By Ahmed, Aftab
Injury of any sort to the breast can cause localized pain and may last for weeks or months.
Mastalgia, or breast pain, is a necessary part and consequence of reproductive life. Like breast swelling, it waxes and wanes during the menstrual cycle and is one of the first symptoms of pregnancy. It is understandable then that many women expect that breast pain will be a thing of the past with the onset of menopause. When that does not happen, they may fear that they have breast cancer. The good news is that breast pain is rarely a symptom of malignancy, irrespective of age. The possibility, however, should be considered along with a number of benign conditions that affect the breasts.
Broadly speaking, breast pain is either cyclical or non- cyclical. Cyclical breast pain correlates with menstruation and results from monthly fluctuations of estrogen and progesterone. While no hormonal abnormality has been linked with cyclical breast pain, it is known that estrogen and progesterone affect the breast, increasing the size and number of ducts and milk glands and causing the breast to retain water.
Just prior to the onset of menstruation, both breasts may swell and become tender, painful and lumpy. The pain may extend to the upper and outer portions of the breast and into the arm. The symptoms may subside when the menstrual cycle is completed. Cyclic pain may worsen during perimenopause, when hormones can surge and drop erratically, and linger into menopause, especially in women taking oral contraceptives or on hormone replacement therapy (HRT).
Non-cyclical breast pain, on the other hand, does not obviously track menstruation and does not follow any predictable pattern. It may be persistent or intermittent, may affect one breast or both, and may involve the whole breast or a cross-section of it. Ordinarily, non-cyclical pain is a symptom of a specific problem- such as a cyst, benign growth, or trauma. Conditions that affect the chest wall, esophagus, neck, upper back, and even the heart can produce symptoms that are felt as breast pain.
Tentative evidence suggests that an imbalance in fatty acid metabolism might play a role in breast pain by sensitizing the breast tissue to hormonal changes. Importantly, fibrocystic changes in the breast tissue may cause cyclical or noncyclical pain in one or both breasts. Women with this rather common condition have thickened tissue or an increased number of cysts in otherwise normal breasts.
Breast pain may be caused by several other factors, however, which are not related to menstrual cycle. Thus, infection of the breast tissue (mastitis) or a rare abscess can cause severe pain. Mastitis is most common in lactating women but can occur at any age. Nursing or chafing from clothing can irritate the skin overlying the nipple, possibly allowing bacteria to enter and infect the breast. Mastitis can cause fever and breast swelling, redness and tenderness. For a more detailed description of disorders of the breast, visit www. bioaginginc. com.
Injury of any sort to the breast can cause localized pain and may last for weeks or months. Trauma does potentially lead to inflammation and a clot in the superficial vein of a breast (thromobophlebitis) that results in pain and swelling, but it rarely progresses to serious outcomes. Some prescription medications can underlie breast pain as well. Aside from hormones, cardiovascular and psychiatric drugs may be the root cause of persistent pain. Also, support problems should be adequately addressed. Heavy, pendulous breasts may stretch ligaments and tissue resulting in pain in the shoulders, back, neck, and breasts.
It should be emphasized here that breast pain is rarely a symptom of malignancy. Thus, a minuscule number of women receive a diagnosis of malignancy in the breast. Other conditions unrelated to the breast, however, could precipitate pain in the tissue. For example, strain in the pectoralis major muscle, which lies directly beneath and around the mammary girth, may be discerned as pain coming from the interior of the breast. Likewise, inflammation of the cartilage joining the ribs to the breastbone (costochondritis) causes a burning sensation in the breast. Furthermore, maladies of connective tissue, shingles, heart disease, gastroesophageal reflux disease (GERD), and, among others, arthritis in the neck or upper back may also manifest as breast pain.
It is indispensable to seek competent professional advice for pain in the breast, especially in light of individual clinical history. This will help to rule out any festering malignancy. Numerous treatment strategies can then be implemented to alleviate acute and severe pain. Thus, pain on account of pectoral muscle strain, costochondritis, or arthritis may necessitate a short course of non-steroidal anti-inflammatory drugs (NSAIDs), along with stretching, yoga, or neck rotation exercises. Mastitis, however, may require antibiotics, as does an abscess, which must also be drained.
Inside the Breast
Breast pain unrelated to menstrual cycle may be caused by conditions that affect the pectoralis major muscle, structures within the breast, and the ribs or sternum.
An increasingly popular approach is lifestyle modification. Ordinarily, a snugly fitting, supportive brassiere should help. For exercise, and if the pain is severe during sleep as well, a sports brassiere may be recommended. While there is no evidence to that effect yet, many women report that abstention from caffeine and nicotine helps mitigate the severity of the pain. By the same token, limited data suggests that the consumption of an extremely low-fat diet (15-20 percent of daily calories from fat) can reduce breast tenderness and swelling.
Even though the data are scant and not entirely reliable, apparently both cyclical and non-cyclical breast pain is somewhat mitigated by evening primrose oil, which contains gamma-linolenic acid, an essential fatty acid. Equally, some reports indicate that fish oil supplements might be helpful as well.
Three rather powerful drugs-danazol, tamoxifen, and bromocriptine- relieve breast pain. These pharmaceuticals usually cause serious side effects and, breast pain. These pharmaceuticals usually cause serious side effects and, therefore, are only reluctantly prescribed to manage severe, unremitting pain that has proven refractory to other options. In addition, there is increasing restiveness among women about using such drugs. Thus, one recent study reported that a mere 18 percent of women at risk for breast cancer opt for using tamoxifen to prevent malignancy. The overwhelming majority is content to hedge its bets. Combined with the recent “scare” associated with NSAIDS-and their molecular cousins COX-2 inhibitors- the reluctance to use powerful medications is not surprising at all. Given its preponderance, however, it is imperative to develop remedies that correct the underlying causes of mastalgia.
Inflammatory response figures prominently in mastalgia, irrespective of the origin of the pain. Inflammation kicks into high gear with infection, and is persistent if pain is presented with concomitant conditions, such as strained muscle, costochondritis, or arthritis. Therefore, resolution of the inflammatory response is an essential factor in any corrective approach to manage mastalgia and related breast maladies. While NSAIDs and COX-2 inhibitors may be helpful under clinical supervision over short terms, these drugs are imminently inadequate to resolve the latent inflammatory response.
How so? Inflammatory response is comprised of a complex cascade of reactions and interactions of many different substances. The most important of these molecular actors are cytokines-proteins that can both precipitate inflammation and help resolve it when the offending stimulus dissipates. Ordinarily, there is a tight balance between anti- and pro-inflammatory cytokines. When a pain stimulus is given- say, an infection, a grazed knee, or hormonal fluctuations during the menstrual cycle-the levels of pro-inflammatory cytokines are increased, causing redness, pain and swelling of the affected area. Thus, a corrective remedy should strive to restore the balance in favor of anti-inflammatory cytokines. Systemic enzymes do precisely that. By re-balancing the immune response to a stimulus, systemic enzymes mitigate the sensations of discomfort and irritation.
Glossary of Breast Disorders
MASTALGIA
Breast pain and tenderness women feel typically during the menstrual cycle. In most cases, breast pain is not a symptom of malignancy. Occasionally, cysts in the breasts cause pain.
CYSTS
Fluid-filled sacs that may develop in the breast and that are easily felt and cause pain.
FIBROCYSTIC BREAST DISEASE
(FBD): A common condition in which breast pain, cysts, and non- cancerous lumpiness occur together. Although termed a disease, FBD is not a disease, since most women have some general lumpiness in the breasts, usually in the upper, outer quadrants.
FIBROUS BREAST LUMPS
Small, non-cancerous, solid lumps composed of fibrous and glandular tissue. Also, known as fibroadenomas. Other types of solid breast lumps include a hardening of glandular tissue (sclerosing adenosis) and scar tissue replacing injured fatty tissues (fat necrosis).
BREAST INFECTION AND ABSCESS
Variously known as mastitis, breast infections are rare, except around the time of childbirth orafter an injury. A breast abscess, which is more rare, is a collection of pus in the breast, and may develop if a breast infection is not treated.
For additional breast disorders and further details, visit www.bioaginginc.com.
Aftab Ahmed, Ph.D.
Copyright Total Health Communications Aug 2005
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