Diet and Lifestyle Are Factors in Breast Pain

Miami, FL —Breast pain is among the most common reasons that women seek medical attention from a breast specialist, and appropriate diagnosis is of utmost concern even though the condition most frequently proves to be benign, according to speakers at the Miami Breast Cancer Conference.

The reasons for breast pain range from hormonal cycles to diet and lifestyle, 2 speakers said in presenting an American and a European perspective on diagnosis and treatment. Benign breast conditions were the focus at a mini-symposium Wednesday as the conference opened here.

An American Perspective: Watch Out for Bursitis

Women who experience breast pain fear they have cancer, so alleviating their cause of distress is essential, according to V. Suzanne Klimberg, MD, a professor of surgery and pathology who is director of the Breast Cancer Program at the Winthrop P. Rockefeller Cancer Institute in Little Rock, Arkansas.

In addition, she noted, 7% of breast cancer patients present with breast pain only, heightening the importance of diagnosing pain.

When a patient complains of breast pain, important first steps are determining the relationship between her symptoms and menstrual cycle, and whether the pain radiates from her arm or bears similarities to bursitis.

There are a variety of factors that could play a role in breast pain, Klimberg said. These include such dietary factors as caffeine use, chocolate intake, cheese, wine, and high-fat meals. Stress can exacerbate the pain, she said.

As a result, reassurance works well for half of the patients with mild breast pain. “These patients think they have breast cancer,” she remarked. For dietary issues, nutritional changes often help.

Klimberg finds the most frequent cause of difficult-to-treat breast pain is bursitis. “Breast pain associated with bursitis is important to diagnose because it is the most often missed and the easiest to treat with physical therapy or trigger point injections,” she said. She uses long- and short-acting pain medication.

A European Perspective: Repetitive Strain Has an Impact

R. Douglas Macmillan, MBChB, MD, FRCS,found that the strain of typing all day at a computer keyboard or toting around a young child frequently causes breast pain treatable in severe cases with steroid injections.

Macmillan, an oncoplastic surgeon and clinical lead at the Nottingham Breast Institute, United Kingdom, said breast pain can be divided broadly into 2 categories:

• Hormonal pain usually linked to the patient’s menstrual cycle and to hormone replacement therapy in postmenopausal women
• Chest wall pain that can be diagnosed more precisely into 2 repetitive strain syndromes by determining which ribs are affected

For hormonal pain, “the mainstay of management is reassurance with expectation of spontaneous resolution,” with severe cases requiring low-dose, short-term, intermittent tamoxifen.

When it comes to chest wall pain, the answer often lies in the patient’s daily activities. Macmillan analyzed rib complaints of 138 women and found that pain was localized to 1 rib in 66% of the patients and to 2 ribs in 21%.

In the serratus syndrome, 2 or 3 adjacent ribs of the upper 8 ribs where the serratus arises are most commonly affected; these patients likely work regularly at a computer although other activities that involve using the same arm position for long periods of time such as hairdressing or lifting might also cause such pain.

In the pectoralis syndrome, pain in ribs 3 to 5 at the origin of the pectoralis minor typically is caused when a patient carries a young child on the affected side or regularly performs similar lifting tasks.

To manage the pain, Macmillan first recommends patients avoid the activity causing the problem. For patients with resistant, more severe pain localized to 2 or 3 ribs, a direct steroid injection such as depomedrone 80 mg worked for 85% of patients in 1 small study. Other treatments can include a Botox injection, acupuncture, or local anesthetic patches.