Breast Pain

Characteristics

Breast pain is the most common breast symptom for which women see a doctor. Fortunately it is rare for breast pain to be a sign of breast cancer.  Breast pain may be described as dull, aching, sore, heavy, sharp, or stabbing.  It sometimes radiates into the arm or the axilla (underarm).  Sometimes, instead of pain, there are symptoms of burning, discomfort, or itching in the breast.  It is most common for the pain to be in the upper-outer quadrant of the breast, although it can be present in other locations.  It can occur in one or both breasts.

 

Timing

Breast pain is usually intermittent.  It may be cyclical, fluctuating with the menstrual cycle, beginning mid-cycle at ovulation, and increasing until menses.  It usually improves or resolves once the menstrual cycle begins.  Breast pain can be non-cyclical (unrelated to the menstrual cycle) or occur in the postmenopausal setting.  It is common for the breast pain to worsen during the 5-10 years prior to menopause.  Symptoms typically improve after menopause unless a woman is overweight or uses postmenopausal hormone replacement therapy.

 

Causes

The causes of breast pain are not well defined.  It is likely that there is a hormonal basis to most cases of breast pain, especially cyclical breast pain; however, the precise nature of the interaction of female hormones on the breast tissue resulting in breast pain is unclear.  It is common for breast pain to be associated with menstrual irregularities, the pre-perimenopausal years, or changes in hormonal medications.

 

Exogenous estrogens, as found in hormone replacement medications, can cause breast pain.  Many herbal products such as ginseng, Dong Quai, Ma Huang, Guarana, and soy contain plant estrogens which may also cause women to experience breast pain.

 

Not all breast pain has a hormonal basis.  Non-cyclical breast pain may be related to underlying breast cysts, breast infections such as mastitis or abscesses, scarring, or injury.  These benign conditions require evaluation and treatment of the underlying problem which may relieve the pain.

 

Medications (over-the-counter and prescription) may cause breast pain, tenderness, and swelling.  These include hormonal, cardiac (heart), blood pressure-lowering, and gastrointestinal medications as well some pain relievers, antibiotics, and antidepressants.  Do not stop taking your prescription medications without consulting your health care provider.

 

Caffeine (coffee, cola, tea) and similar compounds in chocolate may exacerbate breast pain especially for women with fibrocystic breasts.   A diet high in fat and/or salt may also exacerbate breast pain. 

 

Musculoskeletal chest pain may be confused with breast pain, but does not actually originate in the breast tissue.  It is often described as an aching or burning pain caused by the inflammation or injury of the muscle, cartilage, or bones in the chest inflammation of the rib cartilage (costochondritis) or a pinched nerve in the back can mimic breast pain.  Intense exercise or weight lifting can also exacerbate breast pain.

 

Evaluation

A careful history of the characteristics of the breast pain, other breast symptoms, menstrual symptoms, medical problems, other physical symptoms, medications, and diet is very helpful in determining the nature of breast pain.  A clinical breast examination, mammogram and possibly a breast ultrasound may be useful in ruling out underlying breast abnormalities.  If the evaluation is normal, the breast pain is not considered to be a suspicious symptom.

 

 

Management

Management of breast pain should be individualized.  The nature, cause, and severity may be different for each person.

 

Surgery has no role in the treatment of breast pain when there are no abnormalities on breast examination or mammogram, even when the pain appears to be localized.  Most breast pain is not severe enough to require medication.  The following measures have been described in the medical literature, but the results have been variable.  Some studies show that these interventions reduce pain, while others do not.  The measures may be effective for some women, but not others.  These interventions can take several months to relieve breast discomfort. 

 

Dietary changes

It is best to try one intervention at a time for at least one month.  This will allow you to determine what is effective for you as an individual.

 

Caffeine avoidance: Caffeine is found in coffee, tea, soft drinks, and many over-the-counter medications.  Chocolate contains theobromin, which is similar to caffeine, and can also cause breast pain. Data demonstrate that the best results were obtained in women who completely eliminated caffeine; however, even cutting down seemed to help.  Caffeine is not associated with the development of breast lumps or breast cancer

 

Fat reduction: Reduce your intake of high-fat foods.  Your goal should be for fat calories to consist of approximately 25% of your calories per day.  If you have received dietary fat restrictions for other health reasons, please follow those recommendations.

 

Salt reduction: A diet high in sodium causes the body to retain more fluid.  Reducing salt may reduce fluid retention and breast pain.

 

Dietary supplements

Evening primrose oil: A naturally occurring fatty acid (gamma linolenoic acid) in oral capsules.  The recommended dose is 1,500-3,000mg daily.  Take in divided doses twice daily.  Side effects occur in approximately 2% of users and include abdominal bloating or allergic reaction.  Some but not all studies have shown it to be helpful in reducing breast pain.

 

Vitamin E supplements (400 IU or less daily)

 

Vitamin B complex

 

These are not pain medications, so the results are not immediate.  If there is no improvement in the pain after 2 months, discontinue the product, as it is unlikely to help. If it does reduce breast pain, continue it for a total of 6 months.

 

Mechanical interventions

Changing undergarments: A good support bra minimizes movement of breast preventing stretching of nerve fibers and breast ligaments.  For some women, wearing a bra at night might be helpful.  You may have to try different styles of bras or consult a certified bra fitter to discover which one is most comfortable for you.

 

Hot/Cold therapy: Applying a heated pad or ice pack may reduce swelling, thereby reducing breast pain.

 

Breast massage: May reduce pain by helping remove excess fluid through the lymphatic system.

 

Keeping track of your pain

Try and determine the cause of your pain and the pattern of change.  It is helpful to keep a calendar of the days you experience pain and the intensity of the pain.  The following information is important to include: days your menstrual period begins and ends, severity rating a scale of 1-10, location in the breast where the pain occurs, times of day the pain is experienced, and any unusual physical activities, dietary changes, or medication usage.

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When to Contact Your Doctor

If the breast pain becomes persistent or if you develop a new breast finding, such as a lump, nipple discharge, or skin changes, contact your primary care doctor, gynecologist or breast surgeon.