Periodic breast pain is the most common form of breast pain and is part of PMS. It occurs during the luteal phase of menstruation (days 14-28) and gradually resolves after menstruation. Many patients with severe cyclic breast pain have endocrine abnormalities, mainly in the form of irregular menstruation, changes in the duration and volume of menstruation, and elevated estrogen, progesterone and prolactin in the blood circulation. There is no need to be overly alarmed by the occurrence of cyclic breast pain, as most of them are benign and have little correlation with the risk of cancer or true pathological changes. Some studies have even shown that when cancer is ruled out, comfort alone can relieve 86% of mild pain and 52% of severe pain symptoms.
The main non-cyclic breast pains are those of mammary and non-mammary causes. Breast causes include ductal dilatation, trauma, sclerosing mastopathy, and cancer. Ductal dilatation is a large duct in the breast that often occurs around the areola and can be accompanied by symptoms such as nipple discharge, and the degree of ductal dilatation often correlates significantly with the severity of pain. Trauma, on the other hand, is related to external blows, such as inadvertent impact, car accidents, fists and feet of bear children, etc., which can be accompanied by the formation of local lumps and bruises, which can sometimes be very similar to the manifestation of breast cancer. Sclerosing mastopathy is mainly caused by interstitial hyperplasia of the breast, the specific mechanism of which is still unclear. Non-breast-related breast pain is more commonly known as costochondritis, the technical term for Tietze’s disease, which is caused by inflammation of the cartilage in the rib and sternal joints, and can cause significant pain when pressing on the joints.
Breast pain and breast cancer
The next major concern is breast cancer. Not all breast cancer patients have breast pain, but the pain of breast cancer is usually persistent hidden pain or stabbing pain, often in a fixed location, and may involve the back of the shoulder, if it is accompanied by breast lumps or nipple overflow, then you need to consult a doctor as soon as possible. Of course, the relationship between breast pain and breast cancer is still inconclusive. Some studies have shown that women with periodic breast pain have a significantly higher risk of developing breast cancer in the future compared to women without breast pain (RR=3.12, i.e. 3.12 times higher risk); however, some studies have also shown that patients with periodic breast pain have a significantly lower risk of developing breast cancer compared to those without breast pain. Nevertheless, patients with either periodic or persistent breast pain should be alerted to the risk of breast cancer and should be seen as early as possible for scheduled follow-up if your breast pain is associated with
1. a first-degree relative (parent, child, and sibling) with breast cancer
2. a concomitant lump or nipple discharge/blood spill.
3. first menstruation earlier than 14 years of age, menopause later than 50 years of age, not having given birth or not breastfeeding
4. Middle-aged and older women (>40 years old).
How to prevent and treat breast pain scientifically?
First, studies have confirmed that reducing dietary fat intake can significantly reduce cyclical breast pain. That is, reducing the intake of high-fat foods such as fatty meat, cream, whole milk and fried foods can reduce cyclical breast pain. Proper exercise and emotional adjustment and rest are also significantly helpful in reducing breast pain.
Secondly, there are clinical trials that confirm that better supportive bras can reduce breast pain, such as sports bras, which play a role in reducing breast pain by reducing the movement and friction of the mammary glands.
Of course, lifestyle modifications can play a role in the prevention and treatment of cyclical breast pain, but severe cyclical breast pain and non-cyclical breast pain still require timely consultation with a specialist to identify the cause and provide timely treatment, and if medication is needed, it is important to consult a specialist and not to use medication without permission to avoid delay or aggravation.
References
Jay R. Harris, et al.
NCCN (American Cancer Network) Guidelines for the Treatment of Breast Cancer, 2nd edition, 2015