• cyclical breast pain - The most common type of breast pain is associated with the menstrual cycle and is nearly always hormonal. Some women begin to have pain around the time of ovulation which continues until the beginning of their menstrual cycle. The pain can either be barely noticeable or so severe that the woman cannot wear tight-fitting clothing or tolerate close contact of any kind. The pain may be felt in only one breast or may be felt as a radiating sensation in the under-arm region.

  It may be helpful for women to chart their breast pain to determine if the pain is cyclical or not. After a few months, the relationship between the menstrual cycle and breast pain will emerge.

  Physicians continue to study the role that hormones play in cyclical mastalgia. One study has suggested that some women with cyclical mastalgia have a decreased ratio of progesterone to estrogen in the second half of the menstrual cycle. Other studies have found that an abnormality in the hormone prolactin may affect breast pain. Hormones can also affect cyclical breast pain as a result of stress - breast pain can increase or change its pattern with the hormone changes that occur during times of stress.

  Hormones may not provide the total answer to cyclical breast pain, since pain is often more severe in one breast than in the other (hormones would tend to affect both breasts equally). Many physicians believe that a combination of hormonal activity and something in the breast that responds to this activity may hold the answer. However, more research is necessary in order to draw this conclusion.

• cysts - A cyst is a fluid-filled sac, that develops in the breast tissue, which typically occurs in women between the ages of 35 and 50. They often enlarge and become tender and painful just before the menstrual period and may seem to appear overnight. Cysts are rarely malignant and may be caused by a blockage of breast glands.

  Cysts can feel either soft or hard. When close to the surface of the breast, cysts can feel like a large blister, smooth on the outside, but fluid-filled on the inside. However, when they are deeply imbedded in breast tissue, a cyst will feel like a hard lump because it is covered with tissue.

  A physician may identify a lump as a cyst by physical examination, but many physicians confirm the diagnosis by mammography or ultrasound examination. The physician may then perform a fine-needle aspiration as the next step in diagnosing the cyst. This procedure involves guiding a very fine needle into the cyst and drawing fluid from it. This procedure also serves as the treatment for this condition, as once the cyst is aspirated, it collapses and disappears. Cysts can reappear at a later date, in which case they are simply drained again. Cysts are seldom malignant.



• fibroadenomas - Fibroadenomas are solid, smooth, firm, benign lumps that are most commonly found in women in their late teens and early twenties. They are the most common benign lumps that occur in women and can occur in women of any age. Increasingly, they are being seen in postmenopausal women who are taking hormone replacement therapy.

  Fibroadenomas occur twice as often in African-American women as in other American women. The painless lump feels rubbery, moves around freely, and very often is found by the woman herself. They vary in size and can grow anywhere in the breast tissue.

  While most physicians can recognize this type of lump simply by feeling it, generally, the diagnosis is confirmed by mammography or ultrasound and fine-needle aspiration. Sometimes, in very young women, the fibroadenoma is not removed. However, since sometimes these tumors enlarge with pregnancy and breastfeeding, physicians may recommend surgically removing the fibroadenoma.

  While fibroadenoma does not lead to cancer, there is a type of fibroadenoma that has been associated with an increased risk of cancer, particularly in women with a family history of the disease.

• fat necrosis - Fat necrosis is a condition in which painless, round, firm lumps caused by damaged and disintegrating fatty tissues form in the breast tissue. Fat necrosis often occurs in women with very large breasts or in response to a bruise or blow to the breast. This condition may also be the result of a lumpectomy and radiation from a previous cancerous lump. In some cases, physicians will watch the lump through several menstrual cycles, and may perform a mammogram before deciding whether or not to remove it. These lumps are not malignant and there is no reason to believe that they increase a woman's risk of cancer.


• sclerosing adenosis - Sclerosing adenosis is a breast condition that involves excessive growth of tissues in the breast's lobules, often resulting in breast pain. While these changes in the breast tissue are microscopic, they may show up on mammograms as calcifications and can produce lumps. Usually a biopsy is necessary to distinguish this condition from cancer. In addition, because fat necrosis can be mistaken for cancer, the lumps are usually removed through surgical biopsy. Generalized breast lumpiness is known under many different names, such as "fibrocystic disease" and "fibroid breasts." Many of these are misnomers since physicians and researchers now believe that these are just part of the breast changes which many women undergo throughout the various stages of their lives. Many physicians feel that this term has become a catch-all phrase for general breast lumpiness.

  Fibrocystic lumpiness is also described as "ropy" or "granular" and seems to become more obvious as a woman approaches middle age and the milk producing glandular tissue gives way to softer, fatty tissue. However, women with lumpy breasts may experience many other benign breast conditions.

  Lumpiness in the breasts may make actual lumps harder to distinguish. Thus, it is important that women with lumpy breasts perform regular breast self-examinations and have regular physical examinations, including mammography as indicated by the National Cancer Institute guidelines. Knowing the normal shape and feel of your own breasts is important, especially when performing examinations to detect any unusual breast changes.

For more information go to the Center for Young Women's Health website.