Original Study| Volume 23, ISSUE 3, P330-337, April 2023

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Post Treatment Mastalgia is a Common Complaint but not an Indication of Recurrence or Second Primary Breast Cancer

Published:December 13, 2022DOI:


      • Post treatment breast pain or mastalgia is a common complaint.
      • Patients fear that post treatment pain may be a sign of breast cancer recurrence.
      • Post treatment mastalgia, however, is not associated with recurrence.
      • Interval or repeat imaging does not appear necessary and instead patient education and reassurance are important in its management.



      Post-treatment mastalgia is a common complaint in up to 68% of patients after treatment. This symptom is worrisome to patients as many believe it is a sign of recurrence. The current study was performed to evaluate if post-treatment mastalgia is associated with a second breast cancer diagnosis.

      Materials and Methods

      Patients included were seen from January 1, 2000 to December 31, 2020. All patients who were treated for breast cancer and then presented with breast pain during follow up were considered to have post-treatment mastalgia. All patients who were diagnosed with a second breast cancer but did not experience post-treatment mastalagia were also evaluated.


      1799 patients had a mean age 52.9 years. 36% of patients experienced post-treatment mastalgia. Of patients who complained of post-treatment mastalgia, 19 were diagnosed with a chest wall recurrence (CW), ipsilateral breast tumor recurrence (IBTR), or contralateral breast cancer (CBC). 17 of the 19 patients had breast pain after the second diagnosis and treatment were completed. The average duration between their second diagnosis and initial complaint of breast pain was 6.2 years. The two patients who complained of breast pain prior to their second diagnosis did not have mastalgia at the time of their second diagnosis. Local recurrence or contralateral breast cancer were more common in patients without post treatment mastalgia (10.1% vs 0.3%, p < 0.0001) during follow up.


      Post treatment mastalgia is not associated with recurrence. Interval or repeat imaging does not appear necessary and instead patient education and reassurance are important in its management.


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        • Joyce DP
        • Alamiri J
        • Lowery AJ
        • et al.
        Breast clinic referrals: can mastalgia be managed in primary care?.
        Ir J Med Sci. 2014; 183 (Dec): 639-642
        • Ader DN
        • Shriver CD.
        Cyclical mastalgia: prevalence and impact in an outpatient breast clinic sample.
        J Am Coll Surg. 1997; 185 (Nov): 466-470
        • Ader DN
        • Browne MW.
        Prevalence and impact of cyclic mastalgia in a United States clinic-based sample.
        Am J Obstet Gynecol. 1997; 177 (Jul): 126-132
      1. (eds.)Jameson JL Fauci AS Hauser SL Longo DL Loscalzo J Harrison's Principles of Internal Medicine. 20th ed. MCGraw-Hill Education, New York, NY2018
      2. (eds.)Lobo RA Gershenson DM Lentz GM Valea FA Comprehensive Gynecology. 7th ed. Elsevier, Philadelphia, PA2017
      3. (eds.)Townsend CM Beauchamp RD Evers BM Sabiston Textbook of Surgery. 20th Ed. Elsevier, Philadelphia, PA2017
        • Tintinalli JE
        Editor in Chief. Tintinalli's Emergency Medicine.
        9th ed. McGraw-Hill Education, New York, NY2020
        • Kliegman RM
        • Stanton BF
        • St Gerne JW
        • Shchor NF
        Nelson Textbook of Pediatrics.
        (eds.) Elsevier, Philadelphia, PA2015
        • Altıntas Y
        • Bayrak M.
        Evaluation of 1294 Female Patients with Breast Pain: A Retrospective Study.
        Adv Ther. 2018; 35 (Sep): 1411-1419
        • Cho MW
        • Grimm LJ
        • Johnson KS.
        Focal Breast Pain: Does Breast Density Affect the Need for Ultrasound?.
        Acad Radiol. 2017; 24 (Jan): 53-59
        • Chetlen AL
        • Kapoor MM
        • Watts MR.
        Mastalgia: imaging work-up appropriateness.
        Acad Radiol. 2017; 24 (Mar): 345-349
        • Komenaka IK
        • Nodora J
        • Martinez EM
        • Hsu CH
        • Wong T
        • Shah A
        • Caruso DM.
        Mastalgia is a very common complaint but not a predictor of breast cancer.
        J Am Board Fam Med. 2022; (in press)
        • Geving Andersen K
        • Kehlet H.
        Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention.
        J Pain. 2011; 12 (Jul): 725-746
        • Bruce J
        • Thornton AJ
        • Scott NW
        • et al.
        Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer.
        Br J Cancer. 2012; 107 (Sep 4): 937-946
        • Schreiber KL
        • Martel MO
        • Shnol H
        • et al.
        Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain.
        Pain. 2013; 154 (May): 660-668
        • Bruce J
        • Thornton AJ
        • Powell R
        • et al.
        Recovery Study Group. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study.
        Pain. 2014; 155 (Feb): 232-243
        • Hwang ES
        • Hyslop T
        • Lynch T
        • et al.
        The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS).
        BMJ Open. 2019; 9 (Mar 12)e026797
        • Diefenbach MA
        • Weinstein ND
        • O'Reilly J
        Scales for assessing perceptions of health hazard susceptibility.
        Health Educ Res. 1993; 8 (Jun): 181-192
        • Paik S
        • Tang G
        • Shak S
        • et al.
        Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.
        J Clin Oncol. 2006; 24 (Aug 10): 3726-3734
        • Sparano JA
        • Gray RJ
        • Makower DF
        • et al.
        Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer.
        N Engl J Med. 2018; 379 (Jul 12): 111-121
        • Overgaard M
        • Hansen PS
        • Overgaard J
        • et al.
        Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial.
        N Engl J Med. 1997; 337 (Oct 2): 949-955
        • Overgaard M
        • Jensen MB
        • Overgaard J
        • et al.
        Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: danish breast cancer cooperative group DBCG 82c randomised trial.
        Lancet. 1999; 353 (May 15): 1641-1648
        • Weiss BD
        • Mays MZ
        • Martz W
        • et al.
        Quick assessment of literacy in primary care: the newest vital sign.
        Ann Fam Med. 2005; 3 (Nov-Dec): 514-522
        • Komenaka IK
        • Nodora JN
        • Machado L
        • et al.
        Health literacy assessment and patient satisfaction in surgical practice.
        Surgery. 2014; 155 (Mar): 374-383
        • Bovbjerg DH
        • Keefe FJ
        • Soo MS
        • et al.
        Persistent breast pain in post-surgery breast cancer survivors and women with no history of breast surgery or cancer: associations with pain catastrophizing, perceived breast cancer risk, breast cancer worry, and emotional distress.
        Acta Oncol. 2019; 58 (May): 763-768
        • Lundstedt D
        • Gustafsson M
        • Steineck G
        • et al.
        Risk factors of developing long-lasting breast pain after breast cancer radiotherapy.
        Int J Radiat Oncol Biol Phys. 2012; 83 (May 1): 71-78
        • Bell RJ
        • Robinson PJ
        • Nazeem F
        • et al.
        Persistent breast pain 5 years after treatment of invasive breast cancer is largely unexplained by factors associated with treatment.
        J Cancer Surviv. 2014; 8 (Mar): 1-8
        • Forget P
        • Sitter TM
        • Hollick RJ
        • et al.
        The KBCt Group. characterization of preoperative, postsurgical, acute and chronic pain in high risk breast cancer patients.
        J Clin Med. 2020; 9 (Nov 26): 3831
        • Macdonald L
        • Bruce J
        • Scott NW
        • Smith WC
        • Chambers WA.
        Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome.
        Br J Cancer. 2005; 92 (Jan 31): 225-230
        • Peuckmann V
        • Ekholm O
        • Rasmussen NK
        • et al.
        Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark.
        Eur J Pain. 2009; 13 (May): 478-485
        • Gärtner R
        • Jensen MB
        • Nielsen J
        • Ewertz M
        • Kroman N
        • Kehlet H.
        Prevalence of and factors associated with persistent pain following breast cancer surgery.
        JAMA. 2009; 302 (Nov 11): 1985-1992
        • Lumley MA
        • Cohen JL
        • Borszcz GS
        • et al.
        Pain and emotion: a biopsychosocial review of recent research.
        J Clin Psychol. 2011; 67: 942-968
        • Scarella TM
        • Boland RJ
        • Barsky AJ.
        Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment.
        Psychosom Med. 2019; 81 (Jun): 398-407
        • Porter LS
        • Keefe FJ.
        Psychosocial issues in cancer pain.
        Curr Pain Headache Rep. 2011; 15 (Aug): 263-270
        • Franklin KB.
        Analgesia and abuse potential: an accidental association or a common substrate?.
        Pharmacol Biochem Behav. 1998; 59 (Apr): 993-1002
        • Törer N
        • Nursal TZ
        • Calişkan K
        • et al.
        The effect of the psychological status of breast cancer patients on the short-term clinical outcome after mastectomy.
        Acta Chir Belg. 2010; 110 (Jul-Aug): 467-470
        • Schnur JB
        • Montgomery GH
        • Hallquist MN
        • et al.
        Anticipatory psychological distress in women scheduled for diagnostic and curative breast cancer surgery.
        Int J Behav Med. 2008; 15 (Jan-Mar): 21-28
        • Montgomery GH
        • Schnur JB
        • Erblich J
        • Diefenbach MA
        • Bovbjerg DH.
        Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery.
        J Pain Symptom Manage. 2010; 39 (Jun): 1043-1052
        • Katz J
        • Poleshuck EL
        • Andrus CH
        • et al.
        Risk factors for acute pain and its persistence following breast cancer surgery.
        Pain. 2005; 119 (Dec 15): 16-25
        • Polinsky ML.
        Functional status of long-term breast cancer survivors: demonstrating chronicity.
        Health Soc Work. 1994; 19 (Aug): 165-173
        • Shelby RA
        • Scipio CD
        • Somers TJ
        • Soo MS
        • Weinfurt KP
        • Keefe FJ.
        Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer.
        J Clin Oncol. 2012; 30 (Mar 10): 813-819
        • Ahmad Adni LL
        • Norhayati MN
        • Mohd Rosli RR
        • Muhammad J
        A systematic review and meta-analysis of the efficacy of evening primrose oil for mastalgia treatment.
        Int J Environ Res Public Health. 2021; 18 (Jun 10): 6295
        • Kool RB
        • Verkerk EW
        • Winnemuller LJ
        • et al.
        Identifying and de-implementing low-value care in primary care: the GP's perspective-a cross-sectional survey.
        BMJ Open. 2020; 10 (Jun 3)e037019