 Introduction/Background Breast pain is a common complaint for which patients seek medical attention, with a prevalence of up to 70% to 80% [1-5]. However, breast pain or tenderness is rarely found to result from cancer when not associated with a palpable mass or other suspicious clinical finding. Studies show that the incidence of breast cancer in patients with breast pain as their only symptom is 0% to 3.0% [6-13]. Some authors have found no increased risk of malignancy in patients with breast pain, while others have even found a decreased risk when compared to those without pain [14,15]. Breast pain should be triaged into one of two categories: pain that is not suspicious for associated malignancy versus pain that may be clinically significant. Clinically insignificant pain is cyclical (temporally associated with the menstrual cycle) or nonfocal/diffuse, either unilateral or bilateral. This type of pain is not associated with malignancy [8]. Benign causes of breast pain are numerous and include hormonal variations, larger cup size, ill- fitting or unsupportive bra, lower levels of fitness or activity, fibromyalgia, cysts, periductal mastitis, stretching of Cooper ligaments, fat necrosis, surgery, Mondor disease, diabetic mastopathy, duct ectasia, musculoskeletal disease, referred nerve root pain from degenerative spinal changes, herpes zoster, heart disease, biliary pain, and peptic ulcer [3,5,16-26]. Clinically significant pain, while still overwhelmingly due to a benign etiology, has occasionally been found to be associated with malignancy [8,9,11,12]. When malignancy related, pain tends to be well localized and persistent [27]. Therefore, breast pain is considered potentially clinically significant when it persists and is focal, defined as involving <25% of the breast and axillary tissue. Special Imaging C onsiderations Special Imaging Considerations Digital breast tomosynthesis (DBT) can address some of the limitations encountered with standard mammographic views.
Breast Pain.  Introduction/Background Breast pain is a common complaint for which patients seek medical attention, with a prevalence of up to 70% to 80% [1-5]. However, breast pain or tenderness is rarely found to result from cancer when not associated with a palpable mass or other suspicious clinical finding. Studies show that the incidence of breast cancer in patients with breast pain as their only symptom is 0% to 3.0% [6-13]. Some authors have found no increased risk of malignancy in patients with breast pain, while others have even found a decreased risk when compared to those without pain [14,15]. Breast pain should be triaged into one of two categories: pain that is not suspicious for associated malignancy versus pain that may be clinically significant. Clinically insignificant pain is cyclical (temporally associated with the menstrual cycle) or nonfocal/diffuse, either unilateral or bilateral. This type of pain is not associated with malignancy [8]. Benign causes of breast pain are numerous and include hormonal variations, larger cup size, ill- fitting or unsupportive bra, lower levels of fitness or activity, fibromyalgia, cysts, periductal mastitis, stretching of Cooper ligaments, fat necrosis, surgery, Mondor disease, diabetic mastopathy, duct ectasia, musculoskeletal disease, referred nerve root pain from degenerative spinal changes, herpes zoster, heart disease, biliary pain, and peptic ulcer [3,5,16-26]. Clinically significant pain, while still overwhelmingly due to a benign etiology, has occasionally been found to be associated with malignancy [8,9,11,12]. When malignancy related, pain tends to be well localized and persistent [27]. Therefore, breast pain is considered potentially clinically significant when it persists and is focal, defined as involving <25% of the breast and axillary tissue. Special Imaging C onsiderations Special Imaging Considerations Digital breast tomosynthesis (DBT) can address some of the limitations encountered with standard mammographic views.