A breast biopsy is sometimes performed or a needle biopsy. The treatment is symptomatic. Some women find that avoiding caffeine, sticking to a low salt diet, or taking aspirin or mild analgesics may help. Some women find vitamin E helpful, and women with irregular periods find that their symptoms are relieved when they take oral contraceptives. Other agents that have been used include evening primrose oil which has been studied in Europe.
Many women have cyclic breast pain.
If this is severe, I would encourage you to see your physician for a breast pain evaluation. No, most physicians who take care of women, that is gynecologists or family physicians, could be able to do the initial exam and determine if referral to a breast clinic is necessary. There are several studies that suggest that cutting caffeine out completely may improve pain or tenderness - most women that I have suggested this to decide to stick to the caffeine. No, most lumps can be evaluated without surgical removal. Breast specialists use ultra sound, fine needle aspiration, and sometimes mammography to determine whether a lump needs to come out.