FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S PAINFUL BREAST PROBABLY FIBROCYSTIC DISEASE

Question: I'm 29 years old, and for the last six months I've had a painful spot in one of my breasts that doesn't change with my menstrual cycle. Neither my doctor or I can feel a lump in the area where it hurts. I've had an ultrasound that didn't show anything. What could be causing my pain?

Answer: Breast pain, a condition we doctors call mastodynia or mastalgia, can have many causes, including the one that strikes fear in everyone's mind cancer. And the first thing your physician did was to investigate if cancer was the cause of your pain. In making this determination, he or she started with what is probably the most important test to determine whether your lump is a cancer he or she took the history of your discomfort: when it started, where it hurts, how severely it hurts, what makes it better or worse, and whether it changes with your menstrual periods are all important questions. Next, your doctor probably asked about the history of breast cancer in your blood relatives. Together, all this information made it possible to categorize your risk of breast cancer as "high," "medium" or "low." This risk assessment helps determine what other steps will be necessary to diagnose and treat your condition.

Fortunately for you, breast cancer is predominately a condition afflicting women after menopause, so your age alone suggests a non-cancerous cause of the mastodynia. Another helpful sign is the absence of a definite lump, since cancer typically forms an irregularly shaped, fixed, firm lump instead of a soft, movable one.

The most common cause of mastodynia, particularly in women in their 30s and 40s, is fibrocystic breast disease. Typically this condition causes tenderness that varies with the menstrual cycle; the worst discomfort being prior to the onset of the period. For some women, however, the discomfort is present all the time. In this condition there is often a particularly tender, soft, rounded, movable lump or multiple lumps, but this isn't always so.

Infection in a breast gland or collecting duct can produce breast pain as can irritation of the nerve that provides sensation from the breast. Hormonal imbalance can also create mastodynia, but in this case, both breasts are typically involved. Complex, isn't it?

Your doctor ordered an ultrasound examination of the breast to try to clarify the cause of your discomfort. This test is particularly helpful in differentiating between solid tumor-like lumps and fluid-filled cysts. Mammography is also very helpful in identifying breast abnormalities, particularly cancer, but its effectiveness is reduced in young women, like yourself, who still have very glandular breasts. It is much more effective after menopause when the breast glands have shrunk.

Your history and physical examination and ultrasound failed to find a cancer. Hurrah! You probably are suffering from fibrocystic breast disease. There are several treatments for this condition, and you should talk with your gynecologist or family doctor about them. Many women with annoying rather than disabling symptoms choose to live with the problem. Talk with your physician and decide what is best for you.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.