back again! still worried :-(

adviceplease

Hello.. I have posted a couple of times already but i am seeing breast doc again next week so just want advice again please!

Basically constant pain and burning in left breast for Five months now. not related to cycle. Burning also radiates to armpit. Not tender to touch, no rash, discharge etc. No clinical presentation.

I have had mammo, ultrasound, and mri.. all showed nothing. Both breasts are dense due to age. Spoke to numerous docs, even went to ER one night. No one is at all worried just say its mastalgia.

I know biopsy is the only real test. I also know they will say i dont need one and they have no suspicious area to aim for even if they did one.

I just dont know how far to push this. From outside perspective there is nothing wrong, its all just based on what i am feeling inside my breast. I know a biopsy can be negative anywway if it doesnt hit the right area so i guess i cant just demand they keep punching holes all over till they find something!!

Anyway any thoughts would be much appreciated xx

MelissaDallas

Here is some info:

Breast Pain

Breast pain is the most common breast symptom causing women to consult primary care physicians and surgeons.1,2 The high level of public awareness about breast cancer and the concern that mastalgia may indicate disease contribute to this trend.

Mastalgia is more common in pre-menopausal women than in postmenopausal women, and it is rarely a presenting symptom of breast cancer. Although one study found that 36 (15 percent) of 240 women with operable breast cancer reported having breast pain, only 16 (7 percent) presented with mastalgia alone.2 Even in these women, it was not clear whether the cancer caused the breast pain or the symptom of pain resulted in a breast evaluation that identified an asymptomatic cancer.

The etiology of breast pain is unknown. Its relationship to the menstrual cycle and its more frequent occurrence in pre-menopausal women suggest a hormonal etiology, but no reproducible alterations in estrogen, progesterone or prolactin levels have been identified in women with mastalgia. Premenstrual water retention in the breasts has also been proposed as a cause of mastalgia and is the rationale for the use of diuretics in the treatment of this condition. However, one study found no correlation between total body water and breast pain in 39 women with breast pain and 17 control subjects.3

No histologic findings correlate with breast pain. Although “fibrocystic disease” is often present in the biopsy specimens of women with breast pain, studies have shown that fibrocystic changes are also present in the breasts of 50 to 90 percent of asymptomatic women. Hence, the presence of these changes is not proof of a causal relationship.

The evaluation of breast pain begins with a thorough history and a careful physical examination. Special attention should be given to the type of pain, its location and its relationship to the menstrual cycle. Most commonly, breast pain is associated with the menstrual cycle (cyclic mastalgia) and is most severe before the menses. However, breast pain can also be unrelated to the menstrual cycle or can occur post-menopausally (noncyclic mastalgia).

Cyclic pain is usually bilateral and poorly localized. It is generally described as a heaviness or soreness that often radiates to the axilla and arm. The pain has a variable duration and is often relieved after the menses. Compared with noncyclic mastalgia, cyclic breast pain occurs more often in younger women. Most cyclic pain resolves spontaneously.

Noncyclic mastalgia is most common in women 40 to 50 years of age. It is often unilateral and is described as a sharp, burning pain that appears to be localized in the breast. Noncyclic mastalgia is occasionally secondary to the presence of a fibroadenoma or cyst, and the pain may be relieved by treatment of the underlying breast lesion.

Menstrual irregularity, emotional stress and medication changes have been shown to exacerbate mastalgia. In obtaining the history, questions should be directed at identifying problems in these areas.

A thorough breast examination should be performed to exclude the presence of a breast mass. In the absence of a mass, women 35 years of age and older should undergo mammography unless a mammogram was obtained in the past 10 to 12 months. The purpose of the study is to look for concurrent breast pathology in women whose age places them at risk for breast cancer. When the physical examination is normal, imaging studies are not indicated in women younger than 35 years of age.

In the vast majority of women with breast pain, the physical examination and mammography reveal no evidence of breast pathology. In these situations, it is usually sufficient to reassure patients that their breast pain is not caused by malignancy and to discuss the normal physiology of the breast. Patients can also be reassured that breast pain has a high spontaneous remission rate (60 to 80 percent).1

Breast pain should be treated when it is severe enough to interfere with a woman's lifestyle and occurs for more than a few days each month. Before beginning any therapy for breast pain, patients should be asked to document the frequency and severity of their pain on a daily basis for one menstrual cycle using a visual analog scale. The pain scale is also helpful in assessing treatment response in mastalgia, which is characterized by the waxing and waning of symptoms and a high spontaneous remission rate.

Because of the extreme variability in breast pain, only treatments that have been tested in randomized, controlled trials can confidently be considered beneficial. Danazol (Danocrine), an antigonadotropin, is the only drug labeled by the U.S. Food and Drug Administration for the treatment of breast pain. Randomized, controlled trials have demonstrated a response rate of 50 to 75 percent in women with cyclic pain who received danazol in a dosage of 100 to 400 mg per day. About 75 percent of women with noncyclic pain responded to the drug. Because of its significant side effects, danazol therapy is recommended only for patients with the most severe, activity-limiting pain. Side effects of this drug, including menstrual irregularity, acne, weight gain and hirsutism, occur in approximately 20 percent of recipients.1,4

Caffeine avoidance has been a popular treatment measure in women with breast pain. Unfortunately, two randomized clinical trials5,6 and one case-control study7 failed to demonstrate a therapeutic benefit for caffeine restriction.

Vitamin E supplementation has also been advocated as a treatment for breast pain. However, two double-blind, placebo-controlled, randomized trials demonstrated no benefit for this approach.8,9

In randomized trials conducted in Great Britain,4 58 percent of women with cyclic mastalgia and 38 percent of those with noncyclic mastalgia responded to treatment with evening primrose oil (γ-linolenic acid). Side effects occurred in fewer than 2 percent of recipients. This over-the-counter preparation may be an attractive approach for the treatment of severe breast pain.

Surgery has no role in the management of breast pain in the absence of a dominant mass. Even when pain appears to be localized, excision is almost never therapeutic. The approach to the patient with breast pain is summarized in Figure 1.

Evaluation and Management of Breast Pain

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FIGURE 1.

Algorithm for the evaluation and management of breast pain. Only a minority of women require more than reassurance that their pain is not a sign of breast cancer.

Eliza22

That post was extremely helpful to me, and will ask my BS some questions today based on the information presented. I've charted my pain and occurs on average, 20 days out of the month for the last three months.



Thank you so much!



Adviceplease, I really hope your pain is just mastalgia and I'm glad to hear your scans were clear. I wish I could offer more help to you, but I'm in a similar boat. Have my appt with breast surgeon today. Best of luck to you in minimizing pain and figuring out the cause.

adviceplease

Thanks for that MelissaDallas. I have researched mastalgia a lot myself, and truly want to believe that that is all I have wrong with me, and nothing worse. What keeps niggling me though is that although mastalgia is common and IBC is rare, any list of symptoms I have read for IBC lists pain and burning. I feel like if they are symptoms and I have them, how can docs be so sure its just mastalgia? Just too much googling I guess lol!

Eliza22 lt us know how you go with you appt. Hopefully we are both worrying about nothing! xx

Eliza22

I was told I have Fatty Necrosis, but there is no proof to back this up. I did have a breast reduction 11 years ago, so it's plausible. However, I still have other symptoms. Would feel more confident if the necrosis showed on my ultrasound. Ah well- been trying evening primrose oil for two weeks- and posted on a different forum about the length of time one Must take to determine it's effectiveness.



How are you????

Cheer2

Eliza i have a question?? So you dont have any other symptom but the breast pain??and burning by any chance do you ever get upper back pain or sholder pain??and where exactly is ur breast pain

Eliza22

Hi, no I do have other symptoms. They are, nipple discoloration, shape change, change in supraclavical lymph nodes, onset of severe fatigue, and redness near the painful area.



However, along with primrose oil I am going to try a regime of stretches because I DO get back pain, shoulder spasms, and cranial neuralgia like headaches. Often it feels like a pinched disk in my t region- I have pain in the entire breast focused in the nipple and outer left.



I have a lot of musculo skeletal pain due to a birth deformity, and a lower spinal condition. I often use a wheelchair to get around and am no stranger to pain. Haha



What were you thinking cheer2?



(I should be having major spinal surgery this summer so was going to have them MRI my T spine as well as my L/S spine just to be sure).

Cheer2

sorry/my/spacebutton/just/broke/jaj/neways/why/dont/you/ask/for/a/biopsy???since/you/have/redness...from/my..understanding...they..can..only.do.a.biopsy.if.you.have.skin.changes.right???

Cheer2

what.do.you.mean.by.supraclavical.lymphnode.changes..any.by.the.way.how.old.are.you

Eliza22

Hi,



The lymph node above my left collarbone (my left breast is affected) is swollen.



I had a "blind" biopsy- by blind I mean the surgeon did the biopsy based on her physically feeling a mass that she had not imaged at all. The area she performed the biopsy on turned out to be muscle

tissue. If anyone else is reading this, I apologize for redundancy. I have posted on a couple forums.



I'm 28, and waiting two menstrual cycles before going in for a second opinion. The surgeon I saw was wonderful at my original appt, but at my follow up I felt as though she had already determined my diagnosis and had an "agenda."



That's why I'm getting a second opinion, but am waiting to make sure that symptoms persist before I keep "chasing" after something that doesn't exist.



If that makes sense? Haha I'm running on only a little sleep- so I apologize if my post is a bit disjointed.

Cheer2

Adviceplease do you have any other symptoms?? Do you have upper back pain like stabbing pain..I've also have been having pain for a couple months and I'm wondering can they biopsy if there is no skin changes