Mastalgia, Radiological Yield, and Psychological Burden: A Cross-Sectional Comparative Study

Purpose To investigate the clinical, radiological, and psychological correlates of mastalgia and to determine the factors independently associated with anxiety and depression in women presenting with breast pain. Methods In this cross-sectional study, 151 women with mastalgia and 69 controls undergoing breast imaging were assessed. Sociodemographic variables, pain characteristics, clinical history, visual analog scale (VAS) scores, and Beck Anxiety (BAI) and Depression (BDI) Inventory scores were collected. Radiological evaluation was performed using ultrasound or mammography based on age, and magnetic resonance imaging findings were included when available. Group comparisons were performed statistically using univariate tests and multivariate linear regression was used to identify predictors of anxiety and depression among patients with mastalgia. Results Women with mastalgia demonstrated significantly higher anxiety scores than controls (median BAI 10 vs. 7; p = 0.009), whereas depression scores did not differ. Among patients with mastalgia, non-cyclic pain, palpable abnormalities, and a history of breast surgery were associated with greater anxiety according to univariate analysis. In the multivariate model, palpable breast stiffness (β = 5.30; p = 0.013) and a history of previous breast surgery (β = 8.67; p = 0.022) independently predicted increased anxiety, whereas cyclic pain was protective (β = –6.40; p = 0.007). Imaging yielded predominantly benign or normal findings, underscoring the low diagnostic contribution of routine radiological work-up. Conclusion Mastalgia is characterized by a substantial psychological burden despite a low prevalence of radiological abnormalities. Clinical features, such as palpable stiffness and a history of prior breast surgery, are more strongly linked to anxiety than the findings from imaging studies. These results support a more selective imaging strategy and highlight the importance of incorporating psychological assessment in the evaluation of breast pain.