The Birds and the Bees … and … the Breast!?

Mom, I know about the birds and the bees…but tell me – what should I do about this pain in my breast?

For many of us, depending on our cultural backgrounds, the talk about the birds and the bees might be broached cautiously, or not at all in some cultures, and don’t even begin to talk about breasts! At most we would be advised about our bra size and type … probably by the assistant at a department store.

For young women in the 21st century, it is a constant challenge: we have to multitask, be it at home, at work or both! With information bombarding us via all types of media, and of course at our fingertips in this internet era, women can be confused about what information to trust.


What is mastalgia, what causes it and what should be done about it?

Mastalgia is breast pain, either cyclical or non-cyclical (related to menstruation or not) and can make the bravest of us quite fearful … could this pain be cancer?

The current statistics suggest that between eight and nine out of every ten lumps are non-cancerous. Ironically, women will rush to their doctors because of breast pain, but delay coming in for painless, and possibly cancerous, lumps; a generality of course but – with few exceptions – cancerous lumps are initially painless.

The menstrual cycle, with the hormonal effects of oestrogen, is the most common cause of breast pain – ie. cyclical pain that is premenstrual and menstruation related. Fibrocystic disease accounts for most cases of non-cyclical pain.

“Fibro-what?” is the common response to that comment! I prefer not to call it a disease but rather “fibrocystic change” since it affects 40-60% of women in their 30s and 40s. It is a hormonally induced inflammatory condition associated with breast pain, cysts, large ducts and, sometimes, solid lumps (fibroadenosis – the larger lumps are commonly called breast mice).

Screening involves a breast ultrasound in women under 35 years of age – if they have no risk factors or lumps – otherwise a diagnostic mammogram will be performed. Screening mammography will be a baseline / initial mammogram between the ages of 35-40 and then annually from age 40 onwards.

The mammogram and ultrasound will identify changes associated with fibrocystic disease. Women with such changes should cut down on their smoking (preferrably stop smoking), try some evening primrose oil capsules and reduce their caffeine intake – tea, caffeinated coffee, coke and chocolates oh no! A short course of anti-inflammatories will provide relief in active inflammation (such as blocked ducts after breast feeding is stopped).

The importance of identifying fibrocystic change is that it impacts on follow ups, identifying whether complications (inflamed or infected cysts, etc) have developed and, of course, lets women avoid complacency that all lumps they feel are only fibrocystic. PLEASE!! Have all lumps assessed on ultrasound even if they occur before your next follow up.

There is an increasing number of younger women (<35 yrs) being diagnosed with breast cancer due, in part, to increased use of oral contraception, fertility drugs, lifestyle factors and genetic influence.

We are also screening more extensively with increased breast awareness and cancers are being detected earlier.

Other causes affecting younger women include infections and inflammatory conditions related to the nipple such as blocked ducts and abscesses – either related to breast feeding or not.

So ladies, know that mastalgia is common and often treatable once the diagnosis has been made -please have it assesed by your doctor!

Monthly breast self examination is important. Wearing a comfortable bra (no deformed underwires) and going for your scheduled examinations is also important.

I am truly optimistic that we are in an era of change and that women and mothers of the 21st century are going to keep abreast (yes, pardon the pun) of breast health issues, and teach their darlings about breast health awareness from a young age, ideally when menstruation starts. Remember – the birds, the bees and the breasts!

Written by Dr Nadia Jajhay

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