Common Benign Causes of Breast Pain

djmammo · August 2017

Articles dealing with breast pain in patients that have already had a complete workup and breast cancer has been definitively excluded as a cause of the breast pain.

1) A fairly complete non-medical article on the subject: 7 Annoying Causes of Breast Pain and Soreness

2) From ClinicalAdvisor.Com: Managing Breast Pain

Excerpts from this article:

a) "Breast pain is one of the most common problems for which women consult primary-care providers, gynecologists, and breast specialists. Women often think that breast pain indicates cancer, causing them significant anxiety. In reality, the prevalence of women presenting with mastalgia who actually have breast cancer is 1.2%-6.7%.1 In our breast-specialty practice, an estimated one third of the women referred have breast pain."

b) "Unfortunately, options for evidence-based practice for the management of breast pain is sparse in the literature. To better serve this patient population, we have created a comprehensive algorithm to guide clinicians in the management of breast pain (download Figure 1 PDF). This algorithm is based on research, personal practice, and anecdotal literature."

Diagnostic and Medical Treatment Algorithm for Benign Breast Pain: Download PDF

3) Referred pain to the Breast: Breast and Shoulder Pain

4) In my personal experience the leading cause of benign breast pain is related to underwire bras. The classic symptom is pain on the outside of both breasts but is not limited to that presentation. We routinely recommended the patient discontinue wearing an underwire type bra for 3 weeks and then give us a call. Many have found relief from this little trick. Its free and worth a try.

MTwoman · August 2017

thanks DJMammo! this will be a great reference for us to link women who have been through proper diagnostics but who are still worried due to pain issues.

djmammo · August 2017

Jkay775 · August 2017

Djmammo, would you say mammogram, ultrasound and breast MRI with and w/out contrast is enough evidence of no breast cancer if all were neg?

djmammo · August 2017

According to a 2014 study:

1) 3D mammography alone was shown to have a sensitivity of 90.7% for detection of malignant lesions.

2) 3D mammography plus ultrasound had a sensitivity of 97.7% for malignant lesions

3) MRI alone had a sensitivity of 98.8% for malignant lesions

Having all three combined is the best we can offer at this time for detecting breast cancer.

original article here

MTwoman · August 2017

Thanks DJMammo, those sensitivity numbers are really helpful. I'll read the article, but just fyi for those that don't what is the specificity of each?

djmammo · August 2017

In my experience, the problems with sensitivity and specificity in breast imaging is that on the spectrum from definitely benign to definitely malignant, there is a broad area of overlap of these findings in the center that could go either way. This is where the value of combining several imaging modalities becomes clear. Mammo + US roughly = MRI alone in detection of breast cancer.

In day to day practice I consider US to be more specific than mammography. When I see an indeterminate mass on mammo I go to ultrasound to tell me what it is, or at least whether it is cystic of solid.

MRI is very sensitive for enhancing masses but it will show many normal areas of enhancement in addition to the abnormal areas of enhancement. This is where experience in reading breast MRI comes in. If the findings are not large enough to be able to see and evaluate the margin of the mass, I would again rely on US to determine its internal structure.

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From the Susan G. Komen web site:

Sensitivity and Specificity of Mammo vs. MRI compared to Mammo + MRI results of several studies

Click here for article

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From International Journal of Contemporary Medical Research Jan 2017 Click here for article

Excerpt:

"The sensitivity, specificity, Positive predictive value (PPV) and Negative Predictive value (NPV) of mammography in detecting carcinoma breast were 77.8%, 97.7%, 87.5% and 95.6% respectively.

The sensitivity, specificity, PPV and NPV of USG in detecting carcinoma breast were 55.6%, 97.7%, 83.3% and 91.5% respectively.

In our study population 83.0% breast lesion were benign and out of them 77.27% were diagnosed by mammography alone and 72.7% were diagnosed by US alone.

When these modalities were combined, 97.7% of the lesions were diagnosed. The correlation coefficients of mammography alone (0.79), US alone (0.63) and mammography and USG combination (0.88) with FNAC are all positive, and P values are significant of all the modalities.

Conclusion: This study confirms that the mammography and ultrasonography when combined have significantly higher sensitivity and negative predictive value than observed for a single modality in detecting the palpable abnormalities of the breast. "

MTwoman · August 2017

That's great, thanks! 97.7% of lesions diagnosed with combined imaging is pretty impressive. I would imagine that the other 2.3% would be in the group that gets referred for mri? Really nice resources DJMammo.

Jeah · August 2017

Hi gud day

We dont have mammogram in our place but instead elastogram.. What is there difference?

djmammo · August 2017

Jeah

Answered on the "how to read a mammogram" thread

Jeah · August 2017

is elastogram same as 3d mammo?

djmammo · August 2017

Elastography is a part of an ultrasound exam. Very different from a mammogram.

Jeah · August 2017

Hi djmammo, i cant message you cause i have limited msg per day..

my gp told me that the swelling in my arm is not a lymph node, but a nerve that swell.. Does it cause pain even in my breast? I just thought that maybe bcoz of my daily routine here that cause the swell nerve.. But i dont know the connection between the nerve and pain and sensitivity of my breast.. I am already stress of thinking about ibc..

What is much better in my situation, elastogram or mri

djmammo · August 2017

MRI is the most sensitive exam for breast cancer. You need to follow up on your physical symptoms with your doctors as they may not be associated with your breast.

Traveltext · August 2017

DJM. Given the amount of breast tissue in males, would you say an US is as good as a mammogram? I was diagnosed with an US and have them for annual checkups, so I'm assuming this is the case.

djmammo · August 2017

I personally prefer a mammogram for initial diagnosis in males but as long as there are priors for comparison US should be a good follow up for new masses. It won’t however show early calcifications.

Traveltext · August 2017

Thanks, I might look into getting a manogram on my remaining breast next time for comparison purposes.

Obviously, the unreconstructed and concave other side can't be scanned that way, so an US is best for it.

txbluebonnet · August 2017

Thanks djmammo, better to read information here than go crazy googling symptoms like I used to do.

Tawney_girl · October 2017

Hi Guys!

I'm a 28yr old female with 2 boys ages 13 & 4. I've never really had any breast issues except the usual soreness before my cycles and fullness that it would bring. I've always had lumpy breast and was told numerous times they were fibrocystic. No family hx of breast cancer.

1 week ago yesterday I had a sudden pain in my right breast upper outter quadrant. This is a focal area of pain, very specific and not the usual soreness. I also feel like I have pains throughout my breast some days but again hard to tell if it's just from the focal pain that's now spreading? It's constantly there! If I mess with it to much (I need to stop) it gets worse. I went to my pcp who did a self breast exam and found no lumps but fibrocystic breast again & sent me for an ultrasound at a breast care center by me. I had my apt Tuesday and while they didn't find anything I'm baffled by the pain. The tech scanned me & than they go get the actual breast radiologist who comes in and re scans you. She spent 20 minutes on the affected area of concern & nothing! She went down towards my nipple & found a lipoma. But other than that nothing as to why I'm havingthis pain! It's tender to touch & almost feels like that pinched nerve feeling. Not hot, itchy, burning, sharp pains etc, just constant steady pain. She checked my arm & lymph nodes as well and all is well. Any ideas? I have todo a 6mos follow up for the lipoma but other than that I still don't have any answer for this pain. If you close your arm and you have that crease at the top in between your armpit & breast? Well go down about an inch & it's that whole general area. Help!

B-A-P · December 2017

I've had breast pain and tenderness for a year. Inner side of breast and lower quadrant , non cyclical. Area is thickened and lumpy. u/S showed lumpy tissue and my previously dxd fibroadenoma.

Specialist told me to live with the pain

Nipple starting to have yellow discharge when deliberately expressed.

Would fibrosis in the breast cause persistent tenderness to touch?? .right breast has literally no lumpiness or pain like the other one.

The discharge is alarming too but no one will help me figure it out. Dr won't order an mri

djmammo · December 2017

B-A-P

Are there cysts in the area of your pain on ultrasound? They can cause pain. In my experience, in a very large percentage of patients we never found a cause for diffuse pain, especially if its bilateral.

Click here for Nipple Discharge information

BigBitties · April 2018

Hi all! I found a lump on my breast about 3 years ago.. had a mamm.. came back negative.. brushed it off.. searing pain in left breast now, and the lump went from pea sized to almond sized. just had a 3D mamm, and ultrasound both came back Negative.. do you think I should push for a MRI. They said my breasts were dense.. but I haven't gotten a clear answer on the density of them. any help would be appreciated!

Bb4th · May 2018

I developed pain in the past several months in my left breast along with an itchy nipple. This nipple is also warmer than the right. This started about a month after my annual mammo and finally I had an ultrasound and then an MRI and all is negative. I did recently have a blood test w high uric acid but the symptoms are just in the left breast. I feel a lot better having the tests but still wonder about the ongoing syptoms. Any idea what could be causing it?

jaynastick · May 2018

Hi all i recently stopped nursing my 2yr old which I need to mention because she never nursed on my left breast was more comfortable on my right so I would pump the left but I stopped pumping that breast like a yr ago within the past week have been having breast pain in my Left Breast and I noticed some inflammation - went DR no lumps or abnormal color shape nipple etc except left breast seems fuller had 3D diagnostic mammogram and ultra sound done results I was told “Debri in my ducts “ and “area” upper right of left breast (dt normal) told thought it was s possibly a clogged milk duct how canthat be havent nursed on that’s side in over a yr

WOuld like me to follow up with gynecologist and come back for a ultrasound (no need for mammogram) in a month if not cleared them biopsy

I guess my concern is what do they mean by area no one gave me an answer they didn’t say mass or cyst or anytimb

LynzD · June 2018

Hi Jaynastick,

I am in a very similar situation and was curious about your outcome?

Still nurse my 2 year old, right breast only. She never liked nursing on the left side. I do express it (the left side) a tiny bit once daily just so it doesn't dry up, but we're talking drops.

Two weeks ago, my left breast started hurting, excruciating to the touch, in the inner lower area only. Hurts nonstop, no burning or itching. Just a constant sharp pain. No lumps felt, everything looks the same.

I called the gyno first and have an appt next week. Just wondering what yours turned out to be and if it resolved?

Lmjohn · December 2018

did you ever figure anything out. I have very similar symptoms. Very stressed

Common Benign Causes of Breast Pain

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