Overview: Breast pain is a common problem for patients consulting with gynecologists and breast disease specialists. Patients often mistakenly believe that painful symptoms are associated with early stage breast cancer. Benign breast lesions including adenopathy, ductal dilatation, simple fibroadenoma, fibrosis, mastitis, mild hyperplasia, cysts and acromegaly or squamous epithelial hyperplasia are not considered to increase the risk of breast cancer; certain lesions including complex fibroadenoma, moderate and severe typical type or atypical hyperplasia, sclerosing adenopathy, and papilloma have a secondary risk of breast cancer. In contrast, there is a process of transformation of normal breast epithelium to malignancy, i.e. hyperplasia – atypical hyperplasia (precancerous lesion) – carcinoma in situ – invasive cancer is a long process that takes years or even decades. However, when cancer is ruled out, comfort alone can relieve 86% of mild pain and 52% of severe pain symptoms.
Etiology.
1.Pathological pain is commonly caused by: mastitis, breast cancer, breast hyperplasia, also can be caused by ovarian tumors, less often by Monder’s disease .
2.Physiological pain has the following 6 causes.
(1) Breast swelling and pain during puberty: it usually occurs at the age of 9-13. During this period, girls’ breasts begin to develop, starting with nipple elevation and the appearance of hard mound-shaped nodes about pea to broad bean size in the breast tissue under the nipple, with slight swelling and pain. After menarche, it will disappear on its own as the breast matures.
(2) Premenstrual breast pain: More than half of women experience periodic breast pain. Before the onset of menstruation, there is breast swelling, hardness and pressure pain; in heavy cases, the breasts can be swollen and painful when they are slightly shaken or bumped. After menstruation, these changes may disappear. This is due to the increase of estrogen level in the body before menstruation, breast enlargement and edema of inter-mammary tissue; the estrogen level basically drops to normal in 7-10 days after menstruation, and the pain relieves itself.
(3) Breast swelling and pain during pregnancy: Some women secrete a large amount of estrogen, progesterone and prolactin in about 40 days of pregnancy due to the placenta and chorionic villi, which causes breast hyperplasia and breast enlargement, resulting in breast swelling and pain, which can last for the whole pregnancy in heavy cases. No treatment is needed.
(4) Postpartum breast swelling and pain: 3-7 days after childbirth, both breasts are often swollen, hard and painful. This is mainly due to lymphatic retention in the breast, venous filling and interstitial edema and poor ducts in the breast. Prevention and treatment: breastfeeding as early as possible. If there are hard knots, you can apply hot compresses and massage the hard knots before breastfeeding; you can also use a breast pump to attract milk to promote the smooth flow of milk ducts.
(5) Breast swelling and pain after abortion: After abortion, some women complain of breast swelling and pain, and lumps can be palpated. This is due to the sudden interruption of pregnancy and the sudden drop of estrogen and progesterone levels in the body, which suddenly stops the growth of the newly developed mammary glands, causing breast lumps and breast pain.
(6) Breast pain after sex: This is related to the physiological changes in the breast during sex. The sexual desire indifference or sexual life is not in harmony, because of the failure to achieve sexual satisfaction, breast congestion, swelling is not easy to subside, or subside incomplete, persistent congestion will make the breast swelling pain. Therefore, women should pay attention to a good sex life, no orgasm or indifference to sexual desire should go to the doctor.
Classification.
Early American researchers divided breast pain into six subgroups: cyclical breast pain, ductal dilatation, Tiete’s syndrome, trauma, sclerosing mastopathy and cancer. Later, there were two groups: true non-cyclical pain and pain in the chest wall from other causes. A simpler division: cyclic breast pain (about 70%), non-cyclic breast pain (20%) or extramammary pain (10%).
Clinical manifestations.
1, breast pain syndrome: only breast pain without breast lumps, swelling and pain is intense and persistent, such as pinprick-like or knife-like, some are vague. The location of the pain is variable, with varying severity bilaterally, and can be radiated to the axillae, shoulders and back and upper limbs.
2, mastitis pain: local redness, swelling, heat and pain in one breast, accompanied by an increase in body temperature, is often a sign of mastitis. Acute cases are mostly seen in lactation, primigravida; chronic cases are mostly seen in non-lactation, plasma cell mastitis combined with infection.
3. Ovarian tumor breast pain: Because ovarian tumors produce a lot of estrogen, which stimulates breast hyperplasia, thus causing breast pain. About 20% of ovarian tumor patients have combined breast diseases, including breast pain and breast cancer.
4.Breast cancer pain: Breast cancer patients have different degrees of hidden breast pain and stabbing pain, which is progressively aggravated and involves the shoulder and back. About 13% of breast cancer patients have breast pain as the initial symptom, and 6% of them have breast pain as the only early manifestation, i.e. only breast pain but no lump can be felt. In advanced stage of breast cancer, the pain is severe and unbearable, and progressively worsens.
5.Mastopathic pain: The prominent symptom is intermittent pain in the breast. The pain is either diffuse dull pain or restricted stabbing pain, usually involving only one side of the breast, or both sides at the same time with one side being more severe. Most of the pain is confined to one part of the breast, about 50% in the upper outer part and 20% in the upper middle part. Most of the pains have pressure, and sometimes they can be very intense and become the main symptom of the disease.
6, Monder’s disease: is a rare cause of breast pain, its clinical features are localized pain associated with palpable subcutaneous striae or linear skin depressions. The cause is superficial thrombophlebitis associated with a lateral thoracic vein or a branch of its genus. This condition can heal spontaneously, but nonsteroidal anti-inflammatory drugs help to reduce symptoms. Some patients speculate that the skin disease causes cancer causing serious panic.
7. Extramammary pain : (Pain originating from the chest or abdomen and involving the breast is primarily treated for the underlying disease.) Pain originating from the chest wall, Tiete’s syndrome or costochondritis, manifested as tenderness in specific areas of the breast (trigger points); can be treated by local anesthesia or cortisol injections, nonsteroidal analgesic applications.
Prevention and treatment: After ruling out serious underlying pathological processes, the vast majority of patients with breast pain can be relieved by eliminating concerns, reducing psychological stress, and relaxing mental tension with attention to the following areas Only a small percentage of patients (<10%) require special treatment for problems such as the degree and duration of pain.
1.Prevention.
(1) Wear a suitable bra Bra is not only to prevent breast sagging, but also to prevent further compression of the already compressed breast nerve and to eliminate discomfort.
(2) cultivate good dietary habits follow the “low-fat, high-fiber” diet principles, eat more whole grains, beans and vegetables, control the intake of animal protein, and pay attention to the supplementation of appropriate trace elements. Avoid barbecue, fried and high-salt foods; eat less estrogen-fed chicken, beef and sweets. Reducing fat intake in food can significantly reduce cyclical breast pain.
(3) Take vitamins Diet should be rich in vitamin C and vitamin B complex foods. These vitamins help regulate the production of prostaglandin E.
(4) Avoid alcohol and coffee and consume less coffee, cocoa, chocolate and other foods that contain large amounts of xanthine, which can contribute to breast enlargement and induce breast pain. Alcohol consumption is also considered to be a major enemy of breast disease. A study found that women who drink liquor daily have a substantially increased chance of developing breast disease.
(5) Do not abuse estrogen-containing health products or long-term use of beauty cosmetics, as well as long-term excessive use of estrogen in menopausal women; do not self-administer propolis, royal jelly, pollen and some oral solutions containing hormones.
(6) Do not abuse antibiotics application of antibiotics to stop breast pain, is wrong and dangerous. (The exception is when the breast pain is caused by inflammation.) (7) A happy mood is good, the ovaries maintain normal ovulation, progesterone secretion is normal, the mammary glands will not be enlarged by the unilateral stimulation of estrogen, and the breast glands that have been enlarged will gradually recover under the action of progesterone, which will reduce the occurrence of breast pain.
(8) Encourage breastfeeding Pregnancy makes sufficient secretion of progesterone, which can effectively protect and repair the mammary glands, while breastfeeding can make the mammary glands fully develop and degenerate well after the child is weaned, so that they are not easily proliferated.
(9) Hot compress Hot compress is a traditional Chinese medical method, you can use a hot compress bag, hot water bottle or take a hot bath to relieve breast swelling and pain.
(10) Regular checkups, insist on exercise and proper sports do a monthly self-examination of the breast, regular mammograms at professional institutions, do proper breast massage every time you take a bath, and do 5 minutes of breast expansion exercises every day can prevent breast diseases and avoid breast pain caused by breast diseases.
(11) Harmonious sex life Harmonious sex life can regulate endocrine, stimulate progesterone secretion, increase the strength of protection and repair of the breast, orgasm stimulation can also accelerate blood circulation, to avoid breast hyperplasia due to poor blood and Qi flow.
2. Treatment.
(1) Moderate or severe pain lasting less than 6 months has a high chance of self-remission through the above health care after dispelling concerns and does not require special treatment. If you are older than 35 years old and have not had a mammogram in the past 12 months and have new symptoms, you can have a mammogram to rule out abnormal lesions unrelated to breast pain.
(2) In a small number of patients with severe and persistent pain, treatment with triamcinolone acetonide or acetylcholine should be given. Triamcinolone 10mg daily for 3 months; if pain is relieved, the dose can be further reduced to 10mg every other day for another 3 months. For the few patients who do not respond, 20 mg may be given.
(3) For a very small number of patients who do not respond to the above treatment can be switched to danazol or goserelin for 4 months.
(3) For breast pain with serious underlying pathological processes, such as mastitis pain, ovarian tumor breast pain, breast cancer pain, etc., appropriate special treatment is needed according to different pathological processes.