Breast pain

Definition:

Breast pain (mastalgia) is a common complaint among women. You might describe your breast pain as chronic tenderness, sharp burning or tightness in your breast tissue. The pain may be constant or it may occur only occasionally. Some women have severe breast pain, occurring more than five days a month, Severe breast pain may even persist throughout the menstrual cycle. Postmenopausal women sometimes have breast pain, but the symptom is more common in younger, premenopausal women and perimenopausal women. Most times, breast pain signals a noncancerous (benign) breast condition and rarely signifies breast cancer. Still, unexplained breast pain that doesn't go away after your next menstrual cycle or that persists after menopause needs to be evaluated by your doctor. 

Breast Health

General Breast Pain Cyclic vs non-cyclic In general there are two types of breast pain (mastalgia): cyclic and non-cyclic pain. Cyclic pain is much more common, and as the name suggests the pain fluctuates with the menstrual cycle. The exact cause of cyclic pain is not well understood, but it appears that the fluctuations of estrogen and progesterone and prolactin might be responsible for this type of breast pain. Cyclic pain typically begins at ovulation and escalates until the onset of the period, and the pain tends to subside following the menstruation. Both breasts are involved, but many will report asymmetrical pain, pain only in one breast, or more severe pain in one than the other. Women suffering from breast pain report greatest pain in the upper, outer portion of the breast, adjacent to the armpit. The pain is often referred to as dull and the breasts feel sore, and in some cases pain may radiate to the armpit and then to the entire arm. The sufferers of cyclic pain often report reduction if not elimination of breast pain at menopause if they are not under hormone replacement therapy. Unlike cyclic pain, non-cyclic pain is unrelated to the hormonal fluctuation of menstrual cycle. Typically, there is a defined area of tenderness or a focal tenderness, which can help with the diagnosis and treatment of the pain. Unlike cyclic breast pain, non-cyclic breast pain is often felt only in one breast. The causes of non-cyclic pain can vary, but the following are the most common causes: Trauma Macrocysts Periductal mastitis/duct ectasis Pregnancy and breast feeding (Puerperal mastitis) Sclerosing adenosis Cancer Trauma Pain due to fat necrosis (fatty breast tissue that has died and formed cysts), calcification as a result of surgery or other types of trauma can be experienced many years following the initial trauma. Pain associated with trauma to the breasts is described as sore, bruised, or stabbing pain. Macrocysts One of the common causes of non-cyclic focal breast pain. The presence of cysts can be confirmed by ultrasound and can be treated by aspiration. If blood is drawn or the cysts recur, then further study such as biopsy is warranted. Periductal mastitis Periductal mastitis can cause severe breast pain in a significant number of women. The periductal inflammation occurs in non-lactating women when the milk ducts near the nipple become inflamed thus causing extreme breast pain. Other symptoms of this condition are a mass near the nipple, retraction of the nipple, or discharge. Treatment includes antibiotics or, in severe cases, surgery. The pain is described as throbbing and often accompanied by redness and warmth of tissues. Sclerosing adenosis This condition is characterized by the presence of a small mass, 2cm or less, that is firm but poorly defined. The mass if often attached to surrounding breast tissue. Typically the mass is accompanied by breast pain. Pregnancy and breast feeding (puerperal mastitis) Many women report discomfort in their breasts during pregnancy and while breast feeding. The breast pain associated with breast feeding is termed puperpeal mastitis. However, neither case requires any medical intervention unless actual infections arise. Cancer Only a small percentage of women (7–10%) suffering from breast cancer report breast pain as the sole symptom. However, any new onset of non-cyclic pain should be carefully examined and should undergo rigorous differential diagnosis. Non-Breast Pain In some cases women experience breast pain, but the pain does not originate in the breasts. Non-breast pain can be categorized into chest-wall pain and non-chest-wall pain. Chest-wall pain: Tietze’s syndrome (costochondritis) Cervical radiculopathy Non-chest wall pain: Gallbladder disease Ischemic heart disease Tietze’s syndrome (Costochondritis) This condition produces significant chest pain due to inflammation of the bones and cartilage in the chest wall. The pain can be exacerbated by deep breathing, coughing, or other activities involving the chest wall. Costochondritis has no known cause (idiopathic). The condition can subside on its own eventually, but in severe cases injection of anesthetic and/or steroid offers a positive clinical result. Cervical radiculopathy Chronic, recurring breast pain accompanied by pain in the shoulder, arm, and hand on the same side can be caused by cervical radiculopathy where nerve roots (C6-C7) are compressed. The compression of the pectoralis muscle, not the breast parenchyma (breast tissue) causes the apparent breast pain. In addition, pain can be accompanied by weaknesses in other muscles such as tripceps and biceps which is indicative of root compressions. Other non-chest-wall pain that can be incorrectly attributed to breast pain are diseases related to gallbladder and/or heart. Gallbladder infections or cardiovascular abnormalities can exhibit chest pain that can feel as if it is coming from the breasts in women. Changes in breast tissue known as fibrocystic breast condition or disease can also cause breast pain, which is either cyclical or non-cyclical. For more information on this condition

Fibrocystic Breast Disease Fibrocystic breast disease (FBD), or fibrocystic breast condition or changes, is described as common, benign changes involving the tissues of the breasts. Common breast symptoms are swelling and tenderness, nodularity, palpable lumps, nipple discharge, and inflammation. These changes are typically accompanied by breast pain. The discomfort associated with fibrocystic breast disease is often in the upper outer quadrant, is diffuse, and may radiate to the axilla or upper arm. The incidence of fibrocystic breast disease is estimated to be up to 70% of all women. It can occur in women aged 18 or older, but is most common in women between the ages of 30 and 50, and rare in postmenopausal women.

Medical Illustration Copyright ©2007 Nucleus Medical Art, All rights reserved. www.nucleusinc.com The cause of pain associated with fibrocystic breast disease is not completely understood; however, changes in the breast tissue are believed to be associated with ovarian sex hormones because the condition usually subsides with menopause and may vary in intensity during the menstrual cycle. Hormone imbalances have been suggested, such as increased estrogen secretion, deficient progesterone production, and hyperprolactinemia. In fibrocystic breast disease there is a wide spectrum of histopathological changes (microscopic tissue changes) from relatively normal histologic findings to features that exhibit mainly patterns of fibrous change and cyst formation.

Diagnosis

Physical examination by physicians is the first step in the diagnosis of the condition. Lumpy breasts are not necessarily indicative of breast cancer. These lumps can be benign (non-cancerous) and can be definitively characterized with either mammograms, MRIs, or ultrasounds.  

Having lumpy breasts and being diagnosed with fibrocystic breast disease does not increase a woman’s risk of developing cancer. However, fibrocystic breast disease can mask potentially cancerous lumps. Women with fibrocystic breast disease should be diligent in their breast self-exams and physician exams.

Treatment

Once cancer has been ruled out, treatment for nodularity is unnecessary. However, some cysts may be aspirated to alleviate pain. There are non-surgical methods of dealing with the pain associated with fibrocystic breasts. Treatment strategies for pain associated with fibrocystic breast disease range from conservative treatment methods such as non-prescription analgesics, properly fitted brassieres, diet change, the application of local heat, or application of evening primrose oil. However, little scientific data exists on the effectiveness of these treatments. Patients may use prescription analgesics, but in more severe cases danazol may be prescribed. Danazol has several significant side effects and is only prescribed for severe cases. With the exception of danazol, no other therapeutic is approved to treat the painful symptoms of fibrocystic breast disease.  

If you are a woman experiencing cyclical pain associated with fibrocystic breast disease, you may be eligible to participate in an ongoing clinical trial for a novel investigational drug

Breast Health: Breast Cancer Risk Factors

Breast Health: Breast Cancer Risk Factors

Breast Cancer Risk Factors Every woman wants to know what she can do to lower her risk of breast cancer. Some of the factors associated with breast cancer -- being a woman, your age, and your genetics, for example -- can't be changed. Other factors -- maintaining a healthy weight, exercising, smoking cigarettes, and eating nutritious food -- can be changed by making choices. By choosing the healthiest lifestyle options possible, you can empower yourself and make sure your breast cancer risk is as low as possible.

The known risk factors for breast cancer are listed below. Click on each link to learn more about the risk factor and ways you can minimize it in your own life. If a factor can't be changed (such as your genetics), you can learn about protective steps you can take that can help keep your risk as low as possible.

Established risks:

Just being a woman is the biggest risk factor for developing breast cancer. There are about 190,000 new cases of invasive breast cancer and 60,000 cases of non-invasive breast cancer this year in American women. While men do develop breast cancer, less than 1% of all new breast cancer cases happen in men. Approximately 2,000 cases of breast cancer will be diagnosed in American men this year. The biggest reasons for the difference in breast cancer rates between men and women are: Women's breast development takes 3 to 4 years and is usually complete by age 14. It's uncommon for men's breasts to fully form -- most of the male breasts you see are fat, not formed glands. Once fully formed, breast cells are very immature and highly active until a woman's first full-term pregnancy. While they are immature, a women's breast cells are very responsive to estrogen and other hormones, including hormone disrupters in the environment. Men's breast cells are inactive and most men have extremely low levels of estrogen. So hormonal stimulation of highly responsive and vulnerable breast cells in women, particularly during the extra-sensitive period of breast development, is why breast cancer is much more common in women than in men.

Age

Everyone alive is growing older. And as with many other diseases, your risk of breast cancer goes up as you get older. For example, according to the American Cancer Society, about 1 out of 8 invasive breast cancers develop in women younger than 45. About 2 out of 3 invasive breast cancers are found in women 55 or older.

In fact, the aging process is the biggest risk factor for breast cancer. That's because the longer we live, there are more opportunities for genetic damage (mutations) in the body. And as we age, our bodies are less capable of repairing genetic damag

Family History:

Women with close relatives who've been diagnosed with breast cancer have a higher risk of developing the disease.

If you've had one first-degree female relative (sister, mother, daughter) diagnosed with breast cancer, your risk is doubled. If two first-degree relatives have been diagnosed, your risk is 5 times higher than average.

If your brother or father have been diagnosed with breast cancer, your risk is higher, though researchers aren't sure how much higher.

In some cases, a strong family history of breast cancer is linked to having an abnormal gene associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 gene. In other cases, an abnormal CHEK2 gene may play a role in developing breast cancer.

Genetics

About 5% to 10% of breast cancers are thought to be hereditary, caused by abnormal genes passed from parent to child.

Genes are particles in cells, contained in chromosomes, and made of DNA (deoxyribonucleic acid). DNA contains the instructions for building proteins. And proteins control the structure and function of all the cells that make up your body.

Think of your genes as an instruction manual for cell growth and function. Abnormalities in the DNA are like typographical errors. They may provide the wrong set of instructions, leading to faulty cell growth or function. In any one person, if there is an error in a gene, that same mistake will appear in all the cells that contain the same gene. This is like having an instruction manual in which all the copies have the same typographical error.
BRCA1 and BRCA2 genes

Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two).

Everyone has BRCA1 and BRCA2 genes. The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don't function normally and breast cancer risk increases. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every 10 cases.

Having an abnormal BRCA1 or BRCA2 gene doesn't mean you will be diagnosed with breast cancer. Researchers are learning that other mutations in pieces of chromosomes -- called SNPs (single nucleotide polymorphisms) -- may be linked to higher breast cancer risk in women with an abnormal BRCA1 gene as well as women who didn't inherit an abnormal breast cancer gene.

Women who are diagnosed with breast cancer and have an abnormal BRCA1 or BRCA2 gene often have a family history of breast cancer, ovarian cancer, and other cancers. Still, most people who develop breast cancer did not inherit an abnormal breast cancer gene and have no family history of the disease.

You are substantially more likely to have an abnormal breast cancer gene if:
You have blood relatives (grandmothers, mother, sisters, aunts) on either your mother's or father's side of the family who had breast cancer diagnosed before age 50.
There is both breast and ovarian cancer in your family, particularly in a single individual.
There are other gland-related cancers in your family such as pancreatic, colon, and thyroid cancers.
Women in your family have had cancer in both breasts.
You are of Ashkenazi Jewish (Eastern European) heritage.
You are African American and have been diagnosed with breast cancer at age 35 or younger.
A man in your family has had breast cancer.

If one family member has an abnormal breast cancer gene, it does not mean that all family members will have it.

The average woman in the United States has about a 1 in 8, or a 12-13%, risk of developing breast cancer in her lifetime. Women who have an abnormal BRCA1 or BRCA2 gene (or both) can have up to an 80% risk of being diagnosed with breast cancer during their lifetimes. Breast cancers associated with an abnormal BRCA1 or BRCA2 gene tend to develop in younger women and occur more often in both breasts than cancers in women without these abnormal genes.

Women with an abnormal BRCA1 or BRCA2 gene also have an increased risk of developing ovarian, colon, pancreatic, and thyroid cancers, as well as melanoma.

Men who have an abnormal BRCA2 gene have a higher risk for breast cancer than men who don't -- about 8% by the time they're 80 years old. This is about 80 times greater than average.

Men with an abnormal BRCA1 gene have a slightly higher risk of prostate cancer. Men with an abnormal BRCA2 gene are 7 times more likely than men without the abnormal gene to develop prostate cancer. Other cancer risks, such as cancer of the skin or digestive tract, also may be slightly higher in men with abnormal BRCA1 or BRCA2 genes.
Other genes

Changes in other genes are also associated with breast cancer. These abnormal genes are much less common and don't seem to increase risk as much as abnormal BRCA1 and BRCA2 genes, which are considered rare. Still, because these genetic mutations are rarer, they haven't been studied as much as the BRCA genes.
ATM: The ATM gene helps repair damaged DNA. DNA carries genetic information in cells. Inheriting two abnormal copies of this gene causes the disease ataxia-telangiectasia, a rare disease that affects brain development. Inheriting one abnormal ATM gene has been linked to an increased rate of breast cancer in some families because the abnormal gene stops the cells from repairing damaged DNA.
p53 (also called the TP53 gene): The p53 gene provides instructions to the body for making a protein that stops tumor growth. Inheriting an abnormal p53 gene causes Li-Fraumeni syndrome, a disorder that causes people to develop soft tissue cancers at a young age. People with this rare syndrome have a higher-than-average-risk of breast cancer and several other cancers, including leukemia, brain tumors, and sarcomas (cancer of the bones or connective tissue).
CHEK2: The CHEK2 gene also provides instructions for making a protein that stops tumor growth. Li-Fraumeni syndrome also can be caused by an inherited abnormal CHEK2 gene. Even when an abnormal CHEK2 gene doesn't cause Li-Fraumeni syndrome, it can double breast cancer risk.
PTEN: The PTEN gene helps regulate cell growth. An abnormal PTEN gene causes Cowden syndrome, a rare disorder in which people have a higher risk of both benign (not cancer) and cancerous breast tumors, as well as growths in the digestive tract, thyroid, uterus, and ovaries.
CDH1: The CDH1 gene makes a protein that helps cells bind together to form tissue. An abnormal CDH1 gene causes a rare type of stomach cancer at an early age. Women with an abnormal CDH1 gene also have an increased risk of invasive lobular breast cancer.
Genetic testing

There are genetic tests available to determine if someone has an abnormal BRCA1 or BRCA2 gene. A genetic counselor also may order testing for an abnormal ATM, p53, CHEK2, PTEN, or CDH1 gene if it's determined from your personal or family history that these tests are needed.

For more information, visit the Breastcancer.org Genetic Testing pages.

Personal History of Breast Cancer

If you've been diagnosed with breast cancer, you're 3 to 4 times more likely to develop a new cancer in the other breast or a different part of the same breast. This risk is different from the risk of the original cancer coming back (called risk of recurrence).