Breast Pain is common. It usually comes from the chest wall or is cyclical / hormonal in origin.
The risk of incidental Breast Cancer is 0.4% of patients; however, Breast Pain is the main factor in around 15% of all Breast Clinic Referrals which may lead to over-investigation.
Many patients with Breast Pain (in the absence of any other abnormality) can be reassured that in the absence of any other symptoms or findings that it is normal, usually self-limited and not linked with malignancy.
Please see this helpful video from Mr Matthew Barber, Consultant Breast Surgeon at EBU about Breast Pain
There is a helpful patient information leaflet from the Edinburgh Breast Unit, about Breast Pain, that GPs can share with their patients. You can find it under Resources and Links.
J.B & M.B, L.P 07-11-23
Who to refer:
Routine Referral
- Unilateral pain persisting over three months in post-menopausal women
- Intractable pain that interferes with the person’s lifestyle or sleep (for these patients referral to Pain Clinic should be considered)
Who not to refer:
- Women with moderate degrees of breast pain and with no discrete palpable lesion / other breast abnormality
How to refer:
Edinburgh, Midlothian and East Lothian Patients
- Please refer via SCI Gateway to WGH
Western General Hospital >> General Surgery – Breast >> LI Breast – Non Urgent
West Lothian Patients
- Please refer via SCI Gateway to SJH
St John’s Hospital >> General Surgery – Breast >> LI Breast – Non Urgent
Assessment should include:
History
- Consider age, menopausal status, cyclical nature of pain
- Relationship to work or other activities
- Consider risk factors: work, dependents, use of walking aid, neck / shoulder / back problems
Examination
- Rule out any palpable abnormalities or any other abnormalities on examination that would require referral.
- Assess to see what is tender: chest wall vs breast tissue
Management
- Explain and reassure patients that in the absence of any other symptoms or findings that chest pain is usually self-limiting and not linked with malignancy.
- A well-fitted supportive bra may help.
- Regular use of topical NSAIDs (where no contra indications) massaged into the symptomatic area of the chest wall can help.
- Simple analgesia
- Encourage Breast Screening attendance
Please see this helpful video from Mr Matthew Barber, Consultant Breast Surgeon at EBU about Breast Pain
