Mastalgia

What it is

Mastalgia is breast pain, and it is worked through three questions in order.

• The first question is whether she has swelling or not. If a mass is palpated, it is worked up as triple assessment.
• If no mass is palpated, the second question is whether the pain is cyclic or not.
• If it is not cyclic, the third question is whether it is focal or non-focal.

How it is diagnosed

Where a mass is palpated, order imaging and refer to a breast surgeon.

Where no mass is palpated and the pain is cyclic, no imaging is required, since the risk of cancer is low.

Where no mass is palpated and the pain is noncyclic, the imaging follows the focal question.

• Focal, patient younger than 30 years: targeted ultrasonography.
• Focal, patient 30 years or older: targeted ultrasonography and diagnostic mammography.
• Non-focal, patient younger than 40 years with no risk factors: no imaging.
• Non-focal, patient 40 years or older or has risk factors: diagnostic mammography.