In Singapore, one of the most common ailments in women is breast cancer, with 1 in 13 women diagnosed with breast cancer in their lifetime. While the numbers can seem daunting, a large majority of breast cancers are treatable if detected early.
Hence, it is important to know the early signs of breast cancer and to seek medical attention as soon as possible. One of the commonly asked questions about breast cancer is “Does breast cancer cause pain?”. Generally, breast cancer is not associated with pain, and is typically determined by other more distinguishing factors. Nonetheless, individual experiences vary based on the type of breast cancer and how their bodies respond to it.
If you are experiencing breast pain and suspect of having breast cancer, read on to find out more about the association between breast pain and breast cancer, and other symptoms related to breast cancer.
What Are the Different Types of Breast Cancer?
Breast cancer is a complex condition that encompasses many types and stages. Individual experiences can vary based on the type of breast cancer and their body’s unique response. The staging of breast cancer is based on these 2 factors: origin & severity
Origin of Breast Cancer Cells
Cancerous cells can manifest in two main areas:
- Ductal Carcinoma: Growth occurs in the milk ducts.
- Lobular Carcinoma: Growth takes place in the milk glands.
Severity & Staging
Non-invasive breast cancer means that the cancer cells have not spread beyond their origin. On the other hand, invasive breast cancer indicates that the cancer has spread to the surrounding tissues.
The severity of breast cancer is categorised into stages from 0 to 4 based on the tumour size, whether it has spread to the lymph nodes and/or to other parts of the body:
Stage 0: Cancerous cells are only localised in the milk ducts but have not spread to the surrounding breast tissues. (in-situ breast cancer).
Stage 1: Tumour of less than 20mm in diameter is found in the milk ducts or glands. Alternatively, a small tumour between 0.2mm and 2mm in size is found in the axillary lymph nodes (found on the underarms region).
Stage 2: Tumour between 20mm and 50mm in size is found in the breasts, or a tumour smaller than 20mm is found in 1-3 axillary lymph nodes.
Stage 3: The tumour is now larger than 50mm and has spread to the internal mammary lymph nodes or chest walls. It is typically associated with more visible symptoms such as skin colour changes, dimpling, inflammation etc.
Stage 4: The cancer has spread beyond the breasts to other parts of the body such as the skin, chest wall, lungs, brain, heart, etc.
More recently, breast cancer has been analysed based on whether it is sensitive to our female hormones, namely estrogen and progesterone. Some cancer cells have receptors on their surfaces, which can bind to the hormones to make the cancer cells grow. Such hormone-sensitive breast cancer include:
Estrogen receptor positive: Cancer cells have receptors that can bind specifically to estrogen to promote growth.
Progesterone receptor positive: Cancer cells can use progesterone for growth.
Hormone receptor negative: The cancer cells do not have hormone receptors, hence are not sensitive to estrogen and progesterone.
There is no uniform experience among breast cancer patients; symptoms may vary even among patients with the same type of breast cancer. Hence, it is important to consult a healthcare professional for a more definitive diagnosis of the type of breast cancer one may have, so that a targeted treatment can be provided.
What Are The Common Symptoms Of Breast Cancer?
Some symptoms commonly seen among breast cancer patients include:
- Swelling of the breasts
- Lumps in the breasts or underarm
- Dimpling of the skin surrounding the breasts
- Nipple discharge other than breast milk e.g. blood, yellow fluid
- Redness or flaky skin in the nipple area or the breast.
- Nipple inversion
- Any changes in the appearance and size of your breasts
For women aged 20 and above, it is important to perform a breast self-examination every month to check for the symptoms mentioned above. Do note that having one or two symptoms does not necessarily mean you have breast cancer. For example, swelling or breast lumps can be due to hormonal changes during menstruation or pregnancy.
In addition, breast pain does not necessarily indicate breast cancer. The presence of breast pain differs among breast cancer patients. For a more definitive diagnosis, it is best to schedule regular mammogram screening. Women aged 50 & above are recommended to go for a mammogram once every two years. Women 40 to 49, can screen for breast cancer annually, provided their doctor has discussed the benefits and limitations with them.
Does Breast Cancer Cause Pain?
Breast pain, also known as malstalgia, is commonly experienced by women in varying degrees throughout their lives. It is a dull ache that can cause the breast tissues to feel heavy or tight. The pain can either be intermittent or persistent throughout the day, unilateral or bilateral.
Understandably, experiencing breast pain may cause some anxiety about breast cancer. However, in most cases, breast pain is not a sign of breast cancer. A recent study in the British Journal of General Practice showed that the incidence of breast cancer in women experiencing breast pain alone is only 0.4%, which is lower than the 5% of women who experience other symptoms like breast lumps and nipple discharge.
In fact, breast pain is more commonly associated with non-cancerous conditions or natural bodily changes such as:
- Infection/Injury: One common condition that is mistaken as breast cancer is breast cysts, which are fluid-filled sacs in the breasts that could present as lumps. Sometimes, breast cysts cause localised pain in the breasts.
- Menstrual cycle: Hormonal changes during the menstrual cycle can cause breast swelling and lumpiness causing pain weeks before the start of your period, before improving on the day of menstruation.
However, instances do occur whereby a lump may feel painful. This could stem from rare forms of breast cancer, such as Angiosarcoma, a type of breast cancer where cancer cells form in the lining of blood vessels and lymph vessels surrounding the breasts. Another type is inflammatory breast cancer which blocks the lymph vessels, preventing lymph from being expelled and causing the breasts to be inflamed. Do note that these conditions are accompanied by other symptoms such as bruising, swelling, dimpled skin etc.
Nonetheless, if you experience extreme and persistent breast pain, you should schedule an appointment with your doctor to determine the exact cause.
Pain Experience Varies
Each experience is unique, and you should not use pain as a sole indicator of breast cancer. Instead, there are more definitive options for a more accurate diagnosis.
One simple way that is accessible for all is to perform a self-examination every month. As there are more hormonal changes during your menstruation that could affect breast size, it is better to perform the self-examination one week after your menstruation. Stand in front of the mirror and observe your breasts and underarms for:
- Rashes, redness, or lumps on your skin
- Changes in the shape and size of your breasts
- Nipple inversion
- Any bulging or puckered areas around the outline of your breast
Next, using your finger pads, apply different pressure in a circular motion from your collarbone to your cleavage and armpits to check for any lumps or distortions around your breasts. Gently squeeze your nipple to check for abnormal nipple discharge such as blood, yellow, or watery fluid.
Self-examination should be combined with other screening tools such as mammograms and MRI to detect the presence of lumps or other abnormalities. Taking a proactive role in looking out for your breast health increases the chances of detecting breast cancer early, which would make treatment and recovery easier.
Breast pain is seldom associated with breast cancer and is more likely due to other factors such as hormonal changes and infections.
Nonetheless, breast cancer can present itself in other ways. With breast cancer being the leading cancer among women, it is vital to do regular self-examination and mammogram screening for early detection and prevention.
At the Centre for Screening and Surgery, we provide breast screening with a high-resolution ultrasound which can detect both benign breast lumps and breast cancers. Our doctors are trained to provide a comfortable screening experience based on your needs. We also specialise in minimally invasive procedures for breast cancer treatment. If you require a breast screening, call us to book an appointment today!