Dear Mirror Doctor, I am a student at one of the universities in the capital. I have been experiencing pain in my breasts which comes and goes with my periods.
What I am really scared of is the lumpiness I feel in my breasts before my periods. I have heard so much about breast cancer and its early detection, so can you please educate me on the causes of pain and lumps in my breasts?
Worried Lady.
To understand this response better, it is important to talk a bit more in detail about the breast.
Women's breasts are made of specialised tissue that produces milk (glandular tissue) and a lot of fatty tissue. The amount of fat determines the size of the breast, with the shape determined by ligaments and supporting connective tissue.
The breasts have a very rich supply of nerves, accounting for their high sensitivity.
The milk-producing part of the breast is organised into 15 to 20 sections called lobes. The lobes are further subdivided into smaller structures where milk is produced, called lobules. The milk travels through a network of tiny tubes called ducts.
The ducts connect and come together into larger ducts, which eventually exit the skin at the nipple. The dark area of skin surrounding the nipple is called the areola.
The breast begins to change from puberty and continues to develop throughout life. During this period, women may experience various kinds of breast pain and other breast changes.
Some of these changes normally occur during the menstrual cycle, throughout pregnancy, and with ageing. Breast lumps, tenderness and other changes may also occur during these phases.
Most breast lumps and other changes are reassuringly not cancerous.
Lumps within breast tissue are usually found unexpectedly or during a routine monthly breast self-examination.
Most lumps represent changes within the breast tissue as the breasts develop, changes largely influenced by normal hormonal variations.
Breast pain, known in medical parlance as mastalgia, is a common breast problem in younger women who are still having their periods and happens less often in older women.
Although pain is a concern, breast pain is rarely the only symptom of breast cancer, our ultimate fear with breast issues. Refreshingly, though, most breast cancers hardly present with pain.
About two-thirds of women with breast pain have a problem called cyclic mastalgia. This pain typically is worse before the menstrual cycle and is usually relieved by the time the period begins.
It may also happen in varying degrees throughout the cycle. Because of its relationship to the menstrual cycle, it is believed to be caused by hormonal changes. This type of breast pain usually happens in younger women, although some women in their menopause age can experience it when on hormone replacement therapy.
Breast pain that is not associated with the menstrual cycle is called noncyclic mastalgia. It occurs less often than the cyclic form, classically occurring in women older than 40 years. It is sometimes linked to some lumpiness of the breast called a fibroadenoma.
Breast pain or tenderness may also occur in a teenage boy. The condition, called gynecomastia, is enlargement of the male breast which may occur as a normal part of development, often during puberty.
Mastitis is an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding.
This infection causes pain, swelling, redness, and increased temperature of the breast. It can occur when bacteria, often from the baby's mouth, enter a milk duct. This causes an infection and painful inflammation of the breast.
Other causes of pain that do not originate from the breast but can be felt in the breast include costochondritis- an inflammation of the joining points of the ribs, injury or surgery to the breast or chest and shingles.
Many possible causes exist for pain or tenderness in one or both breasts. Most often, the pain can be attributed to harmless causes such as puberty or pregnancy.
It can also be a recurrent problem for women with cyclical pain associated with the menstrual cycle.
Although cancer is a major concern for most women, it is rarely the cause of isolated breast pain.
I will continue next week.
The writer is a member of the Paediatric Society of Ghana and the Director of Medical Affairs, Korle Bu Teaching Hospital.
