BREAST TENDERNESS AND PAIN

Why are my breasts so tender?

Will I need a biopsy?

What can I do to decrease my breast tenderness?

Fibrocystic Disease

Return to Breast Problems Home Page

BREAST TENDERNESS

Why are my breasts so tender?

Breast tenderness is a very common symptom. It is rarely associated with breast cancer, but a thorough exam by an experienced physician is important to be sure.

Most women experience at least some increase in sensitivity or tenderness in their breasts as their menstrual cycle In some women this can become quite severe. The tenderness may be diffuse, involving all of the breast tissue, or it may be localized to one breast, or one area of one breast. Though it usually lessens after the menstrual period it may be constant. It is clear that changing hormone levels in the blood stream are the primary explanation, but there may be other contributing factors. Certain medications may increase tenderness, including birth control pills, estrogen or progesterone (Premarin, Provera, Ogen, Climara, Estratest, and others), and medications which contain xanthines (Theodur, caffeine containing stimulants). Caffeine seems to cause increased breast tenderness for many women, though it seems to have no effect in others. Marked breast tenderness frequently occurs in the very early stage of pregnancy also. Sometimes a cyst can develop and enlarge rapidly, causing localized tenderness. Less commonly, an area of infection may occur which can be extremely tender.

If you have recently noticed that your breasts are more tender, you should be sure to do a good self-exam of your breasts. See if can identify a specific area that hurts, and feel for any lumps. Look for any visible changes such as a visible lump, or a dimpling of the skin, or redness. Schedule an appointment with your physician, and take a list of your current medications. Be aware of how much caffeine you are using, including coffee, tea, sodas, chocolate, and any caffeine-containing medications, such as diet pills or stimulants. Be able to pinpoint when your last menstrual period was, and whether is was normal or not. Ask your physician’s office if you should have a mammogram or other studies before your appointment, and if you should bring your mammograms with you.

Return to top of page

Will I need a biopsy?

For most women with breast tenderness, the physician’s exam will not identify any problem which needs a biopsy. However, occasionally there is an associated lump, which could be a fluid-filled cyst, an abscess, or a solid growth of tissue. Such findings will likely require a procedure, such as use of a needle, or other sort of biopsy or removal. This may frequently be done at the time of the initial visit. (Please note that some insurance companies do not cover procedures to be done on the same day as your exam. If not, you will be scheduled to return for the procedure after your insurance company has given authorization.)

Cysts can be treated simply with drainage of the fluid through a needle. The pain from the fluid drainage is similar to what you would feel if you have a blood test done. The cyst fluid usually has a greenish, yellowish, or brownish tint. There is usually no need to “test” the fluid if it has this typical appearance.

Abscesses usually require a small incision to drain the infection. For small abscesses, treatment can be done immediately. The infection causes more surrounding tenderness than a cyst, so the drainage procedure is likely to be more painful, but brief. The advantage of immediate treatment may outweigh the extra tenderness. Larger abscesses may require drainage in a hospital setting in order to provide adequate sedation and /or anesthesia.

Solid growths of tissue may be biopsied with a needle at the initial visit. Some anesthetic is injected around the area to be biopsied. The needle is then inserted into the lump to obtain a sample of tissue for analysis. An ultrasound machine is frequently used to place the needle precisely. Most women experience little or no discomfort with the procedure.

Return to top of page

What can I do to decrease my breast tenderness?

(There are a number of options discussed below that may help. We have summarized these in a brief one page summary information sheet, which you can review and download or print here.)

Once your physician has examined for any possible problems such as a cyst, abscess or possible cancer, there are several things you can do. If you are taking in any caffeine on a daily basis, try cutting out all caffeine products for a period of six weeks. This simple step may be all that is necessary. If your tenderness goes away, you may want to experiment by starting back on caffeine to see if your tenderness comes back. You may find that there is a certain amount of caffeine which you can tolerate without the symptoms.

Both vitamin E and evening primrose oil have been found to be helpful for many women. Though the exact mechanism of action is not known, both supplements have been found to be beneficial in decreasing tenderness. Recommended dosages for vitamin E range from 400 U to 1000 U per day. It is available at all drug stores and many supermarkets without a prescription. As an added benefit, there appears to be a decrease in risk of heart disease in patients taking vitamin E on a regular basis.

Evening primrose oil is carried by many drug stores, though it may be difficult to find than vitamin E. It is more commonly recommended in England than here in the United States. Recommended dosage is up to four tablets per day. It can cause some gastrointestinal side effects, such as bloating or gas, and changes in your bowel movements. These side effects are less likely at lower dosages.

There are many simple measures to try that may help. If your tenderness is predictable with each menstrual cycle, you may want to begin taking on over-the-counter pain medicine, such as Tylenol, Advil, Alleve, or other, for the week before your period. A good hot bath once or twice a day can help. Changing to a different bra is also occasionally beneficial.

Depending on the severity of your tenderness, you may want to use some or all of these measures. Most women will obtain sufficient relief with the steps described above. For the small group of women with persistent disabling tenderness despite all these measures, there is a hormonal treatment which is very effective, but which has a high likelihood of side effects. It involves use of Danazol, a hormone used in treatment of endometriosis. Side effects include changes in menstrual cycle, voice changes, and body hair growth.

(We have summarized these options in a brief one page summary information sheet, which you can review and download or print here.)

Return to top of page

Breast Pain/ Fibrocystic Disease

Painful breast tissue is an exceedingly common symptom but is usually of “functional” origin and very rarely a symptom of breast cancer. Many years ago, a surgeon named Haagensen carefully recorded the symptoms of women presenting with breast cancer and found that only 5% of patients had pain at time of diagnosis. And this was a long time ago, when screening mammography was not used routinely; breast cancers were often much larger at diagnosis than they usually are today.

Although not typically a symptom of cancer, breast pain is a common reason for patients to seek medical attention. Breast pain appears to be aggravated by abnormal menstrual cycles and may be seen in young women with menstrual irregularity, as a premenstrual symptom, or when hormones, such as estrogen, are taken during and after the menopause. In addition, fibrocystic change, in its severest forms, may cause disabling breast pain. Although many observers find breast pain and tenderness is aggravated by excessive intake of caffeine, nicotine, or commonly used antihistamines, other investigators disagree.

Fibrocystic Disease, Fibrocystic Change (Cystic Mastopathy, Cystic Mastitis).

(Note: This portion is a bit more technical, so be prepared!!)

Fibrocystic change, popularly referred to as fibrocystic disease, represents a spectrum of clinical and histologic findings including cysts, nodular breast tissue, and some other changes that have technical terms like “stromal proliferation, and epithelial hyperplasia”. Fibrocystic change appears to represent an exaggerated response of breast stroma (background and supporting tissue) and epithelium (the lining of the breast ducts and lobules) to a variety of circulating and locally (in the breasts) produced hormones and growth factors. Clinically, patients with fibrocystic change have dense, firm breast tissue with lumps and frequently gross cysts, or pockets of fluid. This condition is commonly painful and tender to touch. Under the microscope, the lesion recognized as fibrocystic complex contains various sized cysts, stromal fibrosis (fibrous background tissue), adenosis (overgrowth of glands), and a variable amount of “epithelial metaplasia and hyperplasia”. All these changes can occur alone or in combination and to a variable degree in the normal female breast. Autopsy studies have questioned whether any of these changes, except perhaps macrocysts, are abnormal. In fact, all of these lesions occur commonly in the breasts of elderly patients and appear to have no particular tendency toward evolving into breast cancer. Since these sorts of changes are so common, it really is not appropriate to term it a “disease”. Nevertheless, the term “fibrocystic disease” is so commonly used, it would be hard to get everyone to stop using it. But ideally, the term fibrocystic disease should be abandoned in the absence of any well-defined clinical and pathologic syndrome.

There is no consistent association between fibrocystic changes and breast cancer. It is well established that women who have undergone breast biopsy for any reason, regardless of the underlying pathology, have a slightly higher risk of developing subsequent breast cancer. Moreover, the incidence of finding fibrocystic disease in autopsied breasts from women dying of causes other than breast cancer exceeds the incidence of these same changes in cancer-containing breasts. For those patients with fibrocystic changes, higher risk appears to concentrate in those whose biopsy specimens show abnormal ductal and lobular hyperplasia and, to a lesser extent, cyst formation. Therefore, the fibrocystic complex appears to be an exaggerated or abnormal response to otherwise physiologic stimuli in most patients and represents a health risk only in certain subsets.

Return to top of page

Return to Breast Problems Home Page