Interviewer: So your breasts are feeling kind of tender and they sort of hurt, is it a normal situation? We're going to talk about that next on The Scope.
Dr. Jones, the situation is I'm not breastfeeding but my breasts are kind of tender. They kind of hurt but they've been hurting for maybe two weeks now. There's not really any lump on it that I can feel and I know there's not a history of breast cancer in my family is this a normal situation?
Evaluating Beast Tenderness in Women
Dr. Jones: Okay that's a great question, but let's start with me asking you some questions. We're just going to pretend you're the patient.
Interviewer: Okay let's just pretend I'm the patient.
Dr. Jones: So how old are you?
Interviewer: I, let's say I'm 24.
Dr. Jones: Okay you're 24 and are you having regular periods?
Interviewer: Yes.
Dr. Jones: Okay, and when you say your breasts, you put that as more than one breast, so both sides are normal?
Interviewer: Let's say the left side.
Dr. Jones: Okay it's only one breast?
Interviewer: Yeah the left side is kind of tender and I'm not really sure what's going on. I know I didn't hit it with anything.
Dr. Jones: Okay, but you think you didn't?
Interviewer: I think I didn't.
Dr. Jones: You don't remember that you did?
Interviewer: I don't remember.
Dr. Jones: All right and when was your last period?
Interviewer: A month ago.
Dr. Jones: Okay, so it turns out that breast tenderness is common and it's often concerning because people think, "Is it a hormonal disorder?" Or clearly, they're worried about whether it's cancer. So first of all, when women complain of breast tenderness the first thing we're going to see is how old they are. So new breast tenderness in a 70-year-old is more concerning than breast tenderness in a 24-year-old.
Interviewer: How so?
Dr. Jones: Well, because breast tenderness in a 70-year-old, those women are not having any hormonal fluctuations. So they don't have the rise and fall of hormones every month that make their breasts more swollen some times of the month than others.
What Causes Breast Tenderness?
So many women have a period of time that is up to two weeks, a little more, a little less, when their breasts can be very tender before the period from ovulation until the period is a time when the breasts are remodeling themselves thinking that they might be ready to getting pregnant. Most of the time we're not getting pregnant and so that's when the breast is tender. One may be more tender than the other, it's often both, but one may be much more tender. It can be tenderness around the nipple or mostly it's about the rest of the breast tissue often in the upper outer quadrant of the breast.
So that's part of the question. Now the rule-outs are most women actually can't remember if they bumped their breast or not. If they bump their breast and get a little tender then they keep mashing on that part of the breast...
Interviewer: And then it hurts even more.
Dr. Jones: And then it keeps hurting and so it's very difficult for someone with a tender area for them to keep their hands off it and not keep exacerbating.
Interviewer: It's almost like a bruise.
Is It a Bruise?
Dr. Jones: It's a bruise but it can be deep a bruise that you can't see. So mostly if we, if someone comes in and says, "I've had breast tenderness for a couple of weeks," then I examine both breasts, I'm feeling for masses, and then I'm trying to feel for anything around the area that's tender, and if I don't feel anything in a 24-year-old I usually schedule her to come back and see me in two weeks with hands off, everybody's hands off their breast. So if there was a bump it gets a chance to heal.
Interviewer: That's a really good rule.
Dr. Jones: It may not work that well at home but it sounds really great in the clinic. Second of all, most breast cancers don't hurt; most breast cancers are slow-growing. So the things that make things hurt are infections.
Interviewer: So the lump itself doesn't hurt?
Dr. Jones: No.
Interviewer: Okay.
Infection or Swelling?
Dr. Jones: So the things that hurt in your body are caused by inflammation, and inflammation is caused by infection, rapid swelling, or something else that might actually cause inflammation. So most breast cancers do not have inflammation around them.
Now there is one kind of cancer that is very rare called inflammatory breast cancer, which often causes redness and swelling in one breast. So not only is the breast tender but it often looks a little red, and it feels a little different, and it feels a little dense. It's a rare kind of cancer, it's something that if women have persistent tenderness in one area of the breast, and hands off, doesn't make it better, and it goes past several menstrual periods then it's worthwhile investigating a little bit more, either with ultrasound or with a mammogram.
But for 24-year-olds the most common thing is that it's cyclic and it's related to the hormones going up and down. The second most common thing is that it got bumped. Breast infections are rare in non-breast-feeding women but there are some people who can get infections in their ducts and they may have a breast infection. Much less common in women who aren't breastfeeding than when they are. More common now with women who... do you have any piercings?
Interviewer: I do not, this patient does not.
Dr. Jones: So nipple piercing also may cause an underlying infection. Then it's time out for the breast, give some breast time out, and then you may want to use some anti-inflammatories like Ibuprofen, leave things alone for a little while, come back and see me after the next period and we'll investigate it again. If it's persistently tender with hands off and can't find anything, it can be worth either a little ultrasound or more investigation. But most of the time it's so common as to be considered normal. So I think you're normal but let me check it out.
updated: July 6, 2023
originally published: October 17, 2014
