Pam Harrison

December 18, 2017

SAN ANTONIO — Breast pain is not a common symptom of breast cancer, and patients who present with breast pain should be reassured that whatever is causing their symptoms is unlikely to be an underlying malignancy, a retrospective review shows.

"Patients complain about all kinds of pain — burning, stabbing, they complain of pain radiating to the nipple or starting at the nipple — I tell my patients that probably all women experience some sort of breast pain, it's a very common complaint," lead author, Ian Komenaka, MD, a surgeon at the Maricopa Medical Center, Phoenix, Arizona, told Medscape Medical News.

"And we found that out of all of the women who presented with breast pain to our safety net institution, we identified only one patient whose breast pain was possibly in the area of interest," Dr Komenaka added.

In the new study, 15 breast cancer diagnoses were made among 1719 patients who were seen for breast pain over a 9-year period at the Phoenix facility.

"The biggest thing is reassurance — [many] women think breast pain is a sign of cancer — and we need to work on education or at least the way we educate patients and reassurance is key," he stressed.

The study was reported here at the San Antonio Breast Cancer Symposium (SABCS) 2017

At the Arizona clinic, 7202 patients were seen by physicians at least once between June 2006 and February 2017. Of that group, 1017 (15%) presented with breast pain.

Another 702 patients presented with a breast "mass," which was later ruled out after a thorough history and physical examination.

Thus, as noted above, 1719 patients were categorized as having mastalgia or breast pain and included in the analysis. More than one quarter had initially sought care at the emergency department.

Stratified by Age

Researchers stratified patients by age and looked to see whether any patient who presented with breast pain or mass was found to have breast cancer on subsequent imaging.

Of 880 patients younger than age 40 years, only one patient had breast cancer — a 37-year-old woman who came in reporting bilateral breast pain.

Importantly from a cost perspective, 85% of women younger than age 40 who reported breast pain underwent some form of imaging, including mammography, ultrasonography, MRI, or computed tomography.

More than two thirds also underwent some form of laboratory testing, as researchers noted.  

Another 524 patients included in the analysis were 40 to 49 years of age.

None of these patients were undergoing screening mammography at presentation, as Dr Komenaka observed. Screening mammography is actually recommended for this age group in the United States, although not in all countries, including Canada.

"We did screen these patients and we found a few cancers," Dr Komenaka said, "but even in this age group, we found only 8 breast cancers out of 524 patients and 4 out of 8 of them had palpable masses," he added.

Another 315 patients were older than age 50 years, most of whom were also not undergoing screening mammography at presentation.

Here again, subsequent mammography detected only 6 cancers in this older age group, none of which was palpable.

Among these 15 patients diagnosed with breast cancer (all age groups), 7 reported bilateral breast pain; 4 patients had pain but in the breast opposite that in which the cancer was detected; pain resolved in 2 others, and in the remaining 2 patients, the pain was on the same side as the diagnosed cancer. In only 1 patient was the pain located in the area of interest. 

"I always ask the medical students I lecture if breast pain is a problem or not and they all say it's not a problem and yet everyone gets worried about it," Dr Komenaka observed.

"So what we are recommending is women under the age of 40 not get any imaging at all, unless you find a lump, which changes the picture. That woman needs to be worked up, which is why a physical exam is important for all women," he said.

"I also tell patients to stop smoking if they smoke, and we suggest they take nonsteroidal antiinflammatory drugs or some herbals, like evening primrose oil, to help with the breast pain," Dr Komenaka concluded.

Other Data Indicate 15% Rate

Asked by Medscape Medical News to comment on the findings, Julie Nangia, MD, associate professor of medicine, Baylor College of Medicine, Houston, Texas, said she similarly encounters patients "all the time" who believe that breast pain is a symptom of breast cancer.

In point of fact, only about 15% of breast cancer is associated with breast pain at presentation — and most of these cancers are large masses that are causing the pain, not some small occult tumor, she pointed out.

"I think one of the biggest problems is that people don't talk about breast pain but the reality is that breast pain is as common as back pain," Dr Nangia said.

Breast pain is as common as back pain. Dr Julie Nangia

 

Among the most common causes of breast pain is not wearing the right bra size and not buying a new bra every 2 to 3 years as women should because the support and the elasticity of a bra wear out.

Women, especially heavier-breasted women, might also search for a good sports bra, which almost always offers superior support to standard lingerie.

"For every 10-pound change in weight, you change your cup size as well, so that's a very common reason for breast pain, too," Dr Nangia added.

Other reasons for breast pain are usually related to hormonal production, which tends to produce cyclic breast pain.

"A lot of women will have breast pain when they ovulate or during their menses," Dr Nangia elaborated.

"So when women ask you about breast pain, getting a good history is key and if the pain is related to either the bra size or hormones, these are easy to figure out and tell you how you should treat these women," she said.

Dr Komenaka and Dr Nangia have disclosed no relevant financial relationships.

San Antonio Breast Cancer Symposium (SABCS) 2017. Poster 4-12-12. Presented December 8, 2017.

For more from Medscape Oncology, follow us on Twitter:  @MedscapeOnc

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