How to Manage Breast Pain?

Have you ever felt a sharp, stinging pain in the breasts and wondered if it could be a symptom of breast cancer or something sinister? Well, you’re not the only one to think so, and justifiably so . Breast discomfort or mastalgia affects about 70% of women at some point in their lives. It is one of the common reasons for women to seek medical help because breast pain is usually associated with the fear of the possibility of cancer and also because breast pain can have a negative impact on your quality of life. Timely evaluation and finding the actual cause is essential as there are many reasons for breast pain which could vary from completely innocuous, hormonal /lifestyle issues to more serious conditions like pathological diseases or cancer.

So, what are the common causes of breast pain ?

There can be two types of breast pain:

• Cyclical breast pain
• Non-cyclical breast pain.

Cyclical breast pain (physiological breast pain)- The most common type of breast pain.

It is the periodic, dull ache that occurs due to hormonal fluctuations during the menstrual cycle. It normally starts a week before your menses and resolves after the end of your periods.

This pain affects both the breasts, in the upper and the outer portion. Sometimes, the pain radiates to the arm. This usually affects women in their 20’s and 30’s but may extend even to women who are approaching menopause.

Cyclical breast pain may cause minor or moderate discomfort, affecting your daily activities but is usually not something that you seriously need to be worried about.

Noncyclical or non- hormonal breast pain-This is not related to the menstrual cycle.

This pain may be described as a tightness, dull aching / sharp shooting or stabbing pain in the breast. It tends to occur in one breast in a localised region , but may radiate to the other parts of the breast also. It may sometimes be accompanied by a breast lump or hardening of the breast tissue, or discharge from the nipple & in such cases, it needs evaluation by a doctor to exclude any concerns regarding breast cancer or a pathological lump in the breast. Once we have excluded the possibility of any other serious condition, we can consider the other innocuous causes of breast pain in females. There are various reasons for noncyclical breast pain like:

• Chest wall pain: This is a musculo-skeletal pain ie , related to the muscles & bones of the chest region. When women go to the gym after a long time and lift heavy weights or do push-ups, or engage in any activity that strains the muscles of the chest wall, they usually experience pain in their chest muscle (pectoralis major). The pain is probably caused due to a muscle pull or soreness of the muscles which radiates to the breasts.
• Large breasts: Large breasts put a dragging strain on the ligaments of the breasts causing it to ache. This also affects the neck, shoulder and the back. An ill-fitting bra that doesn’t provide proper support may also cause pain. Some people believe that wearing underwired bra can cause breast pain however, a well-fitting underwired bra is not associated with breast pain.
• Medications: Certain medications like oral contraceptives which cause breast enlargement and water retention, antidepressants, antipsychotics, cardiac medications like digoxin, spironolactone and antimicrobial agents may also cause breast pain in some women.
• Diet: Foods that cause hormonal fluctuations may cause breast pain, especially those that are rich in phytoestrogen like soya bean, tofu & certain dairy products can cause breast heaviness. Studies suggest that in case of packaged food or processed food, the plastic packaging of the food leaches xenoestrogens into the food and increased levels of oestrogens further causes breast heaviness & pain.
• Pregnancy and breast feeding: There is significant increase in the levels of estrogen and progesterone during pregnancy which causes breast enlargement & pain. These hormones are responsible for the growth and development of the breast tissue to prepare for lactation & breastfeeding the baby after delivery. There are structural changes like increase in breast tissue volume and increased vascular supply to the breast which gives a feeling of fullness and heaviness in the breasts.

• Stress: Stress is another factor that augments any kind of body pain. Stress may aggravate breast pain.

Evaluation of breast pain

Breast pain, more often than not, gets associated with the fear of breast cancer. Well , the fact is that most of the breast pains are benign and harmless ( Phew, isn’t that a relief !). Though breast pain is the symptom of breast cancer, the pain occurs during the later stages. More importantly, whenever you notice a lump in your breasts, whether or not it is associated with pain, get yourself evaluated.

• The evaluation includes history and physical examination by a doctor followed by imaging ( by Breast Ultrasound or Mammography).
• Imaging may not always be required for cyclical breast pain. However, if the pain is focal and is associated with swelling, nipple discharge, skin changes etc imaging should be done to find the primary cause.

Women younger than 40 years are primarily advised an ultrasound of the breasts whereas women more than 40 years of age are best evaluated by a mammogram followed by an ultrasound ,if needed.

• FNAC ( Fine needle aspiration Cytology ) or Breast tissue biopsy maybe required if there is any suspicious looking lump or area seen during the physical examination or imaging.

FNAC involves aspiration of the fluid / tissue cells from the lump through a needle & syringe, which is then tested for any suspicious /malignant cells.

For breast tissue biopsy, a small piece of the breast tissue from the area of concern is taken and sent to the pathology lab for analysis.

Management & treatment of breast pain

Management of breast pain includes lifestyle modifications, medications and home remedies. Although the self-care remedies don’t have proven effectiveness, it can be worth a try. Management of breast pain with medications should only be done under the guidance of your doctor, Never self-medicate.

Cyclical breast pain resolves after the end of your menses and mild pain may not require any treatment. Severe cyclical breast pain or Non-cyclical breast pain will require identifying the underlying cause of breast pain and treatment with medications.

Lifestyle modifications:

• Wear a well fitted supportive bra. Adequate breast support has shown to be effective to reduce breast pain. Wear a sports bra while exercising.
• Diet modifications like reducing caffeine, salt, sugar intake a few days before your periods is known to improve mastalgia. Consuming a low fat diet & stopping smoking is also recommended, however, there are conflicting reports about the effects of smoking on breast pain.
• Reduce stress and practice meditation to calm the mind.
• Drinking turmeric water is said to be effective because of the anti-inflammatory properties of turmeric.
• Maintaining a pain diary helps you and your doctor to identify triggers for pain, factors that relieve it. Note down when your pain begins and resolves as it will help to identify whether it is cyclical or non-cyclical and accordingly define the lines of treatment for breast pain.

A quick fact check: Using underarm deodorants or keeping your phone in your chest pockets do not cause breast pain or breast cancer.

Medications

If your pain doesn’t resolve with the above-mentioned conservative measures, meet your doctor & your doctor may recommend certain medications.

• Painkillers & ointments - Topical NSAID’s like diclofenac are effective to reduce the pain related to muscle & bone issues and they also have lesser side effects. Apply the NSAID cream over the area of pain.
• Natural supplements & therapies- Using vitamin E supplement and evening primrose oil are proposed to reduced breast pain. Studies have shown vitamin E to be effective in women experiencing premenstrual breast pain. Your doctor may also prescribe calcium or Vitamin D supplements to help treat breast pain.
• Hormonal medications- For severe breast pain Danazol, tamoxifen may sometimes be prescribed by the doctor. But these medications may be associated with severe side effects in some people. Your doctor will weigh the risk and benefits of using these medications and then prescribe. Danazol is FDA approved prescription medication for the treatment of fibrocystic breasts. It is associated with side effects like heart and liver problems, weight gain, nervousness, deepening of voice. Tamoxifen is a prescription medication which is used for the treatment and prevention of breast cancer, but the side effects of this medication need to be weighed against the benefits by the doctor.

When to consult a doctor for breast pain ?

Fortunately, majority of the breast pain is not a sign of cancer or anything serious and it resolves over time.However, make sure that you see a doctor for breast pain if there is:

• Persistent pain for more than a couple of weeks
• Severe breast pain
• Pain is worsening or becoming more intense with time
• Pain interferes with routine daily activities
• Pain is accompanied by a breast lump or hardening of breast tissue/ discharge from the nipple or skin changes over the breast region

Getting yourself evaluated and taking treatment for the pain under the guidance of a doctor is very essential for the proper management of mastalgia and you should not hesitate to seek medical help whenever in doubt.