Breast Pain

“Breast pain is the most common breast symptom causing women to consult primary care physicians and surgeons,” writes Monica Morrow, M.D., in a recent article in American Family Physician (2000;61:2371-8, 2385). Morrow is professor of surgery and director of the Lynn Sage Comprehensive Breast Program at Northwestern University Medical School in Chicago and director of the Cancer Department of the American College of Surgeons. The article deals with nipple discharge and breast masses as well as breast pain, but we’ll focus on pain here.

Breast pain, or mastalgia, alone is rarely a symptom of cancer. There are two kinds of breast pain: cyclic and noncyclic.

Cyclic mastalgia, “generally described as a heaviness or soreness,” says Morrow, usually occurs in both breasts and is poorly localized. Often associated with the menstrual cycle, it is most severe before a woman’s period begins but often wanes after menstruation starts. Cyclic mastalgia is more common than noncyclic mastalgia in younger women.

Noncyclic mastalgia “is most common in women 40 to 50 years of age,” writes Morrow. It often occurs in just one breast and is described as “a sharp, burning pain that appears to be localized in the breast.”

The cause of mastalgia, which is more common in premenopausal than postmenopausal women, is unknown. Its frequent association to the menstrual cycle (cyclic mastalgia) has suggested that it may be related to hormones, but no scientific studies have been able to demonstrate a link between breast pain and hormone levels. However, “menstrual irregularity, emotional stress and medication changes have been shown to exacerbate mastalgia,” according to Morrow.

Fibrocystic changes in the breasts apparently do not themselves cause mastalgia. “Although ‘fibrocystic disease’ is often present in the biopsy specimens of women with breast pain, studies have shown that fibrocystic changes are also present in the breasts of 50 to 90 percent of asymptomatic [having no symptoms] women,” writes Morrow. In other words, 50 to 90 percent of women who have no breast pain do have fibrocystic breast changes.

Although breast pain does not usually indicate a serious problem, women should discuss it with their physicians. Keeping notes about the pain’s frequency, location, severity, and relation to the menstrual cycle can help the physician and patient evaluate the pain and look for a cause or an appropriate treatment.

“Breast pain should be treated when it is severe enough to interfere with a woman’s lifestyle and occurs for more than a few days each month,” says Morrow. Avoiding caffeine has been a popular recommendation for easing breast pain, but Morrow says that recent scientific studies have failed to demonstrate any benefits of caffeine restriction. Likewise, studies have shown no benefits for another popular breast pain treatment, vitamin E.

Scientific studies in Great Britain have, however, demonstrated the effectiveness of evening primrose oil in relieving the pain of 58 percent of women with cyclic mastalgia and 38 percent of women with noncyclic mastalgia, Morrow says. The U.S. Food and Drug Administration (FDA) recognizes one drug, danazol (Danocrine), for the treatment of breast pain. But this drug’s potentially significant side effects make it appropriate for only the most severe cases of mastalgia.

Taking over-the-counter pain medications and wearing a support bra may also help to ease breast pain. And, if you suffer from mastalgia, keep in mind that, according to Morrow, 60 to 80 percent of breast pain goes away on its own.