In women under 50, breast pain, which can be cyclical or noncyclical, is a common complaint. Cyclical breast pain is presumably hormonal, occurs at the same time during your menstrual cycle, and resolves on its own within 3 months in 30% of women.
The good news is breast pain is rarely a sign of malignancy and the risk of breast cancer among patients with breast pain as the only symptom is very low (0.8-2%). Yet, when asked about it, 95% of patients with breast pain are worried it's cancer.
What should you do to be reassured? Women with breast pain over the age of 35 should receive a breast examination and a screening mammogram. Breast ultrasound is not needed if there is no mass palpated. If the breast exam and mammogram are negative, reassurance and monitoring your symptoms is the way to go.
Localized breast pain followed by detection of a lump is a different issue and is the presenting symptom in up to 18% of patients with breast cancer.
What doesn’t work for breast pain? Contrary to popular belief, in studies done on Vitamin E and primrose oil neither was found to be effective for breast pain. Additionally, avoidance of coffee, tea, chocolate and colas resulted in no better symptom relief than placebo.
What does work? If you are on an estrogen-progestin oral contraceptive, switching to a non-hormonal method of contraception or a progestin-only method may help. Danazol is the only FDA approved medication for breast pain and reduced cyclical breast pain in women after 12 months more than placebo, but it is associated with side effects: weight gain, heavy menstrual periods and cramping.
The bottom line is cyclical breast pain is common, it is rarely a symptom of breast cancer, and may resolve on its own without any intervention. If your breast pain symptoms persist, a trial of Danazol is worth talking to your doctor about.