Does Having Breast Pain Increase Breast Cancer Risk?

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If you’re having breast pain, you might be wondering if it could be a sign of breast cancer. While most causes of breast pain that are benign, in some cases it can be a symptom, or even the first sign, of breast cancer. A separate question is whether breast pain (mastalgia) due to a benign condition might mean that your risk of developing breast pain in the future is higher. Again, while most often this is not the case, there are some conditions that cause breast pain that are associated with a higher risk of getting the disease. Let’s look at how often breast pain is due to breast cancer, how often people with breast cancer feel pain in their breasts, and the potential risk related to several benign conditions that cause breast pain.

Breast Pain as a Symptom of Breast Cancer

Most of the time, breast pain does not mean breast cancer. This knowledge may be reassuring for many women as the majority of women experience breast pain at some time in their lives, and around 15 percent of women seek treatment for pain relief for the pain. The role of breast pain in cancer can be looked at from several different angles, including the number of people who have breast pain as a symptom of breast cancer, how often an evaluation of breast pain results in a cancer diagnosis, and what percent of women who are diagnosed with breast cancer can look back and realize they have been experiencing pain.

Breast Pain as an Initial Breast Cancer Symptom

A 2017 study looking at presenting symptoms of breast cancer, it was found that only 6 percent of women has breast pain. While this number is low, it’s worth noting that breast pain is the third most common symptom, behind a breast lump (83 percent) and nipple abnormalities (7 percent). In addition, many people are taught that breast cancer is painless, raising the risk that breast pain might be dismissed. This concern has been backed up in research, as another another 2017 study found that the presence of “non-lump symptoms,” in other words, presenting symptoms other than a breast lump, was a factor in delayed diagnoses of the disease—delays in diagnosis and subsequent treatment that could lead to poorer survival rates.

How Often is Breast Pain Due to Breast Cancer

Another study looked at women who were evaluated for breast pain who did not have any other symptoms such as a breast lump, nipple discharge, redness, or breast changes, and who were not pregnant or breastfeeding. In this study it was found that of women who presented with breast pain (mastalgia) alone, only 1 in 500 (or 0.2 percent). Previous studies had found that 0.5 percent, or 1 in 200 women with breast pain alone and no other symptoms (or conditions such as pregnancy) had breast cancer.

Number of Women With Breast Cancer Who Have Pain

For women who have been diagnosed with breast cancer, slightly more than one in six has experienced some form of breast pain in the 90-day period preceding diagnosis.

Breast Pain and Breast Cancer Risk

A separate issue is whether breast pain might not be a symptom of cancer at the current time, but could be a sign of increased breast cancer risk down the line. The quick answer is that certain benign breast conditions associated with risk can cause breast pain, but these have a very small impact on your risk for developing breast cancer. These breast conditions are made of non-proliferative cells, which grow and divide at a normal rate.

Benign Breast Conditions With Low Risk

Many benign breast conditions contribute little (very slight increase) or no increased risk. These conditions are marked by non-proliferative cells that have normal rates of cell growth and division, including:

  • Abscess
  • Ductal ectasia
  • Fat necrosis
  • Fibrocystic changes
  • Mastitis
  • Sebaceous cyst
  • Simple fibroadenoma

Benign Breast Conditions With Moderate Risk

Some benign breast conditions are associated with a moderately increased risk of breast cancer, such that people are 1.5 to 2 times more likely to develop the disease. These conditions are marked by proliferative cells without atypica: cells that grow faster than normal but with no abnormal cells, and include:

  • Complex fibroadenoma
  • Multiple fibroadenomas
  • Radial scar

Fibroadenomas and scar tissue can be removed with surgery or non-invasive ablation by laser, freezing, radio waves, or vacuum. A breast fibroadenoma must be diagnosed with a breast biopsy, so the cells can be tested to rule out other conditions.

Benign Breast Conditions With Heightened Risk

Some benign breast conditions that cause breast pain can significantly increase the risk of breast cancer to 4 times or 5 times the average. These conditions are marked by proliferative cells with atypia: cells that grow faster than the normal rate plus include some abnormal cells. Examples include:

  • Atypical ductal hyperplasia (ADH)
  • Atypical lobular hyperplasia (ALH)

Hyperplasia is a benign condition in which cells grow faster than normal. Atypical hyperplasia is considered a precancerous condition. Atypical cells are abnormal and have the potential to develop into noninvasive breast cancer, such as ductal carcinoma in situ. Discuss the benefits of surgically removing any atypical hyperplasia with your doctor.

Hormones and Breast Pain

There is a difference between cyclical and noncyclical breast pain. Between puberty and menopause, most women have some cyclical breast pain and tenderness as hormone levels change. At menopause, when your menstrual periods end, most breast pain also ceases. Your ovaries will produce lower levels of estrogen during menopause, which results in less swelling and tenderness in your breasts and stomach. Menopausal breast pain is noncyclical and usually hurts in only one breast. Noncyclical breast pain is not hormonal and can be caused by illness, injury, weight gain, or certain medications.

Breast Pain, Hormone Replacement Therapy, and Breast Cancer

For women who are using hormone replacement therapy, breast pain may be a source of concern. In the Women’s Health Initiative Study—the study which raised red flags about hormone use contributing to breast cancer—breast pain was a cause for concern. In women who used combination therapy—that is, estrogen plus progesterone—new onset breast pain and tenderness was associated with an increased risk of developing breast cancer. 

This was not the case for women using estrogen replacement alone. This association between pain after using combination estrogen and progesterone replacement was especially concerning in women who had tenderness before beginning therapy. Anyone who is considering combination hormone replacement therapy should have a careful discussion with her doctor about not only the increased risk of breast cancer but the significance of breast pain.

The Bottom Line

Contrary to the commonly held belief that breast cancer is always painless, it’s true that breast pain can be, and is, sometimes the first symptom of breast cancer. In addition, some benign breast conditions that cause pain may increase the risk of developing the disease in the future. Certainly, breast pain is common and far more often due to something other than cancer. If you do develop breast pain, you don’t need to be overly alarmed, but should make an appointment to talk to your doctor. Breast cancer is most treatable in the early stages of the disease and any breast cancer symptom that is new to you is important to address thoroughly.

Even if your breast pain is not due to breast cancer, the presence of pain is our body’s way of telling us that something is wrong, and can make us anxious and interfere with living our best lives. Your doctor may be able to make recommendations that could reduce your pain and improve your quality of life.

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