Breast Pain: When Should I Worry?

            Breast pain (mastalgia) is very common and can manifest as tenderness, throbbing, sharp, stabbing, burning pain, or tightness in the breast tissue. Breast pain can be cyclic or noncyclic. Cyclic breast pain occurs regularly, often related to the menstrual cycle and changing hormone levels. Noncyclic breast pain, on the other hand, is unrelated to the menstrual cycle, is usually constant, and typically affects one breast in a localized area, although it can spread across the breast.

When Should I See a Doctor?

Breast pain can be alarming for most women, especially if there is a family history of breast cancer, or if the patient has a personal history of breast cancer. Every little pain will worry you even if everything is normal. You should see your doctor if the breast pain continues daily for more than a couple of weeks, occurs in one specific area of your breast, interferes with your daily activities, and awakens you from your sleep. The risk for breast cancer is very low in people whose main symptom is breast pain. Most patients diagnosed with breast cancer arrive at the clinic with zero symptoms of breast pain. However, if the pain is troubling, it’s important to see your doctor. You may need a clinical breast examination by your physician and a diagnostic mammogram or breast ultrasound.

What Are the Causes of Breast Pain?

            Breast pain can be caused by several factors. The common factors for breast pain are from hormonal fluctuations from menstrual cycles, pregnancy, puberty, menopause, and breastfeeding. Other causes of breast pain that is noncyclic will include: birth control pills, pregnancy, infection, inflammation, infertility medications, hormone therapy, prior radiation therapy, antidepressants, breast cysts, fibroadenomas, costochondritis (inflammation where your ribs join the bone in the middle of your chest), having large breasts, and surgical scars. Women that have a high caffeine intake may experience breast pain. It is important to pay attention to see if your breast pain is being caused by menstruation or caffeine, as eliminating these factors can help identify more serious underlying issues Fibrocystic breast disease can cause breast pain, but it is unusual for breast cancer to occur from breast pain.

What Age Group is Affected by Breast Pain?

            Cyclic breast pain, the pain that occurs with your menstrual cycle is more common in women between age 20 to 50 years old. These patients may experience breast pain in one breast or both. Breast pain will most likely occur at least 1 week before your menstrual cycle is set to start and will go away once you start your menstrual cycle. Noncyclic breast pain does not have anything to do with your menstrual cycle and may affect women between age 40 to 50 years old.

What Are the Effects of Breast Pain Based on Gender?

            While women experience breast pain for various reasons, men can also suffer from breast pain, most commonly due to gynecomastia. In men, breast pain is most commonly caused by gynecomastia. Gynecomastia is an increase in the amount of breast gland tissue that’s caused by an imbalance of the hormone’s estrogen and testosterone. Male patients are not ordered routinely at the mammography clinic I work at. When male patients are scheduled, their results are usually gynecomastia if they are experiencing pain. Male patients must have a diagnostic mammogram order for both breasts, regardless of if they are having symptoms on one breast or both. A breast ultrasound may be performed depending on the clinical findings. Mammograms for male patients are taken the same as female patients. In transgender women, hormone therapy may cause breast pain. In transgender men, breast pain may be caused by the minimal amount of breast tissue that may remain after a mastectomy.

Other Causes of Breast Pain

            There may be patients with a history of breast cancer that have experienced breast pain after their lumpectomy and radiation treatment for breast cancer. During follow-up mammograms, these patients often report pain, tenderness, or a full sensation in the breast. It is important to be extremely careful and considerate when positioning and performing compression on these types of patients. I always check with the patient to make sure I am not hurting them and will let them know that they will feel uncomfortable. I always document any limitations due to compression or positioning into the patient’s chart to notify the Radiologist and future mammography technologist. Breast pain can be associated with trauma too, such as a car accident, stress, a workout routine, or a bruise.

When to Image the Breast for Breast Pain

            A breast ultrasound is recommended for women under 30 experiencing significant breast pain or during pregnancy. If the breast pain is all over the breast, a complete breast ultrasound will be ordered for both breasts and the breast with the pain. For women aged 30 years and older, a diagnostic 3-D mammogram will be ordered, and a breast ultrasound will be determined by the Radiologist. At my clinic, if a patient just recently had a mammogram and is not due for their yearly, our  radiologist will suggest performing a breast ultrasound first and will decide if a diagnostic mammogram is still needed after the breast ultrasound scan. This will vary by facility and your radiologist’s preference.

How to Manage and Treat Breast Pain

There are several ways to manage cyclic or noncyclic breast pain. These can be managed and treated by:

·         Anti-inflammatory medications (Tylenol, Advil, Motrin, Aleve)

·         Wearing a well-fitted and supported bra.

·         Eliminating caffeine from your diet.

·         Hormone therapy if needed (speak to your doctor about options).

·         Exercise to reduce stress and stay in shape.

·         Breast reduction (if the pain is caused by large breasts).

·         Avoiding tobacco products.

·         Eliminating caffeine from your diet.

·         Excisional surgery or cyst aspiration may be recommended to relieve symptoms if problems are related to a fibroadenoma, cyst, or benign breast lump.

Conclusion

Breast pain can be concerning, but understanding its causes and knowing when to seek medical attention can provide peace of mind. While most breast pain is not related to breast cancer, it is essential to pay attention to persistent or unusual pain. By managing lifestyle factors, wearing supportive bras, and consulting with healthcare professionals, you can effectively address and alleviate breast pain. If you experience ongoing discomfort or have any concerns about breast pain, don't hesitate to reach out to your doctor for a thorough evaluation and appropriate imaging if necessary. Remember, taking proactive steps can help you maintain your breast health and overall well-being.

 By Myrian Barbin, BSRS, R.T. (R) (CT) (MR) (M) (BS)