As a breast surgeon, specializing in both benign and malignant diseases of the breast, I am asked many questions about breast health and about what is normal. One of the most frequent questions asked is, “Is this pain in my breast okay, or could it be cancer?” Many women feel a variety of sensations in their breast that they call pain, and the good news is the vast majority are not caused by cancer. In most cases, breast cancer is a painless process that occurs over several years. It typically becomes painful once it is large enough to be felt and is growing into surrounding structures, resulting in the pain. Therefore, the first thing to do if you feel a pain is to do a breast exam and check for hard areas that feel different from the rest of the tissue. If anything feels new or harder, contact your doctor immediately for an exam and any necessary tests.
“If it is not cancer, then why does my breast hurt?” Most breast pain is a result of normal differences in the breast tissue called fibrocystic change. It affects as many as 60% of women and can involve one breast more than the other. When women are young, the breasts are dense and firmer, filled with tissue designed to produce milk for a baby. Each month, the breasts prepare for a possible pregnancy. When a period comes, the body reverses those changes. This fluctuation can lead to inflammation, scarring and cyst formation in the breast. These changes result in lumpy fibrocystic breasts, often accompanied by cyclical breast pain that is worse before menstruation. In perimenopause when the hormones are becoming erratic, the pain can worsen and occur more frequently. After menopause, the breasts usually become softer and fattier, and the lumpiness and tenderness improves.
The symptoms of fibrocystic breast pain are described in many ways: aching, heaviness, shooting “electric “pains, pain that travels to the nipple or the armpit, a sensation of milk wanting to let down. Most of the pain occurs in the outer portions of the breasts, but it can occur anywhere. Underwire and poor fitting bras can exacerbate the tenderness by repeatedly aggravating the area with daily movements. For many women, increased caffeine consumption can worsen the pain. The simplest treatments involve caffeine restriction, avoidance of breast manipulation, and anti-inflammatories like aspirin, ibuprofen and naproxen. If the pain persists, see your doctor for further testing.
Kelly S. Dempsey, MD