It’s Breast Cancer Awareness Month, which gives the disease its much-deserved attention. The flip side of all the exposure, however, is that it can trigger unnecessary sleepless nights -- worry that every odd sensation or tender spot is a sign of serious illness. Of course, pains, lumps, and other beneath-the-bra developments should never be ignored -- but it’s important to realize that not every unusual thing going on in our breasts means cancer. Indeed, breasts are incredibly intricate: They consist primarily of fat and connective tissue but also contain lobes, lobules, blood vessels, ducts, nerves, and lymph nodes. Breasts are also highly responsive to hormones, which can cause sensitivity and swelling. Given all these factors, it’s natural that you might be confused.
Pain and Sensitivity
During puberty, budding breasts are extremely sensitive -- as anyone who remembers being hit in the chest during dodgeball knows. And for many women, a similar sensitivity flares up the week before their period. This cyclical pain is so excruciating for some women that they’re convinced something is very, very wrong. The good news is that “cyclical pain is generally not worrisome,” says Amy Kusske, codirector of the UCLA Breast Center at Santa Monica. “Breast cancer does not usually cause pain.”
Which is not to say that doctors want their patients to suffer in silence. “See a physician if your pain is new, if it’s only on one side, or if it persists for more than a couple of weeks,” says JoAnn V. Pinkerton, director of midlife health at the University of Virginia Health Center in Charlottesville.
Typically, cyclical breast pain -- heaviness and soreness, sometimes radiating out from the armpit -- is common in women under the age of 50 and lessens once the period ends. Limiting caffeine is one of the first lines of defense. “Caffeine will often make breasts feel more tender,” says Pinkerton. Even cutting out coffee, tea, and soda just for the week leading up to your period can make a dramatic difference. Reducing body fat is even more effective (though admittedly not quite as easy). “Estrogen production is directly related to body fat,” says Pinkerton. “If you can reduce your dietary fat to 15 percent or less of your caloric intake, it should reduce breast pain overall.” (And no, in this case, switching to a low-fat diet for the week before your period won’t work: This needs to be a significant lifestyle change.) Supplements, too, can relieve breast pain -- specifically vitamin A, vitamin E, selenium, and evening primrose oil. Beth DuPree, medical director of the breast health program at Holy Redeemer Health System, in Philadelphia, regularly advises her patients to take a supplement called diindolylmethane, or DIM, which is found in the cell walls of cruciferous vegetables. “It decreases the levels of two hormones, estrone and estradiol,” she says. “In my patients, I would say it reduces breast pain 85 percent of the time.”
Breast pain that is not cyclical may be the result of trauma -- such as a blow to your chest area -- shingles, or infection. The most common type of infection is lactational mastitis, caused by a clogged milk duct. Breast-feeding mothers know (and fear) this condition, but even women who aren’t nursing get it: The breast reddens and becomes hot and painful. “You can get it through a crack in the skin, and it can be caused by anything from sexual activity to sports,” says Pinkerton. If you have this condition, check with a doctor to see if you need antibiotics.
The condition called costochondritis, meanwhile, is more common in older women. It isn’t even technically breast pain but feels like it -- “It can feel like an elephant sitting on your chest,” says Pinkerton. The source is actually inflammation along the cartilage in the ribs. “You can tell it’s costochondritis if it hurts when you push down on the ribs,” she says. Anti-inflammatories, heat or cold treatments, and steroids should help relieve the pain.
Your bra can hurt your breasts, too. Whether too tight or too saggy, “an improperly fitting bra can cause pain,” Pinkerton says. Have a professional bra fitter measure you -- and don’t be surprised if the most comfortable bra is one made for exercising: “Running shops are often good sources for finding bras with good support.”
Lumps and Lumpiness
“Every new lump or bump requires evaluation,” DuPree says. But remember: Not every lump is a malignant tumor. Cysts and fibroadenomas are both very common benign lumps that can form during a woman’s menstruating years.
Most often found in women between the ages of 35 and 50, cysts are fluid-filled sacs that grow in the breast tissue. When a cyst is close to the surface, it feels squishy; more embedded ones tend to feel harder and more solid. Although cysts are essentially harmless and can disappear on their own, they can hurt. If a cyst is painful, a doctor can aspirate (drain) it with a needle.
While many women get only one or two cysts in their life, others have recurring multiple cysts. “Fibrocystic breasts” tend to have a pronounced lumpiness and are especially sensitive to menstrual changes. The only real risk is that fibrocystic breasts “can mimic or mask breast cancer,” says Pinkerton, who recommends that her fibrocystic patients give themselves breast exams monthly (and consider ultrasound imaging too).
Fibroadenomas are smooth, spherical growths that are usually found in women younger than 30; they rarely cause pain. “Once we evaluate the lump and determine it’s a fibroadenoma, we usually don’t remove it unless the patient is bothered by it or it’s rapidly growing,” says Kusske. As women approach menopause, these lumps sometimes shrink on their own.
If you squeeze your breast and some fluid comes out of your nipple, there’s no need to panic. The ducts of the nipple are pipelines intended to carry milk, so a little discharge is perfectly normal, even if you’ve never breast-fed. “If the discharge is spontaneous or bloody, however, speak with your doctor,” says Kusske. Most bloody nipple discharge is the result of a tumor in a milk duct, known as an intraductal papilloma. “It’s benign, but we will usually want to biopsy it to be sure,” she says.
Less alarming, but plenty irritating, are itchy nipples. Yes, there is an extremely rare form of cancer, called Paget’s disease, that usually presents as one itchy nipple or aureola, but most often itchiness is due to dry skin, an allergy, or chafing. Your best bet is to try lotion, hydrocortisone cream (if you’re not nursing), or a different bra or detergent. If the itch doesn’t subside after a couple of weeks, talk to your doctor.