Natural history of breast pain.

258 patients with breast pain were restudied 2 to 7 years after initial assessment in a special mastalgia clinic. Pain persisted at follow-up in 65% of patients. Mastalgia was cyclical in two-thirds. Mean duration of pain in patients experiencing complete relief before follow-up examination was 6.8 years, while duration of pain persisting at follow-up ranged from 2 to 30 years. In patients who had relief or substantial improvement in pain, the improvement was spontaneous in 22% and resulted from a hormonally related event--menopause, pregnancy, or use of oral contraceptives--in the remainder. Onset of cyclical pain before the age of 20 years was followed by a prolonged course. A quarter of the patients had non-cyclical pain. There were two populations of patients in this group. One experienced relief after a mean of 3 years, and in the other pain still persisted after 2-22 years. Relief was spontaneous in one half, and rarely followed a hormonally related event. About 70% of the patients, with both cyclical and non-cyclical pain, considered that their pain had warranted active treatment. This study indicates that the type of pain and age at onset may allow some prediction of the course of the disease and may aid the choice of therapy.