Breast Pain

Differential Diagnosis

Common Diagnoses

  • Pregnancy
  • Cyclical Mastalgia
  • Cracked or Inflamed Nipple
  • Breast Abscess
  • Mastitis

Occasional Diagnoses

  • Carcinoma
  • Onset of Puberty
  • Lactation and/or Galactocoele
  • Simple Cyst
  • Trauma

Rare Diagnoses

  • Chondritis of Costal Cartilage
  • Angina
  • Cervical Spondylosis
  • Herpes Zoster
  • Mondor’s Disease (Thrombophlebitis of Chest Wall or Breast Veins – Rare)
  • Tuberculosis

Ready Reckoner

Key distinguishing features of the most common diagnoses

PregnancyCyclical MastalgiaInflamed NippleAbscessMastitis
Discrete MassNoNoNoYesNo
Local ErythemaNoNoYesPossibleYes
Diffuse NodularityPossibleYesNoNoNo

Possible Investigations


Possible:Pregnancy test, mammography

Small Print:Swab of any nipple discharge, other investigations if non-breast causes suspected.

  • Pregnancy test worthwhile in bilateral pain if a period has been missed.
  • Mammography may help if pain is accompanied by a mass or ill-defined nodularity but this would normally be performed in secondary care after referral.
  • If the aetiology is infective and the nipple is discharging, a swab may help guide treatment.
  • Other investigations: If a non-breast cause is suspected, other tests may be required according to the pattern of the symptoms, e.g. cardiac tests (angina) or cervical spine X-ray (cervical spondylosis)

Top Tips

  • Offer to examine the breasts even if you are sure from the history that there is no significant pathology – many women fear breast cancer and will find your reassurance hard to accept if they feel they haven’t been taken seriously.
  • Don’t reflexly prescribe in cyclical mastalgia; the patient’s agenda is often to exclude serious disease rather than seek drug therapy.
  • Remember pregnancy as a cause – the patient will not always volunteer this as a possibility, even if she has just missed a period.
  • Unilateral breast pain with no other local signs may be an early symptom of shingles. Check the back in the T4/5 dermatomes for a rash.

Red Flags

  • ‘Chest pain’ may be a euphemism used by a (frequently older) woman in denial. Don’t miss advanced tumour through not examining the breasts.
  • Cancer rarely presents with breast pain but consider this possibility in a woman complaining of constant ‘pricking’ breast pain.
  • A lactating woman with unilateral breast pain and flu-type symptoms is probably developing mastitis – treat early to avoid the development of an abscess.
  • If the pain is related to exertion in a late middle-aged or elderly woman, consider angina as a possibility.
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