Understanding Breast Pain

By Christine Haran

Tender breasts are just one of the many uncomfortable and annoying symptoms millions of women experience prior to their periods. While most women have just mild breast discomfort, others experience more severe pain each month. And some women have breast pain that is not associated with their menstrual cycle, which is known as noncyclic pain.

Sudden or severe breast pain is often a very alarming symptom for women. Breast pain is not usually a sign of breast cancer, but experts say it?s important that women with breast pain, particularly severe pain associated with their menstrual cycle, or any kind of noncyclic pain, be evaluated for breast cancer. "The reassurance is a big part of the evaluation of breast pain." says Sandhya Pruthi, MD, the section head for the Breast Diagnostic and Cancer Clinics at Mayo Clinic in Rochester, Minnesota.

Below, Dr. Pruthi and other members of the team at Mayo?s Breast Diagnostic and Cancer Clinics, Robin Smith, MD, and Jennifer Hazelton, a clinical nurse specialist, talk about the most common causes of breast pain, as well as strategies for easing the pain.


What are the most common kinds of breast pain?
DR. ROBIN SMITH: The breast pain that women experience has been broken down into three primary types. The first is called cyclic mastalgia, and this is pain that is associated with the menstrual cycle. Typically a woman?s symptoms start within the two weeks prior to her menstrual cycle, worsening until the onset of her menstrual period, and then they tend to get better. Some women have pain throughout the entire month, but it improves and worsens according to the time in the cycle.

The second type of pain that women experience is called noncyclic mastalgia, which is pain that may be intermittent or constantly present, but does not appear to be associated with the menstrual cycle at all.

And the third type is breast pain that is actually pain from another source, such as the chest wall. Conditions such as costochondritis, caused by inflammation in the rib joints, can sometimes be perceived as breast pain, as can a number of other medical conditions in the same area.

How do women describe their symptoms?
DR. ROBIN SMITH: Women with cyclical breast pain tend to experience pain in both breasts. It is often described as heaviness, aching, or fullness. It seems as though the patients with noncyclic breast pain have pain that can involve both breasts, but it?s more often one-sided, and it tends to be localized to one area in the breast. Sometimes patients will use terms such as "sharp" or "burning" to describe it.

There?s a wide spectrum in terms of severity because we often pick up breast pain simply by asking patients about their breast symptoms, and most of these women are not very bothered by their pain. Other women actually do have pain severe enough to cause interference with school and work, their physical activities, leisure activities and sexual activity.
Why do hormonal fluctuations cause breast pain?
DR. ROBIN SMITH: I wish we had the answer to that. It seems obvious to all of us that there?s a hormonal role in the cyclical type of breast pain, because it changes with the menstrual cycle and it tends to improve with changes in hormones, such as pregnancy or with menopause. There have been a number of studies performed over many years trying to detect a hormonal abnormality that might explain why some women experience pain and others don?t, or why some women experience severe pain and others have only mild symptoms. Unfortunately, there have not been consistent results. One potential explanation is that certain women may have breast tissues that may be more sensitive to normal circulating hormones.

What causes noncyclic breast pain?
DR. ROBIN SMITH: When someone presents with noncyclic breast pain, we carefully evaluate them to see if we can find an explanation. And of course, what the patient is usually concerned about is the possibility of cancer. Fortunately, the risk of cancer is low, but it?s not insignificant. About 2 to 3 percent of women who come to a clinic for evaluation for breast pain?usually that?s reasonably severe breast pain?have a cancer at the site.

So the majority of noncyclic breast pain is caused by benign conditions. Sometimes we will find benign tumors in the breast, such as a fibroadenoma, which is a common benign tumor, or a breast cyst that may have been causing her localized pain. But most of the time we don?t find a clear-cut explanation for noncyclic breast pain.


Why isn?t breast pain usually a symptom of breast cancer?
DR. ROBIN SMITH: Although pain can be a symptom of cancer, it is surprising how seldom this is the case. Cancers start out as small clusters of abnormal cells that grow over time and may spread to other sites. Malignant tumors in the breast may not cause any symptoms for months, or occasionally, years. Cancers can cause pain by inducing inflammation or swelling, by invading a region with a rich nerve supply or by putting pressure on other sensitive tissues, but this does not occur until the tumor becomes larger. The risk of breast cancer in women with localized breast pain is low, but not insignificant, and merits appropriate medical evaluation.

Do infections cause breast pain?
DR. ROBIN SMITH: We do see patients with mastitis, an infection of the mammary gland, or sometimes an abscess. Quite often these occur around the time of pregnancy and lactation, and it can be very painful. Usually, these women have other clinical findings of redness, swelling, maybe some discharge from the nipple.
DR. SANDHYA PRUTHI: Postmenopausal women describe pain around the areola that is called periductal mastitis. They don?t always have the classic red breast, nipple discharge or even the sign of an abscess. It?s just a very subtle set of symptoms where the woman says, "You know, it just hurts behind the nipple."

What role does diet play in causing breast pain?
DR. ROBIN SMITH: There have been some studies supporting an association between caffeine and breast pain, but other studies have really not supported a relationship. But I have many patients come in and simply tell me that they know that if they drink too much coffee or soda that has caffeine, they experience a worsening of their symptoms. Other women don?t find a relationship between caffeine and their symptoms. I think it?s worthwhile, in a woman whose symptoms are severe and who has a significant caffeine intake, to undertake a trial of bringing that caffeine consumption down.

When would you advise a woman with breast pain to be tested for breast cancer?
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