Breast pain (mastalgia) is something most women experience over the course of their lives, and often, for different reasons and at different times. Many women during their reproductive years experience breast pain or tenderness right before their menstrual period. Known as “cyclic” breast pain, this type of pain or increased sensitivity is caused by hormonal changes associated with the menstrual cycle.
Other, noncyclic, breast pain can be caused by a number of factors, including injury, infection, pregnancy, medications and even large breast size. When this type of breast pain occurs in both breasts and in equal amounts, it is often caused by pregnancy or an outside factor that would affect both breasts equally, like medications. When it occurs in one breast or in one specific area, it is most commonly due to breast size, benign cysts or fibroadenomas (non-cancerous breast tumors) and, on more rare occasions, breast cancer.
Evaluation of breast pain will most likely begin with a physical breast exam by your provider. In some cases, you may need to have an imaging test of your breast. Breast imaging can be done with mammography, ultrasound and/or MRI. Most major medical organizations recommend mammograms every 1-2 years for all women, starting at age 40. Depending on breast density, family history and more, additional screenings may also be necessary.
Be sure to do a breast self-exam every month, in order to familiarize yourself with the look and feel of your breasts. By doing regular self-exams, you will be more likely to spot right away any changes that occur. The National Breast Cancer Foundation provides three strategies for effective breast self-exams:
Make sure to wear well-fitted bras that provide adequate support and don’t dig in or restrict circulation. When purchasing a new bra, don’t assume that the same size bra you bought last is the right one for you now. Breast size and shape can change in response to age, weight, hormones, exercise and other factors. For a good fit, use a measuring tape to determine your band size and cup size, before heading to the store:
A variety of medications can cause breast pain, including certain types of hormonal medications, antidepressants, high blood pressure and heart medications, and long-term steroids. If you are taking any medications which list breast pain as a possible side effect, explore alternatives with your health care provider.
Breast pain can be caused by a number of factors, including hormonal changes, injury, infection (mastitis), breast size and other underlying conditions, including non-proliferative masses such as cysts and fibroadenoma, and proliferative masses with or without atypia. In rare cases, proliferative masses with atypia (atypical hyperplasia) may indicate the presence of breast cancer, but breast pain typically is not the first symptom associated with such masses.
Up to half of American women ages 20-50 have fibrocystic breasts, a common noncancerous condition that can cause breast pain, cysts and lumps that suddenly appear and go away. Believed to be caused by rising and falling levels of hormones, especially estrogen, fibrocystic breasts don’t appear to increase a woman’s chances of developing breast cancer, but can make breast cancer more difficult to identify. Some women with fibrocystic breasts find their symptoms are improved by limiting or eliminating their caffeine intake.
Contact your health provider for a conversation and follow-up. While most breast lumps are noncancerous, the presence of a lump may indicate a need for further testing, including a mammogram, ultrasound, magnetic resonance imaging (MRI) or fine needle biopsy.
Most breast lumps are noncancerous—and, in fact, most women have them. According to the American Cancer Society, 80-85% of breast lumps are harmless, especially in women under 40. Most are related to the menstrual cycle, but some can also be related to a plugged milk duct or a breast injury. If you feel a lump, of any size or consistency, be sure to mention it to your health provider.
Tingling or soreness in the nipples can be a symptom of cyclic breast pain, early pregnancy, latch problems during breastfeeding and occasionally, other conditions, such as periareolar infection (also called periductal mastitis) and mammary duct ectasia. These conditions often have no obvious cause but may be related to trauma or conditions that impair immunity, such as diabetes or rheumatoid arthritis. Very rarely, nipple pain is due to Paget disease, a rare cancer of the nipple and areola (darker-pigmented area around the nipple).
Mastitis refers to inflammation of the breast and is most commonly associated with lactation-related infections; however, it can also occur in women whose breasts aren’t producing milk. Regardless of cause, most cases of mastitis can be successfully treated with antibiotics.
For most women, mammograms are not painful. There are two plates that are used to compress the breast tissue. This pressure can feel like an ache and usually lasts only seconds. If you are still having your periods, you might consider timing your mammogram to be done in the week right after your period, as the breasts are often less tender during this time.
Digital breast tomosynthesis, also known as 3D mammography, is a test that takes X-rays of the breast and puts them together in a 3D image. During the 3D part of the exam, an x-ray arm sweeps over the breast, taking multiple images in seconds. Tomosynthesis can be used to screen for early signs of breast cancer in women with no symptoms as well as a diagnostic tool for women that are having breast cancer symptoms. In addition, tomosynthesis can be much more accurate than traditional mammography in screening for breast cancer in women who have dense breasts. Overall, tomosynthesis can detect a higher portion of cancers than standard mammography and at a lower overall radiation dose.
Talk to a care navigator or schedule an appointment at the Women’s Health & Wellness Center.