Breast Education - Breast Awareness

Breast pain is more common than you might think – and it’s only rarely associated with breast cancer. It’s estimated that more than half of all women have breast pain at one time or another; many experience pain every month for a week or so prior to menstruation.

To understand breast pain, it’s helpful to understand the anatomy and development of the breast. Breast growth starts during puberty, when hormones are starting to flow. Milk glands, ducts and fat are stimulated to grow, eventually forming breasts.

Monthly breast pain

The same hormones which cause breast growth and development can continue to affect the breasts until menopause (or after, if hormone replacement therapy is used). This regular discomfort, known as “cyclic mastalgia”, is often associated with breast fullness in both breasts and will disappear after the period starts. This is due to two primary hormones – estrogen, which is responsible for getting the uterus ready for pregnancy, and progesterone, which helps maintain a pregnancy if fertilization occurs . If pregnancy doesn’t occur, the hormone levels drop, the uterus sheds it’s lining, the breasts are soft and pain-free, and the cycle starts again.

Your doctor may have told you that you have fibrocystic disease in the your breasts, although calling fibrocystic changes “fibrocystic disease” may be too much -- something affecting more than 70% of all women shouldn’t be considered a disease!

Fibrocystic changes are include the development of cysts (small fluid-filled sacs) and/or rubbery irregularities and lumps within the breast tissue, and is seen in many women with “lumpy breasts”. Cysts will usually enlarge uncomfortably in the premenstrual period, and return to normal after the period starts. Rubbery lumps (fibroadenomas) are generally freely moveable within the breast tissue.

The problem with fibrocystic changes is that they can make finding a tumor difficult. The breasts may be dense and difficult to evaluate, either by exam or mammography. This is one reason that monthly breast self-exams are so important. No one knows the typical feel and shape of your breasts better than you do, and any new lump should be checked by your doctor.

The good news is that lumps that regularly enlarge and reduce in size with your period are usually completely benign.

Cyclical pain is treated with a number of different medications and dietary changes, depending upon the degree of severity. Your gynecologist can guide your treatment, but it’s always a good idea to wear a supportive bra 24 hours a day in the days before your period starts. Over-the-counter pain medications such a aspirin, ibuprofen or acetameniphen may be helpful, as might warm compresses.

Non-cyclical breast pain

Non-regular breast pain (“non-cyclical mastalgia”) is not associated with premenstrual hormone changes. The character of the discomfort can range from a mild tingling sensation to sharp pains in one or both breasts and the cause may be more difficult to figure out.

There are many causes for this type of breast pain. They may include an injury or strain to the breast itself or to chest wall muscles, bone or cartilage. Pain is common after breast surgery, sometimes lasting for several months. Breast infections are common in nursing mothers and may cause redness, swelling and pain. A benign tumor called an intraductal papilloma may cause pain. Some medications can cause breast discomfort. None of these are generally serious nor dangerous conditions.

A very small number of patients with breast pain may have cancer, so investigation of the causes of the pain will probably be a good idea, especially if the pain is associated with a new lump.

When should non-cyclical breast pain raise an alarm?

Go to see your doctor if you have any of the following problems. Pain is rarely associated with breast cancer, but it’s always better to be safe since early detection is important in treatment.

  • Pain which is localized to one spot and continues for several weeks
  • Pain associated with a new lump, thickening
  • Pain associated with skin redness and swelling or changes in the skin texture
  • Pain associated with clear or bloody discharge from a nipple
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