Assessing and managing benign breast lesions leading to mastalgia: A review of 840 patients.

OBJECTIVE

Mastalgia often raises malignancy concerns. This study explores its link to benign breast conditions, and cancer.

MATERIAL AND

METHODS

This retrospective study included 840 patients presenting to the surgical clinic with breast disease between January 2016 and January 2023.

RESULTS

This study included 840 patients (800 female, 40 male) presenting with mastalgia, either as an isolated symptom or in combination with other complaints. In 350 cases (41.6%), pain alone was reported; in 410 cases (48.8%), pain with a lump; and in 18 cases (2.1%), pain with nipple discharge. Non-cyclic pain (51.5%) was more common than cyclic pain (42.5%), with pain most frequently localized to the right breast (53.5%), followed by bilateral (23.8%) and left breast (17.8%) pain (p<0.001). A significant association was observed between mastalgia and neck/shoulder pain (10.7%, p<0.001). A family history of breast cancer was present in 16.6% of patients. Histologic analysis revealed fibrocystic changes (42.2%), fibroadenoma (21.1%), and ductal ectasia (11%) as the most common diagnoses. Malignancy was detected in 6 cases (1.3%, including 1 male patient), with a significantly higher prevalence in the pain + lump group (p<0.001). Other findings included mastitis (9 cases), abscess (53 cases), and fat necrosis (4 cases). Patients with suspected malignancy underwent biopsy based on radiologic suspicion (BIRADS 2-4a) and physical examination.

CONCLUSION

Mastalgia is predominantly a benign condition, but non-cyclic pain, particularly when associated with a lump, warrants thorough evaluation to exclude malignancy. The link between mastalgia and fibrocystic changes shows that research is needed into the causes and consequences. It is not a malignancy indicator, accurate diagnosis requires histological and radiological assessments.