Breast Pain
This guideline applies to adults over 18 years with breast pain in the absence of other significant breast symptoms.
Introduction
Breast pain is not a risk factor for breast cancer and if breast cancer is found it is often an incidental finding
Cyclical breast pain resolves spontaneously within 3/12 in 20-30% of women.
Non-cyclical pain responds poorly to treatment but may resolve spontaneously in 50% of women.1
Red flags
Signs and symptoms suggestive of breast cancer (e.g ulceration, breast lump, skin distortion, recent nipple retraction/distortion, new asymmetric nodularity persisting after menstruation/2-3/52, inflammation not responding to treatment)
Previous breast cancer
A significant family history of breast or ovarian cancer (see family history guidelines)
Key Features of Assessment
History:
Pattern of pain – cyclical/non-cyclical, focal, unilateral/bilateral (If unclear get patient to complete a breast pain calendar)
Check red flag symptoms as above
Ask re history of breast implants/tissue expanders and type (textured or polyurethane)
Check possibility of pregnancy
Family or personal history of breast/ovarian cancer
If male consider gynaecomastia (and check diuretics and cardiac medications)
Management
Provide patient information:
Breast Pain [booklet with symptom diary]
Referral
2ww:
Refer if signs or symptoms suggestive of breast cancer (see red flags)
Symptomatic Breast Clinic (via the 2ww form)
Refer is breast pain and:
Previous breast cancer in the same breast
Significant family history and not known to family history service (pts under the service already usually have open access)
No response to conservative measures as above after 6 weeks.
Supporting Information
For professionals:
NHS – Breast Webinar '22
NICE Clinical Knowledge Summaries (CKS) – Scenario: Management – How Should I Manage Cyclical Breast Pain?
For patients:
Breast Cancer Now – Breast Pain
Patient – Breast Pain
References:
Goyal A. Clinical evidence. Clinical evidence; Breast pain. 2011. [cited 2016 Apr 18]. [Abstract]
GPs should not refer breast pain patients for cancer investigation.Pulse. 2022 Feb
Breast pain- Cyclical.NICE 2023 Aug [cited 2022 Dec 15]
Page Review Information
|
Review date |
21 March 2024 |
|
Next review date |
21 March 2026 |
|
Clinical editor |
Dr Madeleine Attridge |
|
Contributors |
Mr Iain Brown (Consultant Breast surgeon) Miss Polly King (consultant Breast surgeon) Dr Rebecca Osborne (GPwSI Breast) |