Breast Pain

Breast pain has a variety of innocent causes: The commonest are puberty and pregnancy. It can be a troublesome recurrent problem for women with cyclical mastalgia. Cancer is very likely to be a major concern: this is an uncommon cause and pain is an unfortunately late sign of the disease.

Published: 2nd August 2022 | Updated: 15th August 2022

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

Likely: None

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.
Report errors, or incorrect content by clicking here.
Website disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter.

The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.

This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.