Introduction

Most women consider premenstrual mild cyclic breast pain (mastalgia) lasting for one to four days as normal. For some, however, mastalgia can be moderate-to-severe and last over five days each month, causing a great discomfort. Women with mastalgia are generally reluctant to consult medical personnel and those who do will often report recent quantitative or qualitative increases in their pain (Dixon, 1999). Because of increased awareness of breast cancer, more women than ever before are seeking professional advice (Klimberg, 1998) (see also ‘Cancer: breast’). Subjective by nature, mastalgia is difficult to quantify and, at present, few physicians adopt a systematic diagnostic approach. Available treatments are few and limited by low efficacy and multiple side effects.

Prevalence and classification

Mastalgia is the most common breast complaint for which women consult their healthcare providers: up to 70% of women under 55 years old experience it (Arona, 1998; Dixon, 1999). Many patients with mastalgia consult once (36%) or more (5%) (Ader & Shriver, 1997). Neither marital status, household income, education, nor race appears to influence these rates (Ader et al., 2001). Breast pain is usually classified as cyclical mastalgia (CM) and non-cyclical mastalgia (NCM). CM occurs in a predictable pattern, often premenstrually, while NCM is described as a constant or intermittent breast pain with no relationship to menstruation. Chest wall pain accounts for 7% of the consulting women.