Doctors outline when breast pain is worrying and when it is not

Breast pain is common, experienced by the majority of women at some point, and is usually benign, but doctors warn that new, persistent or one-sided pain warrants medical assessment. Experts have set out guidance for when women should seek help and described the main causes, from cyclical tenderness to infections and the small risk of cancer.

The National Institute for Health and Care Excellence (NICE) estimates that around 70% of women experience breast pain, also called mastalgia, at some time. About 120,000 women are referred each year to specialist NHS breast clinics for further investigation after reporting breast pain. "For some women, breast pain can be severe and yet many feel they have to grin and bear it," said Dr Karen Morton, a consultant gynaecologist based in Surrey. "Others may feel embarrassed discussing it. But if it's stopping you from doing everyday activities, seek help."

Clinicians typically distinguish between cyclical and noncyclical pain. Cyclical mastalgia is linked to the menstrual cycle and is the most common pattern: women report twinges, aches and tender spots that fluctuate with their periods. Noncyclical pain does not follow the cycle and may occur in a single area or on one side.

A range of conditions can cause breast pain. Hormonal changes are often responsible for cyclical symptoms. Infections such as mastitis, benign lumps including cysts, and musculoskeletal problems can also produce breast discomfort. Some medications have been associated with breast tenderness; doctors say hormonal treatments, including certain contraceptives and hormone replacement therapy, as well as other drugs, may contribute to mastalgia in some patients.

While most cases are not serious, clinicians say pain can occasionally signal a more worrying problem. "For example, one-sided pain may be a sign of breast cancer," said Professor Kefah Mokbel, a consultant breast surgeon at the London Breast Institute. He added that this is uncommon: "only 2 per cent of breast-pain cases are due to cancer."

Doctors advise that any new, persistent or unexplained breast pain should be reported to a general practitioner. During assessment, a GP will take a history and perform a physical examination; if there are worrying features, such as a lump, skin changes, nipple discharge or persistent unilateral pain, the patient may be referred for imaging—typically a mammogram or ultrasound—and specialist review.

Management depends on the cause. Reassurance and watchful waiting are appropriate for many women, particularly when symptoms are cyclical and examinations are normal. Where infection is identified, antibiotics may be prescribed; pain relief and lifestyle measures are commonly recommended to reduce symptoms. When medication is suspected to be contributing to pain, clinicians may review current prescriptions and consider alternatives.

Experts emphasise the impact breast pain can have on quality of life. The high number of referrals reflects both the prevalence of symptoms and the difficulty of differentiating benign causes from the small proportion of cases linked to cancer. Women experiencing pain that interferes with daily activities or that is new or confined to one breast are encouraged to seek prompt medical advice so appropriate evaluation and reassurance can be provided.