Patients often express anxiety about mastalgia because it is a frequent breast problem. The purpose of this research was to ascertain whether or not mastalgia is an indicator of breast cancer and to assess the usefulness of a subsequent diagnostic evaluation. Analysis of data obtained prospectively on 8,960 patients at a safety-net hospital between June 1, 2006, and December 31, 2020. The incidence of mastalgia and the presence of breast cancer in a patient’s family history were recorded. The average age of these 8,960 patients was 45. About 70% of the population was Hispanic, and just 16% of adults had sufficient health literacy. In this study, over 31% of patients (2,820 out of 8,960) reported experiencing breast pain. About 20 (0.7%) of the 2,820 patients evaluated for breast pain were diagnosed with breast cancer. Cancer of the breast patients averaged 49 years old, and 6 patients had masses detected by palpation, but only 3 reported cancer-specific pain (10 bilateral, 7 contralateral). Over the course of the study, 1,280 patients less than 40 years old were screened with breast imaging. At 0.9% per 1,000 exams, the cancer detection rate was low. Breast imaging was performed on 99% of women aged 40 to 49 and 99% of women aged 50 and up. At age 40–49, the Cancer Detection Rate (CDR) was 10 per 1,000 examinations; at age 50 and more, it was 14 per 1,000. In very unusual cases, mastalgia might be a sign of breast cancer. Patients under the age of 40 are not advised to undergo imaging unless there are additional indications. In patients who are of screening mammography age, further investigation to determine the “cause” of breast pain does not appear to be necessary.