Dolor en los senos como síntoma de cáncer de mama o mayor riesgo
primera señal, de cáncer de seno. Una pregunta aparte es si el dolor en los senos (mastalgia) debido a una condición benigna puede significar que su riesgo de desarrollar dolor en los senos en el futuro es mayor. Nuevamente, aunque en la mayoría de los casos este no es el caso, hay algunas afecciones que causan dolor en los senos que están asociadas con un mayor riesgo de contraer la enfermedad. Veamos con qué frecuencia el dolor de seno se debe al cáncer de seno, con qué frecuencia las personas con cáncer de seno sienten dolor en sus senos y el riesgo potencial relacionado con varias afecciones benignas que causan dolor de seno.
El dolor de mama como un síntoma de cáncer de mama
La mayoría de las veces, el dolor en los senos no significa cáncer de seno. Este conocimiento puede ser tranquilizador para muchas mujeres, ya que la mayoría de las mujeres experimentan dolor en los senos en algún momento de sus vidas, y alrededor del 15 por ciento de las mujeres buscan tratamiento para aliviar el dolor. El papel del dolor mamario en el cáncer puede observarse desde varios ángulos diferentes, incluida la cantidad de personas que tienen dolor mamario como un síntoma de cáncer mamario, la frecuencia con la que el dolor mamario resulta en un diagnóstico de cáncer y el porcentaje de mujeres. Las personas diagnosticadas con cáncer de mama pueden mirar atrás y darse cuenta de que han estado experimentando dolor.
El dolor de mama como un síntoma inicial de cáncer de mama
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 conditionsassociated 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:
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:
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.
I am Dr. Christopher Loynes and I specialize in Bone Marrow Transplantation, Hematologic Neoplasms, and Leukemia. I graduated from the American University of Beirut, Beirut. I work at New York Bone Marrow Transplantation
Hospital and Hematologic Neoplasms. I am also the Faculty of Medicine at the American University of New York.