Breast Pain
Problems and solutions
Problems and solutions benign | pain | discharge | lumps | male problems

 

Breast Pain/Mastodynia

 

Pain in the breast is a frequent complaint and almost all women experience it at some stage.

Importantly breast cancer only presents with pain in 10% of cases and this is a constant pain localised to an area usually associated with a mass. If there is no mass and constant pain, a mammogram or sonar should be obtained. Only 2% of these cases will be associated with a malignancy.  The chances of there being no mammographically detected malignancy and still a missed cancer is only 0,1%.

 

20% of “breast pains” are actually due to non-breast pathology such as:

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cardiac problems (heart related)

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respiratory problems (pneumonia, pleuritic chest pain)

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gastro intestinal problems (reflux heartburn)

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rib inflammation (costochondritis)

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shingles (Herpes Zoster infection)

 

When breast pain becomes excessive (severe pain with nodularity), it begins to interfere with the patient’s lifestyle (they cannot wear seatbelts, sex becomes intolerable, etc).  These women have what is referred to as mastalgia. All women over 40 with breast pain should have mammograms and a thorough clinical assessment and women under 40 should have an ultrasound. Breast pain can be related to hormone flux in the menstrual cycle. This is called cyclic mastalgia (67%) There is another variety of breast pain that is non-cyclical (non-cyclical mastalgia).  This accounts for only about 26% of breast pain. 10% of breast pain is chest wall pain (costochondritis or Tietze’s disease).

All patients presenting with breast pain should have a thorough history and clinical examination. True breast pain can be divided into four different types.

 

Burning, shooting pains
This is usually as result of duct dilatation and is related to duct ectasia, smoking and pollution. The patient experiences burning discomfort in the breast and occasional shooting pain in the breast. Anti-oxidants may help for this type of pain.

 

Full, heavy uncomfortable breasts (one feels like one needs to feed a baby)
This is caused by stress (physical, emotional, mental) which results in transient changes in the prolactin levels (a stress hormone). It is important to check thyroid function, prolactin levels and medication as well.

 

Isolated medial and lateral pain on pressure
This is costochondritis, a condition that causes chest pain due to inflammation of the cartilage and bones in the chest wall.

 

Pain extending from the armpit down towards the nipples
This pain is usually worse at the end of the day and is related to breast hygiene (poor fitting bras and large breasts with pulling on the breast ligaments).

 

The concept of breast hygiene needs to be addressed when dealing with breast pain.

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Ill-fitting bras or old bras, combined with large breasts, result in pain under the breasts and in the axillary tail, particularly as the day progresses, and as gravity takes its toll on the breast ligaments.

 

Treatment for breast pain entails the following:
All women with breast pain should be placed on a pain chart for four months and told to chart their pain with its variations over the menstrual cycle.

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Vitamin B6 (pyridoxine) and gamma linolenic acid (evening primrose oil) should be tried first (gamma linolenic acid tends to stabilise breast epithelial activity via prostaglandins metabolism).The dose of evening primrose oil is two capsules daily. The B6 and evening primrose oil should be taken in combination. Treatment is continued for a minimum of three months and more than 70% of patients have a good response. Some studies suggest taking up to six capsules per day.


Low dose anti-oestrogens (SERMS) are also used to treat breast pain (Tamoxifen, Fareston) although these do not have FDA approval in the USA.

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Some studies suggest crushing these SERMS and mixing them in KY jelly and applying them topically to the breast tissue.

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Finally using indol 3 carbinol (active ingredient in cruciferous vegetables such as cabbages and broccoli) may help as this substance mimics the action of tamoxifen in the breast).

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In post menopausal women Evista is very good for breast pain.

 

Chest Wall Pain
Costochondritis or Tietze’s disease which is pain and tenderness over the costochondral junctions (the ribs under the breasts) accounts for 10% of breast pain. Costochondritis may be related to excessive muscle strain (sport) or a recent viral infection. Treatment is to abstain from doing the implicated sport for a few weeks or take NSAIDS (non steroidal anti inflammatory drugs). Some doctors recommend arnica oil for this.

 

Mondor's disease
Mondor’s disease is pain in the lower or lateral aspect of the breast from a thrombophlebitis of a vein crossing within the breast tissue.  Anti inflammatory drugs (NSAIDS) give rapid relief. Aspirin or Annica can be used as well.