Breast pain, also called mastalgia, is very common. It may feel like heaviness, tenderness, burning, stabbing or an ache, and it can affect one breast or both. Pain alone is rarely the presenting symptom of breast cancer, but persistent or focal pain and pain with another breast change should be assessed.
Cyclical hormonal breast pain
Cyclical pain follows the menstrual cycle. It often affects both breasts, feels heavy or tender, may extend towards the armpits and becomes worse in the days before a period. It usually improves when the period starts. Hormonal contraception, fertility treatment, pregnancy and perimenopause can change this pattern.
Keeping a simple pain and menstrual diary for several weeks can show whether there is a consistent cycle.
Non-cyclical causes inside the breast
Pain that does not follow the cycle may come from a cyst, benign breast change, previous surgery, trauma or very large heavy breasts. Some medicines can contribute, including certain hormonal treatments, antidepressants and cardiovascular medicines. Do not stop a prescribed treatment without discussing it with the prescribing doctor.
Mastitis or a breast abscess usually causes a painful, warm, swollen area, sometimes with redness, fever or flu-like illness. It is more common during breastfeeding but can occur outside lactation and needs prompt treatment.
Pain from the chest wall
Many people who feel “breast pain” are actually feeling pain from the muscles, ribs or cartilage beneath the breast. Costochondritis, muscle strain after exercise, poor posture, neck or shoulder problems and minor injury can all be felt in the breast area. Chest-wall pain is often reproduced by pressing on one spot or by moving the arm or upper body.
Can breast cancer cause pain?
Most breast cancers do not cause pain, and breast pain alone is unlikely to be cancer. However, pain should not be used to rule cancer in or out. Arrange an examination if pain is new and persistent in one specific area, especially if there is a lump, nipple discharge, new inversion, skin dimpling, redness that does not settle, a change in breast shape or an underarm lump.
What can help benign breast pain?
A properly fitted supportive bra can reduce movement and strain. Note when the pain occurs and avoid repeatedly pressing the sore area. Paracetamol or an anti-inflammatory medicine may help if it is medically safe for you; check with a clinician or pharmacist if you have stomach ulcers, kidney disease, take blood thinners, are pregnant or have another reason to avoid these medicines.
Evidence for routinely avoiding caffeine or taking supplements is inconsistent. A targeted plan based on the cause is more useful than starting several remedies at once.
What happens during assessment?
The clinician will ask about timing, menstrual pattern, pregnancy or breastfeeding, medicines, exercise and other symptoms. The examination includes the breasts, lymph nodes and chest wall. Imaging is not needed for every type of breast pain, but ultrasound or mammography may be recommended according to age, examination and whether the pain is focal or associated with another finding.
When is urgent review needed?
Seek prompt assessment for a hot, red, swollen and painful breast, particularly with fever or feeling unwell, because infection or abscess may be present. Arrange a breast-clinic assessment for persistent focal pain, a new lump, bloodstained discharge, nipple or skin change, or a change in shape. New severe chest pain with breathlessness, sweating or pain spreading to the arm or jaw is a medical emergency and should not be assumed to come from the breast.
The practical message
Most breast pain is hormonal, benign or related to the chest wall. Understanding the pattern is reassuring, while checking persistent focal symptoms ensures that infection and other important causes are not missed.
Source reviewed
American College of Obstetricians and Gynecologists — Benign breast problems and conditions: https://www.acog.org/womens-health/faqs/benign-breast-problems-and-conditions
