Breast pain: Not just a premenopausal complaint

In most cases, breast pain goes along with reproductive life, and many women expect breast pain to go away after menopause. When it doesn't, they may fear they have breast cancer. Fortunately, breast pain is rarely a symptom of cancer, regardless of age. Still, that possibility should be considered, along with a number of noncancerous conditions that affect the breasts.

Breast pain, sometimes referred to as mastalgia, is either cyclical (the most common type) or noncyclical. Fibrocystic changes in breast tissue may cause cyclical or noncyclical pain in one or both breasts. Women with this very common condition have thickened tissue or an increased number of cysts in otherwise normal breasts.

Cyclical breast pain is linked to menstruation and apparently results from monthly fluctuations of the hormones estrogen and progesterone. A few days before menstruation, both breasts may swell and become tender, painful, or lumpy. The symptoms subside when menstruation ends.

Noncyclical breast pain may be constant or intermittent, may affect one breast or both, and may involve the whole breast or just a small part. Noncyclical pain is usually a symptom of a specific problem, such as a cyst, trauma, or a benign tumor.

Anatomy of the breast area

Breast pain unrelated to menstrual cycles may be caused by conditions that affect the pectoralis major muscle, structures within the breast, and the ribs or sternum.

Several conditions can cause breast pain that's not related to the menstrual cycle. Infection of the breast (mastitis), most common in lactating women, or an abscess can cause severe pain. Some prescription medications can also cause breast pain. Apart from hormone drugs, the most common culprits are certain cardiovascular and psychiatric medications.

Heavy, pendulous breasts may stretch tissues in the breast, causing pain in the shoulders, back, neck, and breasts. Strain in the pectoralis major muscle can cause pain that feels as if it's coming from inside the breast. Activities that strain the pectoralis muscle include raking, shoveling, and lifting.

Costochondritis — an inflammation of the costal cartilages which join the ribs to the breastbone — can cause a burning sensation in the breast. Breast pain may also be a symptom of connective tissue disease, such as Ehlers-Danlos syndrome, an inherited disorder. Arthritis in the neck or upper back may affect sensory nerves exiting the upper spinal cord and cause numbness or pain in the breast.

It's important to discuss any breast pain with your clinician. She or he will take a careful history to try to rule out any conditions outside the breast. Your risk for breast cancer will also be assessed, including a breast examination and a check of your chest wall and underarms.

For breast pain arising from pectoralis muscle strain, costochondritis, or arthritis in the spine, a short course of nonsteroidal anti-inflammatory drugs (NSAIDs) may help, along with stretching, yoga, or neck rotation exercises. Mastitis requires antibiotics, as does an abscess, which will also need to be drained.

It usually helps to wear a well-fitting, supportive bra and a sports bra for exercise (and, when the pain is particularly severe, for sleep). Some research has shown that a very-low-fat diet (15%–20% of daily calories from fat) can reduce breast tenderness and swelling. Although the data are inconsistent, there's some evidence that both cyclic and noncyclic mastalgia are modestly improved by evening primrose oil, which contains gamma-linolenic acid (an essential fatty acid). Some women find that minimizing or eliminating caffeine intake can reduce breast pain, but there is no solid scientific evidence to support this claim.

Three medications — danazol, tamoxifen, and bromocriptine — have been shown to relieve breast pain, but these drugs can cause serious side effects and are typically reserved for breast pain that is severe.

October 2005 Update