Breast pain is extremely common and at least 2 out of 3 women will suffer from breast pain at some time in their lives. Although it can be worrying, breast pain is not usually a symptom of breast cancer especially in the absence of other symptoms such as a lump.
There are two general types of breast pain. There are those that occur in relation to the menstrual cycle, so called “cyclical mastalgia” and those where the pain is not related to the menstrual cycle.
A pain that occurs in the breast at different times of the menstrual cycle is a sign of the sensitivity of the breast tissue to the normal fluctuations in hormone levels during the monthly cycle. Although this is a common symptom for most women it rarely causes interference with personal relationships or physical activity. The usual time for cyclical breast pain is in the week or two weeks leading up to menstruation. The pain is usually relieved by the onset of menstruation. Cyclical mastalgia is not related to breast cancer or the future development of cancer. The most likely part of the breast to be affected is the outer part of the breast as the breast tissue heads towards the armpit as this is where there is the highest concentration of the milk producing tissue.
Treatment Strategies for Cyclical Mastalgia
1. Ensure that you have appropriately fitted and comfortable bra.
2. Dietary intervention: There is some evidence to show that what you take in your diet affects the sensitivity of the breast. A high fat diet and in particular animal fat and also a high caffeine intake have been associated with increasing levels of breast pain.
3. Dietary supplements: There is limited evidence to support the use of dietary supplements in the form of either vitamin B6 or evening primrose oil (EPO). However, used correctly for cyclical mastalgia alone evening primrose oil may reduce the symptoms if used continuously for a 3-month period. Your local health food supplier may be able to advise you of any other supplements that may be of benefit. The active component of EPO (GLA) is also available in Starflower oil.
4. Hormonal manipulation: If things become desperate the next step is to alter the hormonal environment that the breasts are in and this may entail changing oral contraceptive brand, coming off the oral contraceptive altogether or even suppressing the normal female hormones. These can be discussed with your own GP. The 2 drugs most commonly used for the suppression of menstrual cycle and cyclical mastalgia are Tamoxifen and Danazol, both of which have quite marked side effects. For Tamoxifen the serious side effects are overgrowth of the lining of the womb and an increased risk of developing clots in the leg. The most likely personal side effect is that of severe hot flushes and menopausal symptoms. For Danazol there is often weight gain, increased facial hair growth and acne. Neither of these drugs can be used as a contraceptive.
Pain in the breast coming and going with the menstrual cycle is termed “cyclical mastalgia”. It is usually due to the hormonal sensitivity of the breast at different times of the month, it is not associated with breast cancer and does not normally require treatment unless severe and interfering with usual activities.
Non-cyclical breast pain.
The pain originating from the breast itself
Single areas of tenderness in the breast may indicate an area of unusual growth, this may be simply what is termed as “benign breast change” which is disorganised turnover of normal breast tissue. This may be the formation of cysts that are collections of fluid within the breast and can be painful or it may be related to inflammation following injury and lastly may be due to infection. If the pain is persistent or severe or there are any associated skin changes or lumps you should consult your doctor who will refer you as appropriate. It is very unlikely for these symptoms alone without a lump or distortion of the skin of the breast to be indicative of breast cancer.
Nerve endings to the breast may become hyper sensitive if the nerve pathways they share with other structures are over active, for example, if there is localised inflammation in the joints of the ribs, the overlying breast is likely to feel more sensitive than usual. Similarly if there is a trapped nerve root in the spine the nerves to the breast are affected and the breast itself will feel more sensitive. This pain is more likely to be “nagging” in nature, worse on movement and difficult to pinpoint. Referred pain or localised inflammation can often settle with a short course of anti-inflammatories (eg ibuprofen or Neurofen). Occasionally further treatment such as osteopathy or acupuncture is required.
Non-cyclical breast pain
This may come from the breast and may be the result of disorganised breast turnover and you will need to see your GP if the pain is in a single spot accompanied by the presence of a lump or changes to the skin. If your pain is more diffuse, worse on movement and difficult to pinpoint it is most likely that this pain is referred from other structures in and around the breast or due to a trapped nerve root.
Breast pain alone is not a reason for performing a mammogram. However, if you are over 35 and there is also a lump associated with a pain then a mammogram may be an appropriate investigation. Cysts, which are small collections of fluid can be drained without the need for mammography. For women under 35 the breasts are too dense to make any meaningful interpretation of a mammogram and an ultrasound is often requested if there is a lump accompanying your pain. For women over the age of 50 it is recommended that mammograms are performed at 3 yearly intervals through the NHS breast screening programme. Women over the age of 69 are entitled to a NHS mammogram every 3 years but they have to refer themselves to the screening unit.
Breast Care Campaign
Blythe Hall, 100 Blythe Road,
London, W14 OHB.
Breast Cancer Care
Kiln House, 210 New Kings Road
London, SW6 4NZ.
Free phone 0808 800 6000
3 Bath Place, Rivington Street
London, EC2A 3JR
Tel 0207696 9003
Fax 020 7696 9002
Free phone 0808 800 1234
|Siobhan Laws Version 1.1 2005||
Winchester and Eastleigh Healthcare Trust