Definition of terms:
Abscess - A collection of pus from
Pain in the breast is referred to as mastalgia or mastodynia. This pain may be characterized as cyclic, noncyclic or musculoskeletal. Only about 10 percent of breast pain is associated with breast cancer. A physician's examination and a mammogram can determine the cause of the pain. Breast pain may be uncomfortable and annoying, but it is usually not unbearable. What seems unbearable is the fear that it may be cancer. However, all breast pain needs evaluation to determine its cause. To assist your physician, it will be helpful if you understand the different kinds and characteristics of breast pain.
Cyclic pain appears to be related to the female hormones estrogen, progesterone and prolactin. Their effect on breast tissue varies at different times of the month and life cycle. Pain related to these changes usually begins at ovulation and increases until the menstrual period begins. After menstruation, the pain decreases. Both breasts are usually involved, but occasionally, one breast will experience a greater degree of pain. Often, the pain is greatest in the upper-outer quadrants (from the nipple back toward the armpit) and sometimes radiates to the arm pit and arm. The discomfort is felt throughout the area and is often described as a dull, aching pain, as if the breast were filled with milk. Pre-menopausal women experience this pain. Menopause relieves the symptoms.
For some women, birth control pills may relieve cyclic pain. The pills cause the hormones in the body to remain more consistent and balanced. Dietary changes have also helped some women. Refraining from or greatly reducing the amount of caffeine (coffee, tea, colas, chocolate) consumed and eating a low-salt diet may provide relief for some women. Supplements, including vitamin E and B-complex, are occasionally recommended by physicians as helpful. Ask your physician for recommendations.
Danazol®, a male hormone drug, may be prescribed for highly painful mastalgia not relieved by other methods of treatment. It is effective in altering the balance of female hormones. Some women avoid taking the drug because it is expensive and because it can cause unwanted masculine side effects, such as the growth of facial hair.
Noncyclic pain differs from cyclic pain in that it has no relationship to the menstrual cycle. This pain can be continuous or may only occur from time to time. The pain is usually localized to a specific area in one breast(unilateral). Described as a sharp, stabbing or burning sensation in the breast, the pain is most often found in the fourth decade (30s) of life. This pain has been linked to fluid-filled cysts, fibroadenomas, duct ectasia, mastitis, injury and breast abscesses. Treatment may include withdrawing the cyst fluid, surgically removing the fibroadenoma, prescribing antibiotics, or having surgery for duct ectasia, mastitis or abscesses.
Some noncyclic pain is also related to musculoskeletal causes. The most common is pain that comes from a pinched nerve in the back, cervical or dorsal radiculitis. Often, a history of back injury, scoliosis, arthritis or osteoporosis is involved. One breast will be painful.
If the second intercostal nerve is involved, the pain and tenderness will appear in the upper, outer breast, under the arm and will extend down the arm often causing numbness and tingling of the fingers. If the pressure is coming from the third nerve in this area, there will be pain and tenderness along the nipple line.
To check for this pain, a physician will ask the patient to elevate her arm on the painful side over her head. The physician, standing behind the patient, lifts the painful breast toward her breastbone and applies pressure in the mid-underarm area. If the pain is coming from a pinched nerve, this will cause a very tender area(s) to radiate pain into the breast. Pressure applied to the mid-axillary line causes pain.
Another cause of breast pain originates in the area of the breast bone and ribs and is known as Tietze's syndrome. It is commonly called painful costochondritis (inflammation of the cartilage of the ribs). This pain is localized to the medial half (closest to breastbone) and is tender when pressure is placed on the breastbone, when the rib cage is moved, or when a deep breath is taken. This pain often occurs after doing heavy lifting or activities that stretch the upper body. If the pain is from costochondritis, ibuprofen or aspirin, taken for several days on a regular basis, will usually reduce the pain.
Other causes for breast pain may be from phlebitis (an inflamed vein), called Mondor's syndrome. Even infected teeth have been shown to cause referred breast pain. Additionally, some herbal products such as Ginseng and Dong Quai will cause breast tenderness and pain.
If you cannot determine if your pain is cyclic or noncyclic, keep a record of the pain you experience daily and its time in your cycle. After two months, you will be able to tell if the pain is associated with the fluctuating hormones of your menstrual cycle, or bears no relationship to hormonal changes.
Cyclic pain has no relation to cancer and noncyclic pain is rarely a sign of cancer. However, it should be checked out. Most often, breast cancer pain is localized in the breast (one place hurts), continuous (not changing with different times in the menstrual cycle), and usually occurs in only one breast.
If you have breast pain, schedule a breast exam with a physician. After a complete history and breast exam, a mammogram will probably be ordered (if over 35) to search out any cause not apparent on the exam. If the exam and the mammogram are negative (no suspicious findings), a search to determine what type of pain and how to relieve your pain should be started. If a lump or cyst is found, a biopsy may be needed to remove the suspicious area or to rule out cancer. It is important to inform your physician of any new prescription or over-the-counter medications you are taking, including herbal supplements.
Ninety percent of breast pain is not related to cancer, but all pain needs a thorough evaluation by a physician to be assured that cancer is not present.
For more information, please call The Connie Dwyer Breast Center at (973) 877-5189.