Breast Pain is not Always a Symptom of Breast Cancer

About 5 million women in the United Kingdom get breast pain, or “mastalgia”.  Indeed, 4 out of 10 women working in Marks and Spencer said they had experienced breast pain recently and just over one in five women said the breast pain had been severe.  Breast pain isn’t normally a sign of breast cancer. Breast cancers are usually although not always painless.

TYPES OF BREAST PAIN

Breast pain can either be “cyclical” (related to the menstrual cycle) or non-cyclical.  Cyclical breast pain tends to affect women who are in their late 20s and 30s and the pain is at its most severe for a week or 10 days before a period.

Non-cyclical” pain can be either true non-cyclical pain (pain in the actual breast at any time in the month) or muscular pain, which arises from inflammation in the muscles.  It tends to affect older women.

CYCLICAL MASTALGIA

Many women notice that their breasts feel heavier, fuller or sore in the days before their period.  Breast may also feel lumpier.  Some women have these changes each month, but the reason why most women with pain or discomfort in their breasts see a doctor is that this pain is new to them.  The pain is usually described as heaviness or an ache, rather like the toothache with the breast being tender to touch

Normally, the pain affects the outer half of the breast.  The pain can vary from month to month and can sometimes be present for many years.  Cyclical breast pain usually stops at the menopause (unless hormone replacement therapy is taken) but pregnancy, the use of oral contraceptives and having children do not usually affect it.  Certain movements can in crease the pain; this is particularly important for women whose occupations include lifting and prolonged use of the arm.  Breast pain can have a major impact on people’s lives and the effects of breast pain are often underestimated.

NON-CYCLICAL MASTALGIA

Non-cyclical breast pain can arise from the breast itself, from the muscles and ribs under the breast or from sites outside the breast.  Woman who have pain coming from the muscles or ribs, often complain of tender spots over the ribs, next to the breast bone, or over the ribs just outside the breast.  Non-cyclical breast pain can be present all the time, but it usually comes and goes and does not have a regular pattern, although it may be made worse using the arm muscles.  The pain is most commonly described as burning or drawing, but it can be stabbing in nature.

WHAT CAUSES BREAST PAIN

Although cyclical pain happens each month before a period, studies have not shown a clear link between hormone levels and breast pain. 

Women with breast pain have been found to have some abnormalities in the level of certain fatty acids in the blood.

TREATMENT OF CYCLICAL BREAST PAIN

Mild breast tenderness which occurs immediately before a period and disappears after the period is rarely, if ever, a symptoms of a serious problem.  If the pain is so bad, that is interferes with daily activities, drug treatment may be necessary

WHAT HELPS THE PAIN?

Reassurance (knowing there is no serious cause)

Most women can cope with breast pain once they have been examined and nothing wrong has been found.  Wearing a good supporting bra eg a sports bra can be helpful.

Low Fat Diet

Eating a low fat diet can help. 

Danazol

Danazol (prescribed by your doctor) can be useful, but some women experience side-effects such as weight gain, increased facial hair or lowering of voice. Danazol SHOULD NOT be taken by patients on the oral contraceptive pill and while on this drug, women should use mechanical forms of contraception (sheath, caps, coils). 

Tamoxifen

Tamoxifen can also be useful. Side effects include hot flushes and vaginal discharge.  These are however, more serious side effects and Tamoxifen, should be given only after consultation in a Specialist Breast Unit.

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