What's causing your breast pain?

Breast pain can vary in intensity and is typically felt as tenderness, burning, a sharp stabbing pain, or as an aching heaviness. It may occur in both breasts, one breast, or in the underarm area. Up to 70% of women will have breast pain (mastalgia) at some point in their lives, although only around 15% will require medical treatment.

Breast pain and cancer

Mastalgia is not usually an early sign of cancro al seno. However, it's still important to see your doctor if you're concerned about breast pain.

There are three main categories of mastalgia.

Clinical nurse specialist Carolyn Rogers explains that cyclical breast pain is particularly common.

"Most women are able to live with the discomfort as a regular part of their menstrual cycle," she says. "But for some it does present as severe pain every month that may interfere with sexual, social and physical activities."

Cyclical breast pain

Cyclical breast pain is due to a fluctuation in hormones during your menstrual cycle which makes your breast tissue more sensitive, although the exact cause is unknown. This discomfort tends to affect both breasts (bilateral) and usually occurs during the week or so before your period. Often the pain is accompanied by changes.

Non-cyclical breast pain

Non-cyclical breast pain can affect women at any point in their lives and the pain can be continuous or intermittent. Discomfort may be felt in one or both breasts and can be generalised or specific to one area.

"Cysts are small, fluid-filled sacs that are completely benign and many women get them," says Rogers. "Most don't discover they have breast cysts until they have an investigation such as an ultrasound. Some cysts are larger - rather like a balloon filled with water - and can cause a lump which you can feel. When women go to the doctor with a breast lump and discomfort, this is often the reason."

It is common for fibrocystic breasts to become lumpy and painful before a period as a result of hormonal fluctuations. At menopause, women taking HRT may also be more susceptible to breast cysts.

Rogers reassures that these cysts do not increase your chance of developing breast cancer - just as breast pain is not a common symptom of cancer.

At puberty, girls develop breast buds which may feel sore - some discomfort is normal and should pass in time. Enlargement of male breast tissue (gynaecomastia) can also cause pain during puberty, but also in older men.

Chest wall pain

Also known as extra-mammary pain, this is often triggered by respiratory infection or trauma elsewhere that can cause referred pain to the breast, or pain on the chest wall. Inflammation of the cartilage of the ribs and breastbone (sternum) can also give rise to referred breast pain, particularly conditions such as chondritis and Tietze's syndrome.

Evening primrose oil and vitamin E supplements used to be recommended as self-help measures for cyclical breast pain.

However Rogers says there is no definitive research to prove that this is helpful, as the evidence is inconsistent.

"There are a couple of medicines that can be prescribed for breast pain," she adds. "But they have quite significant side effects which is why clinicians are reluctant to prescribe them."

These would usually be anti-hormone medicines and only prescribed by a specialist.

Non-cyclical breast pain responds less well to treatment, unless a specific trigger is identified that can be addressed. Stress and anxiety have been linked to non-cyclical breast pain, so finding ways to counter stress levels, such as mindfulness practice, yoga and exercise, may be helpful. NSAIDs - such as topical ibuprofen - may also offer some relief.

Rogers explains: "It can often be difficult to determine the cause of non-cyclical breast pain. However, in about 50% of women it will settle down by itself."

Treatment for chest wall pain will depend on what is causing it. A pulled a muscle in your chest is likely to improve over time and can be treated with over-the-counter pain relief. More serious conditions will require medical advice.

It is important to check your breasts regularly and develop an awareness of what they look and feel like, so you are more able to detect any changes should they arise.

"Anything new for you is a concern," says Rogers. "If you have a pain in one breast only, that is much more localised and persistent, then get that checked out. The same goes for nipple discharge and skin changes."

These types of changes would mean your doctor will want to check there are no cancerous changes.

She also suggests keeping a diary of the severity and timing of breast pain symptoms, as this will give your doctor an indication of whether the issue is likely to be cyclical or not.