Bosom Buddy
Cancer is not as often associated with breast pain as with a lump in the breast
By REBECCA B. SINGSON, MD
Many women visit a gynecologist fearful of the pain in their breast area, afraid that it is a symptom of cancer. Because the gynecologist is the primary and only physician seen by most women, he or she ends up screening complaints and problems of all sorts.
CYCLICAL MASTALGIA
"Cyclical mastalgia," used interchangeably with "cyclical mastodynia," is the medical term for periodic pain and tenderness of the breast. As many as 56 percent of women complain of breast pain but luckily, it is less common in Asian women, for still unclear reasons. This usually occurs in women between 20 and 45 years old, and declines in menopause.
Pain is most common in the upper outer quadrant of the left breast and may even radiate to the arms and armpits. It may even worsen in the second half of the menstrual cycle. The breast feels heavy and extremely tense. Nipple pain can make even the touch of clothing or the brassiere unbearable. If these symptoms regularly appear before a period, together with headache, bloating, and mood swings like irritably and depression, this may be associated with premenstrual syndrome.
To most women, pain comes with breasts that feel lumpy and nodular. The physician is likely to diagnose this as fibrocystic disease of the breast. Women with many children and those who breast-feed for a long time appear to have a lower risk of developing this disease and mastalgia.
There are some interesting theories as to why mastalgia occurs. Some researchers have found a connection between methylxanthines-found in soft drink, coffee, tea, and chocolate-and the frequency of breast pain. A deficiency of vitamins A, B1, or B6 has also been mentioned as a possible reason. One of the most interesting theories on breast pain is that it is a normal female reaction with the aim of reducing sexual contacts before menstruation and to increase sexual activity and, therefore, fertility during the ovulation period.
MENSTRUAL CHANGES AND THE BREAST
The breast tissue under a microscope can be visualized as a white cloth with dark pink polka dots. The white cloth is the background with loose connective tissue called stroma, while the dark pink dots are the glands from which milk will be produced for breast-feeding. Immediately after a menstrual period, estrogen makes the pink dots grow bigger and produce buds. Progesterone makes the stroma swell with water. This is why breasts have some fullness and tenderness during the premenstrual phase.
When menstruation comes, the drop in estrogen and progesterone hormone levels causes the ducts to shrink. The stroma loses its water and swelling and goes back to normal.
If an abnormality develops during the shrinkage of the ducts or the regression of the stroma to its former state, a patient will end up with breast cysts, adenosis, mastitis, and even carcinoma.
WHAT TO DO
The breast self-examination is best performed one week after the menses. Any lump that may be detected is best brought to the attention of a gynecologist or a surgeon.
A woman must avoid restrictive clothing like tight brassieres, especially during the menstrual period, to allow the egress of water and facilitate the return of the duct to premenstrual size, thereby avoiding cysts and pain.
Research has also shown that patients who reduce their fat intake by 15 percent had significant relief from breast pain compared to a control group. The intake of hormone-riddled beef, chicken, and pork can also be reduced, as well as chemically processed meats and flavorings and bottled and canned food.
Herbal supplements that have had some success in alleviating breast pain are capsule extracts from the Vitex agnus castus, a plant that has some effect against prolactin, which influences the physiology of the breast tissue. Pain medications like paracetamol or mefenamic acid may be taken for relief.
Breast pain is usually hormone-related more than a cancer-related phenomenon. In fact, in the early stages, breast cancer is more usually associated with a breast lump and not breast pain. So a physician can ask her patient to relax, because the pain on her breast need not give her sleepless nights.
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