Synopsis
Develop the ability to distinguish common cyclical or musculoskeletal breast pain from focal disease, identify accompanying cancer warning features and plan proportionate assessment and symptom relief, while explaining uncertainty and arranging reliable review.
- Distinguish diffuse bilateral cyclical tenderness from a new focal persistent site, and separate background nodularity from a dominant mass.
- Ask about menstrual timing, pregnancy, lactation, hormonal medicines, trauma, activity, bra support and pain reproduced by neck, shoulder or chest movement.
- Examine both breasts and nodes, then palpate ribs, costochondral joints and pectoral structures when an extra-mammary source is possible.
Investigation priorities
Establish whether pain predictably varies with cycles, activity or support.
Management branches
A 31-year-old reports bilateral upper-outer breast tenderness before each period and general lumpiness that settles afterwards; examination finds no dominant mass or skin change.
- Confirm cyclic timing, pregnancy possibility, medicine changes and absence of focal warning symptoms, then examine both breasts and the chest wall for a reproducible alternative source.
- Explain that bilateral cyclical pain with symmetrical nodularity and no dominant lesion is commonly benign, while defining the changes that would require renewed assessment.
Key medicines
Paracetamol500 mg to 1 g by mouth per dose, at least 4 hours apart, up to four doses and a maximum of 4 g in 24 hours; without clinician advice, use for no longer than 3 days.Check the dose with a clinician or pharmacist below 50 kg and in liver or kidney disease or regular excess alcohol use. Avoid simultaneous products containing paracetamol and seek urgent advice after overdose.