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Breast Pain

 
   
 

Breast Pain

Pain in the breast is often referred to as mastalgia or mastodynia. Up to 2/3 of women have some breast pain at various stages in their life.  This pain may be mild or, in extreme cases, interfere with daily living. Studies have found ranges from 8-30% of women have moderate to severe pain lasting 5 or more days per month that affects quality of life. 

Many women fear that they have breast cancer when they have pain in the breast. However, less than 10% of women diagnosed with breast cancer have pain. It is important that all breast pain be checked by a doctor to find the cause of the pain.

CAUSES OF BREAST PAIN

  • Cyclical Breast Pain

Cyclical breast pain affects up to 40% of women before menopause (most often in their 30’s). Changes in hormone levels each month can increase sensitivity of breast tissue. Normally, during each menstrual cycle, the breasts are prepared for the changes needed for pregnancy.  Fluid may be retained before periods, making the breasts swollen, heavy and painful. This resolves with menstruation.

Most cyclical breast pain occurs in the luteal phase of the menstrual cycle after ovulation and before menstruation.  Treatment for cyclical breast pain can vary depending upon what the cause is thought to be. Reducing sodium (salt) intake does not help cyclic breast pain as is often associated with hormonal levels not fluid retention.  Recent studies have found that the use of water pills and restricting salt intake are not effective treatments for cyclical pain.

  • Non-Cyclical 

This type of breast pain is not related to the menstrual cycle. The pain tends to be in one specific area.  The cause may be the irritation of breast tissue (for example, after biopsy), injury to the breast, large cysts or breast infection. Studies have found that the intensity of pain in non-cyclical mastalgia or breast pain was associated with hormones and in more recent studies, the width of milk ducts (a condition that occurs when the duct fills and stretch due to a build-up of cells that line the duct).

Taking hormone replacement therapy can produce this type of pain which tends to be constant and is often not cyclical in nature.

  • Non-Breast Origin Pain 

Often chest-wall pain can be mistakenly thought of as breast pain.  Too much exercise or swelling between the ribs (costochondritis) can cause this feeling.  This pain usually has no pattern, almost always affects only one breast and will usually go away in time. It may be associated with a history of trauma or previous surgery at the site but should be assessed to rule out disease.

ASSESSING OF BREAST PAIN

Your doctor will take a thorough breast health and family history, and then examine your breasts.  A mammogram and/or ultrasound may be done to rule out another cause for the pain (cysts).  It is important to identify the site, strength and duration (how long it lasts) of the breast pain.  It is also important to identify what has been done to relieve the pain and what has either worked or not worked in the past.

It may be worthwhile to track your pain on a calendar for a period of time so that you can give it to your doctor. The following are some examples of different kinds of breast pain and how they might be described (Preece PE et al 1976).[1]

Breast pain related to monthly period or cycles Pain that has a definite pattern, pain is experienced with ovulation cycles just before menstruation, it is more common in pre-menopausal women; often in both breasts and is often described as sharp, shooting stabbing, heavy, aching, deeply tender or throbbing.
Breast pain that is not related to monthly periods and is non-cyclical Seems to have no pattern and is sometimes constant, no association with menstruation; pain may occur with women taking hormone replacement therapy, tends to be in one spot and is often under the nipple or just to one side, it may occur in only one breast or may be on both sides; often described as heavy, aching, tender, burning, pulling, or pinching.
Chest wall or Non-breast origin pain No pattern, any age; almost always on one side only; may occur between the ribs or in the muscles and can be associated with surgery in the area, other injury or trauma and may be referred pain from another area; need to rule out cancer.

MANAGEMENT OF BREAST PAIN

If breast pain interferes with your quality-of-life and daily activities, you may want to try the following:

  • wearing a well-fitting, supportive bra. This can bring relief for breast pain and is very important if you do active sports.  Some department stores and specialty stores can offer you advice about a bra fits you best.
  • changing your diet.  Being overweight can increase the amount of estrogen in the body which may cause some types of breast pain.
  • exercising regularly. Exercise causes an increase in endorphins, the naturally-occurring pain killers in our bodies. This can decrease breast tenderness. Regular physical exercise may play a role in overall improvement of breast health and decrease your risk of cancer. However, very strenuous exercise may cause muscle stain or swelling between the ribs (costochondritis).
  • eating flax seed. Many women who eat flax seed report a decrease in cyclical breast pain eating. Two tablespoons of crushed flaxseed (not flaxseed oil) taken daily for 3 months was found to be effective for cyclical breast pain in studies.
  • applying an anti-inflammatory gel to the skin is effective for breast pain. Anti-inflammatory gels can be prescribed by your doctor or a pharmacist can recommend a product that is available without a prescription.

At this time, there is not enough evidence to recommend the use of Evening Primrose Oil in the treatment of breast pain. Ginseng may actually cause breast pain. Vitamins, such as Vitamin A, E, and B6 have not been proven to be helpful in the treatment of mastalgia. Vitamin A is a fat-soluble vitamin which can be toxic in large doses. 

For more severe pain, see your doctor for an assessment of drugs such as Tamoxifen and Danazol which can be used to change your hormone levels. Your doctor may also be able to make recommendations about:
  • aspiration (removing fluid) of larger simple cysts
  • antibiotics for breast infection
  • adjusting your dose of hormone replacement therapy or oral contraceptive
  • medications you may be taking that could aggravate breast pain

Remember that most often breast pain is not associated with cancer. However, breast pain needs to be checked to determine the cause of pain and rule out cancer. Any pain that lasts for long periods of time is difficult to deal with. Relaxation and distraction are important pain management tools in addition to your doctor’s care plan.

[1] Preece PE, Mansel RE, Bolton PM, Hughes LE, Baum M, Gravelle IH. Clinical syndromes of mastalgia. Lancet. 1976; 02(7987): 670-3.