Breast Pain (Mastalgia)
Patients with breast pain as their only symptom is not seen at the Mitchells Plain Breast Clinic. They can be treated by their primary health care provider. The treatment is not complex and these patients do not require any special investigations. Bilateral mastalgia is not an indication for a mammogram.
Most women (up to 7 in 10 women) develop breast pain at some stage in life develop breast pain at some stage in their life.
In about 2 in 3 women the pain develops in the days just before a period - cyclical breast pain.
In the remainder, the pain is not related to periods - non-cyclical.
The pain is often mild but in some women, it is more severe and can affect the quality of life. Treatment, over and above simple reassurance, may be necessary for these women.
Cyclical Breast Pain
Cyclical breast pain is common. It can occur at any age after periods start, but most commonly occurs between the ages of 30 and 50. It does not occur in women past the menopause when the periods have stopped.
What are the symptoms of cyclical breast pain?
In many women the symptoms are mild. Indeed, it can be considered normal to have some breast discomfort for a few days before a period. However, in some women, the pain can be severe and/or last longer - up to 1-2 weeks before a period. The 3-5 days prior to a period are usually the worst. The pain usually eases soon after a period starts. The severity can vary from month to month. Typically, the pain affects both breasts. It is usually worst in the upper and outer part of the breast and may travel down the arms. In patients with cyclical breast pain, their breasts may also become larger, tender, and slightly lumpy in the week or so before a period.
What causes cyclical breast pain?
It is thought that women with cyclical breast pain have breast tissue which is more sensitive than usual to the normal hormone changes that occur each month. It is not due to any hormone disease, or to any problem in the breast itself. It is not serious, but it can be a real nuisance.
What are the treatment options for cyclical breast pain?
No treatment may be needed if the symptoms are mild. Many women are reassured by knowing that cyclical breast pain is not a symptom of cancer or serious breast disease. The pain quite often settles by itself within 3-6 months but can come back from time to time.
If the pain is more severe, or for the times when it may flare up worse than usual, treatment options include the following:
Support the breasts. Wear a well-supporting bra when you have pain. Some women find that wearing a supporting bra 24 hours a day for the week before a period is helpful. It is best to avoid underwired bras. Wear a sports bra during exercise.
Painkillers such as paracetamol or ibuprofen. Take regularly on the days when the breasts are painful.
Topical ('rub-on') anti-inflammatory cream. For example, topical diclofenac or topical ibuprofen (Voltaren Gel).
Diet. Fatty acids may have a role in causing breast pain, so adjusting diet by reducing animal fats (such as butter, cream, and fatty meat) and increasing your intake of fresh fruit and vegetables can be helpful.
Evening primrose oil is often recommended as a treatment for breast pain. A dose of 1-2gms (2-4 tablets) of Evening Primrose oil each day for a period of 6 weeks is required before the benefit can be assessed. Improvement in the severity of cyclical and non-cyclical mastalgia is 58% and 38% respectively. If symptoms improve continue these tablets.
Non-cyclical Breast Pain
Breast pain can be present all the time, or 'come and go' in a random way. This type of breast pain is not related to periods and is most common in women over 40. The pain may be in just one breast and may be localized to one area in a breast. Sometimes the pain is felt all over one or both breasts. There are various causes. For example:
Pain coming from the breast tissue itself in the absence of any lumps, tumours, or other abnormality being detected. The reason why this type of pain occurs is not known.
Pain coming or radiating from the chest wall under the breast rather than the breast itself. Muscular or bony problems of the chest wall account for some cases.
Infection is a cause in a small number of cases.
Breast cancer is a very uncommon cause of breast pain (less than 5% of breast cancer cases)
What is the treatment for non-cyclical breast pain?
In many cases, the pain goes after a few months without any treatment. Anti-inflammatory painkillers such as ibuprofen may ease the pain. Topical anti-inflammatory cream (Voltaren gel) may also work. Other treatments may be appropriate, depending on whether a cause is found.
Breast Pain and Breast Cancer
Women with breast pain often worry that the pain is caused by breast cancer. But, the first symptom of breast cancer is usually a painless lump. If there is cancer associated with pain it is likely that another symptom such as a breast lump, breast enlargement, distortion of the skin, or redness of the skin will also be noticed or the pain will be unilateral and most likely focal in nature. These changes should be easily spotted on an assessment by a doctor.
Patients with breast pain and none of the symptoms of breast cancer are not seen in the Mitchells Plain Breast Clinic. Remember for each inappropriate referral the waiting times for individuals with breast cancer will increase. We can only see a fixed amount of patients and effort needs to be focussed on symptoms associated with underlying breast cancer.
If you feel your patient should be seen because of concern please contact us by email at breastsurgendo@gmail.com or phone or Whatsapp us on 072 1751815. Please provide patient name, DOB, and hospital number of patients in all correspondence.