Mastalgia: A contemporary narrative review of evaluation and management

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BSTRACT

Mastalgia is the most common breast-related complaint encountered in clinical practice and accounts for a substantial proportion of referrals to specialist breast clinics. Although rarely associated with malignancy, breast pain frequently generates significant cancer-related anxiety and may impair quality of life. This narrative review synthesizes contemporary evidence regarding epidemiology, pathophysiology, diagnostic evaluation, and management strategies for mastalgia. Cyclical mastalgia is hormonally mediated and may reflect altered prostaglandin metabolism, fatty acid imbalance, and enhanced tissue sensitivity to estrogen and prolactin. A structured, pain-pattern–driven approach beginning with reassurance and mechanical support, progressing through lifestyle optimization and selective nutritional supplementation, and reserving pharmacological therapy for refractory cases remains the cornerstone of management. Randomized evidence supports flaxseed, omega-3 fatty acids, and vitamin E—particularly in combination regimens—in cyclical mastalgia, although effect sizes are modest. Correction of confirmed vitamin D deficiency may provide symptomatic benefit, but robust randomized data remain limited. Low-dose tamoxifen (5–10 mg) remains the most effective therapy for severe cyclical mastalgia. Dopamine agonists, such as cabergoline, may be considered in selected refractory cases. Central sensitization mechanisms may contribute to persistent noncyclical mastalgia and warrant multidisciplinary management. Surgical intervention has an extremely limited role and should generally be discouraged.