Breast tenderness/pain

• Fibrocystic changes: Fluctuates with the menstrual cycle, often bilateral, common in women aged 30-50.
• Premenstrual syndrome (PMS): Accompanied by other PMS symptoms such as mood swings and bloating.
• Hormonal medications (e.g., oral contraceptives): Can exacerbate cyclical breast pain.

• Trauma: History of recent injury to the breast.
• Infection (mastitis/abscess): Typically presents with localised pain, erythema, and possible fever; common in breastfeeding women.
• Breast cysts: Can be painful, particularly if large or rapidly enlarging.
• Costochondritis: Pain often radiates to the breast but originates from the costosternal junctions; reproducible on palpation.
• Breast cancer: Rarely presents with pain as the first symptom; consider if associated with a palpable lump, skin changes, or nipple discharge.

• Cardiac: Angina or myocardial infarction presenting with referred pain to the breast.
• Pulmonary: Pleuritic pain due to conditions like pulmonary embolism or pneumonia.
• Gastrointestinal: Gastroesophageal reflux disease (GERD) or peptic ulcer disease causing referred pain.

• Muscle strain: Typically localised, associated with physical activity.
• Spinal issues: Cervical or thoracic spine pathology causing referred pain to the breast area.

Sudden onset suggests trauma or infection, while gradual onset may indicate benign conditions like fibrocystic changes or malignancy.

Sharp, localised pain is more suggestive of musculoskeletal causes, while dull, aching pain that fluctuates with the menstrual cycle points to hormonal influences or fibrocystic changes.

• Nipple discharge: Consider ductal ectasia, mastitis, or malignancy.
• Fever and malaise: Suggestive of mastitis or breast abscess, particularly in lactating women.
• Skin changes: Peau d’orange or skin retraction may indicate breast cancer.

• Past Medical History: Previous breast pathology, hormonal disorders, or surgeries may be relevant.
• Drug History: Hormonal medications (e.g., HRT, OCP) can influence breast pain.
• Family History: Family history of breast cancer or other malignancies may increase suspicion.
• Social History: Alcohol intake and obesity are risk factors for breast cancer.

• Mammography: First-line in women over 40 or with a palpable mass.
• Ultrasound: Useful in younger women or for evaluating cystic versus solid lesions.
• MRI: Considered in complex cases, high-risk patients, or where other imaging is inconclusive.

• FBC and CRP: To assess for infection or inflammation.
• Hormonal profile: If hormonal causes are suspected.
• Breast biopsy: Indicated if malignancy is suspected.