Benign breast disease includes mastalgia, fibrocystic breast disease, breast cellulites and abscesses, nipple discharges, and galactorrhea. Although benign breast disease is much more common than breast cancer, the specter of breast cancer is so overwhelming that the primary evaluation of the woman is to eliminate cancer as the cause quickly and adequately. Benign breast disease occurs in women age 20-50 and declines after menopause, whereas the incidence of breast cancer continues to increase with age. Surgeons have been the primary researchers; again little research has been accomplished comparing non-surgical to surgical evaluations, or adequately evaluating non-surgical evaluations. Little new research has been accomplished in the last five years. Mastalgia: Breast pain (mastalgia) may be unilateral (75%) or bilateral, continuous or intermittent, related to the menstrual cycle (40%) or associated with a mass. Breast pain alone was the presenting complaint in 15-50% of women attending breast clinics. How often pain is associated with breast cancer is uncertain. Breast pain was the presenting complaint of 5-24% of women with operable breast cancer in “surgical breast clinics” (a population that may be skewed). A recent 20-year cohort study in France of 247 women with cyclic mastalgia who did not use hormones found that the risk of cancer increased with the length of time they complained of cyclic mastalgia. Women who had cyclic mastalgia for more than three years were five times more likely to develop cancer. Women who develop pain with a mass should have the mass evaluated first. Breast masses in women age 50 or younger usually are benign but need evaluation (Figure 19.1).
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