utility of targeted sonography in the evaluation of focal breast pain. J Ultrasound Med. 21(5):521-6; quiz 528-9, 2002
Duijm LE et al: Value of breast imaging in women with painful breasts: observational follow up study. BMJ. 317(7171):1492-5, 1998
Fox H. Are patients with mastalgia anxious, and does relaxation therapy help? Breast. 6:138-42, 1997
Goodwin PJ et al: Cyclical mastopathy and premenopausal breast cancer risk. Results of a case-control study. Breast Cancer Res Treat. 33(1):63-73, 1995
McNicholas MM et al: Pain and increased mammographic density in women receiving hormone replacement therapy: a prospective study. AJR Am J Roentgenol. 163(2):311-5, 1994
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.