By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

FIBROCYSTIC DISEASE LIKELY CAUSE OF READER'S BREAST PAIN

Question: I’m 30-year-old freshman medical student, and for the last several months I’ve had a painful spot in one of my breasts. I went to the student health center and the doctor asked me to observe if the pain changed with my menstrual cycle. A few months later I went back and reported that the pain didn’t change with my cycle. My doctor then had an ultrasound test done. It was negative. He also wasn’t able to find a lump where it hurts. What could be causing my pain?

Answer: Breast pain, a condition called mastodynia or mastalgia, can have many causes. As you will discover in your medical studies, the first thing a physician does is to determine if the most dangerous possibility -- in this case breast cancer -- is the cause of the patient’s symptoms. Your doctor, in making this assessment, probably started with what is often the most important test in arriving at a diagnosis. He took the history of your discomfort by asking you a number of important questions: When did it start? Where does it hurts? How severely does it hurt? What makes it better or worse? Does it change with your menstrual periods? Next, he 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 more common in 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, as well as the ultrasound, failed to find cancer. That’s good news! 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 Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.