January 20, 2019
Sore breasts

Understanding Sore, Achy Breasts

by Stephanie Watson

Breast pain and tenderness are common complaints of women of all ages—from puberty to menopause and beyond. Any changes in your breasts can put you on high alert for breast cancer. Yet, more than 99 times in 100, the cause is something far less sinister.

Up to 80 percent of women feel soreness, heaviness, burning, or other types of mild to severe pain in their breasts at some point in their lives. For some of these women, breast pain—called mastalgia—can come and go over a period of many years. Although most breast pain is benign (noncancerous), it can interfere with physical, social, and sexual activities and sleep. Nearly half of women who see a doctor for a breast related issue do so because of pain.

Though breast pain can be an unsettling symptom, the odds of it actually being caused by breast cancer are less than 1 percent. In women who get regular breast cancer screening mammograms, the likelihood of pain being a sole symptom of cancer is 0.5 percent, according to the American College of Radiology (ACR).

Breast Pain May Lead to Unnecessary Testing

A study by researchers from MD Anderson Cancer Center in Houston found that imaging tests such as mammography, ultrasound, and MRI are widely overused in women with breast pain, given the extremely low rate of cancer diagnoses associated with this symptom.

What causes breast pain?

Doctors divide types of breast pain into three categories: cyclic, noncyclic, and extramammary.

1. CYCLIC MASTALGIA

The most common type of breast pain, cyclic mastalgia affects about two-thirds of women, mostly in their 30s and 40s. Pain, tenderness, and sometimes swelling in both breasts coincides with fluctuating hormone levels during the menstrual cycle. The pain is usually spread over a wide area (called nonfocal pain) in both breasts and is often most severe in the breast’s top outer portion. Most mild cyclic breast discomfort is considered normal. Fibrocystic changes in the breast tissue, characterized by lumpy breasts, can also cause pain; the condition mostly affects women between ages 20 and 45.

Hormonal fluctuation during perimenopause (typically ages 45 to 55) can cause burning, throbbing, or sharp pain in one or both breasts, and breasts can change in size and shape. About 40 percent of women who experienced breast discomfort during their periods will get relief once they reach menopause. Cyclic mastalgia can also occur with menopausal hormone therapy use.

2. NONCYCLIC MASTALGIA

This type of breast pain isn’t associated with the menstrual cycle, and its onset is most common in women in their 40s and 50s. Noncyclic mastalgia affects about one-third of women with breast pain. In about half of those women, it goes away over time without treatment. Noncyclic mastalgia is usually focal pain that’s sharp and burning in a single breast, most often below the nipple. Common causes include:

  • Lumps. Several types of benign breast lumps may cause pain. Cysts are fluid-filled lumps that move around when you touch them and can feel tender to the touch. They typically go away on their own; if they’re bothersome, your doctor may be able to drain them. Fibroadenomas, solid breast masses that tend to occur in younger women, may go away on their own as well, but if they grow, you may need to have them surgically removed.
  • Ductal ectasia. This condition occurs when milk ducts beneath your nipple become clogged with fluid, causing pain in the area of the duct. It occurs most frequently in perimenopausal women but can also appear after menopause. Ductal ectasia can go away on its own. In some cases, surgery may be needed.
  • Mastitis. Inflammation, sometimes caused by an infection, can lead to pain, swelling, redness, and warmth in the affected breast. Mastitis is more common in lactating women as milk ducts become clogged, but it can sometimes affect women who aren’t lactating.
  • Medications. Menopausal hormone therapy and some antidepressants and cardiovascular drugs can cause breast discomfort and pain. Your doctor may be able to reduce your dosage or switch you to another drug.
  • Large breasts. Ligaments in very large breasts can stretch, causing pain in your breasts, neck, back, and shoulders.
  • Injury or surgery. Trauma to the breast can cause lingering pain in a small percentage of women. Women who have had breast surgery may continue to feel pain afterward, especially if they have substantial scar tissue or had complications such as nerve injury, infection, or blood vessel damage (hematoma). A breast implant can also cause pain, particularly if it was implanted beneath the large chest muscle, pectoralis major, that underlies the breast.
  • Inflammatory breast cancer. Rarely, pain is a sign of this aggressive form of breast cancer. Its hallmark symptom is skin over the breast that has taken on a thickened, wrinkly appearance like the surface of an orange. Treatment typically begins with chemotherapy.

3. EXTRAMAMMARY BREAST PAIN

Sometimes breast pain is from a source other than the breasts. Nerves that run through each breast can carry pain from other areas of the body, such as the chest wall, lungs, heart, gallbladder, or spine. A muscle strain, a fractured rib, a compressed nerve, an infection, or disease in those areas can cause pain to radiate into the breasts.

Getting a diagnosis

If you have breast pain that doesn’t go away, or you have other worrying symptoms (see inset, “Breast Warning Signs”), consult your gynecologist or primary care provider.

The doctor will examine your breasts, looking for any suspicious signs such as lumps, skin changes, and nipple discharge. These signs would likely warrant a mammogram and possibly an ultrasound exam.

Breast Warning Signs

Pain is rarely a sign of breast cancer. However, if you experience any of these symptoms with or without pain, report them to your doctor right away.

Treating breast pain

If your mastalgia is caused by an underlying disorder, then the primary focus is treating its cause. If your breast pain is benign and not caused by an underlying disorder, or to help with the breast pain during treatment of an underlying disorder, try the following conservative measures to reduce discomfort:

  • Wear a supportive bra. It’s important to wear a bra that’s supportive and fits you properly. If you’re buying a new bra, ask the salesperson to help you find the right fit. Women with large breasts will find more support from a bra reinforced with underwire. Wear a high-impact sports bra when you exercise to prevent painful bouncing. You can also wear a soft bra while you sleep to alleviate nighttime discomfort.
  • Apply heat or ice. A warm compress or heating pad or an ice pack may help relieve discomfort. A gentle massage may also help soothe tender breasts.
  • Take a pain reliever. If other measures don’t afford sufficient relief, you can try over-the-counter medication such as acetaminophen (Tylenol and others) or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen (Advil, Motrin, and others). Alternatively, a topical prescription cream or gel containing the NSAID diclofenac (Solaraze, Voltaren, Cambria, and others), might improve your pain without the potential side effects of oral NSAIDs, such as headaches, dizziness, and stomach pain or bleeding.

Other possible remedies

Some women report pain relief by restricting caffeine, fat, and salt intake or taking the herbal supplement evening primrose oil, even though little evidence confirms that those remedies are effective. The dietary measures are considered safe, but primrose oil may cause stomach pain or nausea (less likely when taken with food), rashes, and headache and interact with certain anticlotting drugs. You can also try relaxation therapy.

If you have severe and persistent cyclic mastalgia that’s not relieved after six months of conservative therapy, oral prescription drugs may help—but they can also cause serious adverse effects.

Tamoxifen (Nolvadex), used to treat breast cancer, helps relieve breast pain. It can increase the risk of blood clots and endometrial cancer and cause menopause-like symptoms such as hot flashes and vaginal dryness.

Danazol (Danocrine) is a synthetic form of male hormones approved by the FDA to treat mastalgia. Danazol can cause side effects such as weight gain, muscle cramps, deepening of the voice, and hot flashes. Tamoxifen and danazol are taken for about three to six months and then tapered off.

This article first appeared in the December 2018 issue of UC Berkeley Health After 50.

Also see Reduce Your Risk of Breast Cancer?