Update on Breast Pain

In GP-bulletin by Karina Cox

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  • Breast pain is very common and, in the absence of a palpable abnormality, is rarely associated with any worrying pathology.
  • Breast pain can be cyclical or non-cyclical.
  • The most common cause of breast pain seen in the breast clinic is referred pain from the chest wall.
  • Most episodes of breast pain are self-limiting and will settle with simple measures.
  • To find out if the breast pain is coming from the chest wall i.e costochondritis, press firmly on the medial ribs (close to the sternal border). There is often a specific trigger point.
  • Breast pain can be treated with regular simple analgesia or NSAIDs for 6 weeks.
  • A small proportion of patients with breast pain will improve with high dose Evening Primrose Oil (1g TDS) but they need to take it regularly for 6 weeks.
  • Consider checking vitamin D levels and supplement as necessary because a small retrospective study performed in Birmingham showed a correlation between Vitamin D deficiency and non-cyclical mastalgia. There was an improvement in symptoms noted in 77% of deficient patients after vitamin D supplementation.
  • For patients with costochondritis, topical NSAIDs applied to the trigger area twice a day for 2 weeks often results in symptom improvement. It is also useful to remind patients to be mindful of their posture as sitting hunched over a desk can exacerbate chest wall pain!
  • If the pain persists for more than 6 weeks (despite simple measures and reassurance) a referral to a breast specialist is warranted.