Breast pain is very common. A survey of women found that almost half had mild breast pain, and about 1 in 5 had severe breast pain, although most had not reported these symptoms to their doctor. Breast pain is the most common breast-related symptom for which patients seek medical treatment, and accounts for about half of breast-related office visits. Fortunately, breast pain is rarely due to cancer.
Most commonly, breast pain is cyclical, meaning that it is related to the normal hormonal fluctuations of the menstrual cycle. Usually it is felt the week before the start of menses, and resolves after the end of menses. Hormonal breast pain tends to be in both breasts, and most severe in the upper and outer aspects of the breast. Minor cyclical breast discomfort is very normal. However, in a small number of women, this cyclical pain can be moderate to severe, affecting day-to-day activities.
Noncyclical breast pain does not follow the usual menstrual pattern. It tends to be on one side and in different locations of the breast. There are many causes of noncyclical/non-hormonal breast pain:
- Large breasts: Large breasts tend to pull on the ligaments of the breast, and discomfort may involve the neck and shoulder as well.
- Diet: Many patients report that cutting back on caffeine has greatly improved their breast pain. Also, a low-fat, high complex carbohydrate diet has been shown to be helpful in some small studies.
- Smoking: Smoking might increase breast pain by increasing epinephrine levels in the breast. Epinephrine is involved in the perception of pain.
- Medication: Up to one third of women taking postmenopausal hormone therapy may experience some degree of noncyclical breast pain. Luckily, this tends to resolve over time. Other medications can also contribute to pain, including some antidepressants, cardiovascular agents, and antibiotics.
- Chest wall pain: This is most commonly from irritation of the pectoralis major muscle. Examples of activities that can cause this muscle pain include waterskiing, raking, rowing, and shoveling.
- Pregnancy: It is important to consider pregnancy as a common cause of breast pain. Half of pregnancies are accidental or unintended.