Mastalgia Mastalgia is a recognized organic condition that is studied less thoroughly than other breast problems (108,109). Inﬂammatory cytokines were implicated in the etiology of breast pain. A study evaluating expression of interleukin-6 and tumor necrosis factor-α in painful and non-painful breast tissue showed lower levels of these cytokines in painful breast tissue during the luteal phase; however, these levels did not reach statistical significance (110). Elevated estrogen, low progesterone, or an imbalance in the ratio of estrogen and progesterone were suggested as a possible cause for the symptoms (111).
Natural History of Mastalgia
Approximately 70% to 80% of women experience severe breast pain at some time in their lives (112,113). Mastalgia accounts for 30% to 47% of breast clinical evaluations (111,114). In 15% of the patients, the mastalgia is so severe that it alters lifestyle and requires repeated investigations and treatment (112). Mastalgia interferes with sexual (48%), physical (37%), social (12%), and work or school activities (8%) (115).
Types of Mastalgia Breast pain is a distressing constellation of symptoms that is classified as cyclic, noncyclic, or extramammary (116). Cyclic mastalgia is related to exaggerated premenstrual symptoms beginning in the luteal phase of the menstrual cycle, associated with breast engorgement, pain, ache, heaviness, and tenderness that is bilateral and can last for more than 7 days in 11% of women (116–118). Cyclical mastalgia is more prevalent in women in their third and fourth decades of life and accounts for two-thirds of all breast pain symptoms (119). Noncyclic mastalgia is independent of menstrual cycles and is described as achy, burning soreness. It may be intermittent or constant, is usually unilateral, occurs in the fourth and fifth decades, and is more difficult to treat than cyclic mastalgia (116). Extramammary pain is perceived to be located in the breast but is related to an extramammary site. Chest wall muscular pain, costal cartilage symptoms, herpes zoster, radiculopathies, and rib fractures are among some of the more common causes of extramammary pain. Costochondritis (Tietze syndrome) is a manifestation of chest wall pain that is frequently interpreted as breast pain.