Most women seen in a breast clinic will not have breast cancer. Many will not have a definite lump and most lumps are not cancer but are due to other benign conditions such as breast cysts or fibroadenomas. Many women present with areas of nodularity in the breast that may also be painful or tender and these areas are often referred to as benign breast change.
To explain this it is helpful to understand the make up of the breast and how it changes under the influence of hormones and with age.
The breast can be thought of to consist of gland tissue and fat. There is also some elastic tissue which gives the breast its shape. Normal gland tissue feels quite nodular; a good way to picture it is as a scaled down packet of frozen peas. Now, imagine the breast as a clock face, divided into 4 quadrants. On the right side 3 ‘o’clock is in the middle with 9 ‘o’ clock towards the armpit. The reverse is the case on the left. The bottom half of the breast is mostly fatty tissue and so is softer when compared with the upper half. The quadrant towards the armpit (between 9 and 12 ‘o’ clock on the right and 12 and 3 ‘o’ clock on the left) contains most of the gland tissue and this is the quadrant that feels the most “lumpy”. In fact, lumpy is a bad term as there are not usually any lumps, it is just nodular. The nodularity of the gland tissue can be assessed on the “Marsh Packet of Frozen Peas Scale”! This gland tissue responds to changes in the hormone levels and so, not unexpectedly, is more pronounced just before a period and in pregnant and breast feeding ladies. The best time to check the breast is about a week after a period has finished as it tends to be less nodular. Also, most commonly in the late thirties or early forties, the gland tissue seems to become more sensitive to the hormone levels and many women develop breast pain. This is, not surprisingly, mostly in the area of the breast that has most of the gland tissue but can also affect the upper arm ad the side. Painful or nodular breasts occur as a result of fluctuations in hormone levels and to changes in the sensitivity of the breast tissue at different times in the menstrual cycle and at different times in life. The term “benign breast change” refers to these normal changes in the breast and does not signify that the breast tissue is changing into anything abnormal.
Benign breast change has been given a wide variety of names, such as benign mammary dysplasia, cystic mastitis, fibroadenosis and fibrocystic change. All these should really be discarded as they simply refer to normal breasts. There is no such thing as “benign breast disease” and the term “benign breast conditions” is much better.
TREATMENT OF BENIGN BREAST CHANGE AND BREAST PAIN (MASTALGIA)
There are some treatments which may reduce pain and, possibly, swelling in the breasts. The treatment may also alleviate some of the symptoms of pre-menstrual syndrome (PMS or PMT). Unfortunately there is no one treatment that works for everyone and different ladies may get relief from different remedies. Many will find nothing works. Although these treatments may help with the discomfort, they do not tend to decrease the nodularity.
Things that have been suggested include:
Evening primrose oil. This contains gamalenic acid which seems to make the breast cells “calmer”. It only works in about 60% of women and it can take 4-6 months for it to have an effect. It cannot be used if you suffer from epilepsy.
Reducing caffeine (in tea, coffee, chocolate and coal drinks) intake and stopping smoking may help some ladies.
Stress can undoubtedly affect the body’s hormones, increasing breast pain, and cutting down stress (often easier sad than done) can be beneficial.
Many women, unknowingly, wear badly fitting bras and being properly measured can be a big help in reducing discomfort.
Simple analgesics such as ibuprofen or even paracetamol can help. Ibuprofen seems to be a bit better, suggesting that the fundamental cause of breast pain may be a sort of inflammation in the cells of the gland tissue.
Keeping generally fit also seems to help, although some women will get an increase in their breast pain when they first start a fitness programme. Because breast pains are related to the hormone oestrogen, which is stored in fatty tissue, not being overweight may be helpful.
Other women find that complimentary or alternative medicines are helpful including acupuncture, reflexology and homeopathy.
Remember, benign breast change is normal. Whilst it can undoubtedly be a nuisance it is not a risk factor for breast cancer and the symptoms tend to subside after the menopause.