Breast Pain
Breast pain is common, affecting up to 70% of women over their lifetime.
It is not usually serious, but you should see your doctor if the pain does not improve.
Breast pain on its own, without any lumps or other examination findings, is not associated with an increased risk of breast cancer.
In fact, studies have shown that the risk of breast cancer in a woman presenting with pain only and with normal examination findings is less than that of women without any symptoms attending for screening mammogram
Symptoms
Pain in one or both breasts, often described as dull, heavy or aching. The breast may feel tender in a localised area. Breast pain may be cyclical (linked to periods) or non-cyclical.
Cause
Breast pain linked to periods
Breast pain linked to periods usually:
- begins up to 2 weeks before a period, gets worse and then goes away when the period ends
- feels dull, heavy or aching
- affects both breasts and sometimes spreads to the armpit
Other causes of breast pain
Other causes of breast pain include:
- a poorly fitting bra, particularly underwired bras benign breast cysts
- injuries or sprains to the neck, shoulder or back – these can be felt as breast pain
- medicines like the contraceptive pill and some antidepressants
- conditions like mastitis or a breast abscess
- pregnancy
- hormone changes during the menopause
Diagnosis
Keeping a diary of your breast pain can be helpful to identify a link with your periods. This may also help to see if any activity is provoking the pain or if your symptoms coincide with a change in medication.
It is very helpful to know how to check your breasts and to be breast aware:
- How should I check my breasts? – NHS (www.nhs.uk)
- ‘Know your breasts: a guide to breast awareness and screening’ booklet (breastcancernow.org)
Selfcare and more information
To help ease breast pain:
- wear a properly fitted bra during the day and a soft bra to sleep in
- take simple painkillers like paracetamol or ibuprofen or you can try rubbing a painkilling gel like ibuprofen or diclofenac onto the painful area
There’s little evidence that vitamin E tablets or evening primrose oil help with breast pain
When to contact your GP
You should arrange to see you GP if:
- the pain is not improving, or painkillers are not helping
- there is a history of breast cancer in your family
You should seek an URGENT appointment if:
- you have breast pain and have a very high temperature or feel hot and shivery
- any part of your breast is red, hot, or swollen
- there is a hard lump in your breast that does not move around
- you get nipple discharge, which may be streaked with blood
- 1 or both breasts change shape
- the skin on your breast is dimpled (like orange peel)
- you have a rash on or around your nipple, or the nipple has sunk into your breast
These can be signs of something more serious
You can call 111 or get help from 111 online.
Assessment
Your GP’s main concern will be to rule out the possibility of cancer and you will need to have your breasts examined.
If your GP finds a lump or anything else concerning like nipple retraction or skin dimpling, you may be referred on the fast-track suspected cancer pathway to your local breast cancer specialist for further investigations.
However, cyclical breast pain with lumpy areas in both breasts in a younger woman (under age 30) is much more likely to be due to benign breast disease, and your GP may decide to keep you under observation. Most cases settle within 3-6 months.
A red, hot swollen area would suggest mastitis, and is more common when you are breast-feeding. This needs swift treatment, to prevent progression to a breast abscess.
Breast-feeding mothers can sometimes develop a deep-seated yeast infection (candidiasis) which causes deep breast pain.
Treatment
Clearly the treatment of breast pain depends on the likely cause.
Infections of the breast like mastitis or candidiasis respond to antibiotic or antifungal medications.
Breast abscesses need to be drained, so you would need to be admitted to hospital urgently.
Most other cases of breast pain can be managed with self-care alone (see above).
If the pain is thought to be muscular you may be advised to avoid a particular activity which could be aggravating the condition.
If the pain is due to a type of medication, you should discuss the options with your GP.
Referral
If your GP suspects breast cancer, or wishes to rule this out, you may be referred on the fast-track suspected cancer (or 2 week wait) pathway. You should be seen at your local breast clinic within a few weeks of referral.
Pain is only an indication for suspected cancer referral when found in combination with a lump in women over the age of 30.
Women with breast pain and a lump under the age of 30 may be referred on the routine pathway.
Possible further investigations include:
- An ultrasound scan is helpful to distinguish between cystic (fluid-filled) or solid lumps. It may be possible to aspirate (draw off the fluid within) a cyst at the same time as the scan.
- A mammogram is an X-ray of the breasts. It is less helpful in younger women as denser breast tissue makes interpretation more difficult. In the UK, women are offered 3 yearly mammograms between ages 50 and 70 as part of the NHS National Breast Screening Programme. It would be unusual to repeat a mammogram if this has been performed within the last 12-18 months.
- A breast biopsy may be performed if there is a solid lump or a suspicious area on imaging. This involves inserting a needle into the area and removing a small piece of tissue for examination under a microscope.
You can find more information on local breast clinics here:
- Royal Devon Exeter University Hospitals Trust (rdehospitals.nhs.uk) Eastern Site
- Royal Devon Exeter University Hospitals Trust (rdehospitals.nhs.uk) Northern Site
- Breast Care Unit clinics – Breast Care Unit (torbayandsouthdevon.nhs.uk)
Your GP may consider referring you to a Breast Pain clinic if this is available in your area.
Breast Pain Clinic – General Information (torbayandsouthdevon.nhs.uk)
In other areas, your GP may consider routine referral to the local breast clinic if your pain is persistent and not settling with treatment
Waiting for a specialist opinion
If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.
How long will I wait?
If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.