Breast cancer is believed to only affect adult women over the age of fifty. But in recent years, this disease has become much younger. Therefore, there is nothing strange in the fact that a considerable number of young women and girls who have pain in the mammary glands sound the alarm.
It's important to understand
Every third woman of childbearing age experiences periodic painful sensations in the mammary gland.
It is important to understand that the reasons why the mammary glands hurt may be related to the premenstrual cycle. The same symptom is observed in women in the first months of pregnancy. In this case, there is no reason to sound the alarm, since this phenomenon is absolutely normal.
Reason to see a doctor
A considerable part of women are faced with non-cyclical. This is observed in most women who have crossed the forty-year threshold. In this case, the gland may hurt only in a specific area of one breast.
The presence of painful sensations localized throughout the mammary gland and extending to the axillary region is considered a rare occurrence. Non-cyclic mastalgia develops. In order to correctly answer the question of why women experience pain in this case, you need to understand what the reasons are.
Provoking factors
The reasons why most women complain that their breasts hurt are quite varied:
- anatomical features;
- disturbed balance of fatty acids;
- mastitis;
- presence of fibroids (cysts).
Why does pain occur in the first case? Many women experience breast injury or surgery in this area. Some young ladies mistake discomfort that has arisen in the wall or for pain in the mammary gland.
Mastitis is a particular danger for women. In order to avoid developing this disease, it is important to know why it occurs. The reasons why mastitis develops are associated with the penetration of infection into the body of a nursing woman. Stagnation forms in the mammary gland.
When painful sensations are provoked by a cyst, the woman notes their clear localization.
Development of mastopathy
Fibrocystic growths in the female breast are defined in medicine as mastopathy. Some doctors believe that mastopathy is a precancerous disease. But in most cases, this pathology is strictly benign.
Only a highly qualified mammologist can clearly answer the question of why a young lady develops mastopathy. Most often, this disease occurs against the background of hormonal imbalance.
The following reasons are noted:
- pathologies of the thyroid gland;
- chronic inflammation;
- neuroses;
- late pregnancy;
- abortions performed.
The risk group includes young ladies aged thirty to fifty years. But this does not mean that mastopathy does not affect young girls. There have been cases when teenagers aged 16-18 years turned to a mammologist with complaints of breast pain. “Intermediate” age is considered to be 25-27 years.
Often, treatment of mastopathy involves surgery. But before you make a decision, you need to visit at least three doctors. Sometimes even taking Aevit vitamins can help a young lady.
Considering that mastopathy tends to recur, treatment should be systematic. In some cases, the pathology “falls asleep” for several decades.
Development of cancer
A paradoxical fact: most women, having discovered a lump in the breast or experiencing pain in the gland, try in every possible way to delay visiting the doctor. The reasons for this behavior are related to the fact that young ladies, especially young ones, are afraid to hear confirmation of their fears from the doctor.
Breast cancer is a very insidious disease. At stage zero, the disease is completely asymptomatic. Often a young lady does not have to complain at all that her gland hurts.
In most cases, the malignant neoplasm is localized in the upper outer region of the mammary gland. The contours of the neoplasm cannot be called clear. In this case, the skin is like an orange peel. There is also an opinion that a malignant tumor “lives” only in the upper part of the breast. But there is no absolute proof of this.
As the disease progresses, the nipples become retracted and discharge appears. Often the discharge has a foul odor. The greatest danger is bloody discharge. Unfortunately, it is impossible to do without surgery.
But there is no need to panic in advance. Today, even such a serious disease as breast cancer can be successfully treated. There have been cases when women who were operated on in a timely manner were even removed from the register over time.
There's no need to hesitate
A woman should not neglect the opportunity to visit a doctor if she experiences at least one of the symptoms listed below.
- Painful sensations are not associated with the menstrual cycle.
- The nature of the pain is burning and squeezing.
- The pain is localized in only one place.
- Over time, the discomfort only gets worse.
- The mammary glands become deformed or change color.
- Liquid is released from the nipples.
- Discomfort is present every day.
- Discomfort prevents the young lady from living a normal life and performing everyday duties.
- Body temperature rises.
- Another “tip” from the body is the enlargement of the lymph nodes in the armpit.
Sometimes a young lady of reproductive age may complain that the gland hurts when touched. There is no need to self-diagnose. If a woman has previously been diagnosed with a cyst, then observation by a mammologist should be regular. An ultrasound of the mammary glands will help determine the exact cause. This is especially true for “late-parous” and nulliparous young ladies.
Don't forget
Every woman has a choice - to be tormented by vague fears or to live without feeling the sword of Damocles hanging over her. To do this, it is worth being examined by a mammologist and gynecologist twice a year. This is especially true for middle-aged women.
One of the most common complaints among women of reproductive age is breast pain. This phenomenon is much less common among representatives of the fair sex who have experienced menopause. If you experience unpleasant sensations, you should definitely contact a doctor, but you should not consider them as something terrible. In most cases, the cause of pain is non-hazardous health conditions. Let's talk about them in more detail so that you know why your chest hurts, what the reasons are, and also discuss methods of dealing with such unpleasant sensations.
Why do women's breasts hurt?
Hormones
As you know, the mammary glands are organs whose full growth and development are regulated by the production of sex hormones. That is why the appearance of painful sensations in the fair sex is often explained by changes in the normal ratio of hormone production that affects breast tissue or cells. The causes of hormonal imbalances can be very different.
Shortly before the onset of menstruation, the amount of hormones in our body increases, helping to consolidate and develop a possible fetus, if one occurs. At this stage, the breast may become slightly enlarged and painful, due to the stretching of the capsule. Itching may also occur due to irritation of the superficial nerve endings on the stretched skin. At this time, pressing on the nipples may cause the release of a small amount of colorless or yellowish liquid. All unpleasant phenomena disappear with the onset of menstruation.
In the middle of the cycle, short-term chest pain may occur in parallel with pain in the lower abdomen; they develop as a result of the action of hormones that ensure ovulation.
With prolonged hormonal imbalance, namely with the predominance of estrogen synthesis, constant swelling of the breast tissue, as well as the formation of mastopathy, can be observed. The mammary glands become engorged and sore. In this case, a woman may find it impossible to wear bras and tight clothing. Heaviness or small nodules may be felt inside the breast tissue.
This disease requires close attention and proper therapy.
Pregnancy
In the first three months of bearing a baby, the mammary glands may hurt due to the influence of progesterone, which is responsible for preserving the fetus. As a result of the production of this substance, alveolar tissue grows; the glands can increase in size, preparing for breastfeeding.
In the second trimester, the discomfort subsides, but may again begin to bother the expectant mother closer to the onset of labor. In this case, fullness and pain develop due to the production of prolactin, which ensures the formation of lactation.
Lactation
Pain may bother a new mother immediately after childbirth, when active milk production is observed. To eliminate discomfort, breastfeeding should be done on demand.
When breastfeeding, stagnation of milk may occur, as well as infection. This causes mastitis, while the nursing mother feels severe pain in the chest, the tissues on the sides of the glands turn red, and a swollen area of compaction is observed. The temperature may rise and the woman’s general condition may worsen.
Abortion
After an artificial termination of pregnancy, your breasts may hurt for one week. For longer-lasting unpleasant effects, you should consult a doctor.
Non-hormonal reasons
The chest may hurt due to ordinary bruises, sometimes the cause of this phenomenon is the development of infectious lesions (shingles). Unpleasant sensations can be triggered by intense weight training. Unilateral pain can be explained by injuries and sprains.
If the unpleasant sensations are localized on the left, it is worth ruling out problems with the cardiovascular system. The main difference between dangerous pains is intensity and burning sensation.
However, such phenomena can be explained by other factors:
Cervical or thoracic osteochondrosis;
- scoliosis;
- stress, depression, neurosis, bloating;
- disease of the costal cartilages;
- problems with the stomach or pancreas and other pathological conditions.
What to do if your chest hurts (treatment)?
Therapy is carried out depending on the reasons that caused the problem. To correct premenstrual syndrome or ovulatory pain, the doctor may prescribe the patient vitamins and herbal preparations that have mild hormonal activity.
For purulent inflammation of the mammary gland, it is often recommended to take a course of antibacterial medications; sometimes surgical intervention to open and drain the lesion may be necessary.
To eliminate diffuse forms of mastopathy, it may be necessary to take hormonal medications, and nodular formations or cysts are usually treated with surgical methods.
A painful symptom caused by muscle strain or inflammation can be mitigated with the help of anti-inflammatory tablet formulations, as well as ointments or warm compresses.
Conclusion
We talked about why the chest hurts, what the symptoms were, and also talked about treatment. It is worth considering that the appearance of pain in the chest area rarely indicates the development of cancer, but this possibility exists. In any case, if unpleasant sensations appear, it is advisable to quickly seek medical help.
Chest pain is a fairly common complaint for premenopausal women, but it is much less common in older women. If your chest hurts, there may be several reasons, and some of them pose a serious threat to life and health.
Types of pain
Basically, doctors distinguish between two types of chest pain:
Such pain is not a pathological condition and worries many women on the eve of menstruation. There is no point in worrying about them and seeing a doctor every month.
- Non-cyclical. If the chest hurts without any system, then the pain is called non-cyclical. Most often it hurts not in both glands at once, but only in one. There are several reasons that provoke the development of this unpleasant syndrome.
Non-cyclical pain in the mammary gland is usually aching, but the pain can intensify in response to movements and touches to the chest, and sometimes it also hurts in the armpit area, thus limiting movements in the arm.
Common reasons
The reasons why one mammary gland is affected by pain are very diverse.
- Mastitis. Mastitis is a process of inflammation that affects breast tissue. If this disease develops in the postpartum period, then the first signs can be noticed already 3-4 days after birth. The breast becomes a place of stagnation of milk - this is why mastitis develops in women in labor.
This pathology occurs not only in women who have recently given birth and breastfeeding, but also in completely healthy ones. If a woman’s immunity is weakened, and chronic processes occur in the body, for example, sinusitis, then pathogenic microorganisms can enter the mammary gland.
- Mastopathy. Mastopathy is another reason why one breast may hurt. This disease is characterized by the formation of benign neoplasms, which are represented by the proliferation of ducts inside the lobules, gland vesicles and the connective tissue itself.
As a result, some structures in the chest become excessively compressed while others expand too much, resulting in a feeling of soreness that can radiate to the armpit and limit the movement of the arm.
Mastopathy usually develops against the background of severe hormonal imbalances and is dangerous because benign neoplasms degenerate into malignant ones if the approach to treatment is inattentive.
Fibroadenoma is closely related to the work of the hormonal glands, since if you conduct an examination on the eve of or during the menstrual cycle, you can notice a decrease in the size of the tumor.
- Cancer. This pathology is especially dangerous and does not provoke pain if it is at an early stage - this is its main insidiousness.
As the tumor grows and spreads, it begins to affect the nerve endings, which leads to the development of pain in the gland affected by the tumor. Complaints describing pain may differ from patient to patient depending on the location of the tumor.
Untreated mastopathy, as well as late childbirth, contribute to the development of cancerous tumors in the mammary glands.
More rare causes
- Fat necrosis. Why does fat necrosis develop in the mammary gland? The most common cause of this pathology is injuries in the mammary glands. Due to the similarity of symptoms, this pathology is often confused with cancer.
- Cyst. If there is pain in the breast, then the development of a cyst may explain why this symptom appears. A cyst is a cavity made of connective tissue that is filled with fluid.
The reason why cystic formations form is still not fully known, although there are many assumptions. The most dangerous cyst in the mammary gland is that with the slightest injury there is a risk of damage to the walls, which is why the contents of the cyst spill into the surrounding tissue.
The pain in women with cysts is usually severe and cannot be ignored.
- Incorrectly selected underwear. A bra that is the wrong size or made of synthetics is why the mammary gland often hurts.
This happens due to the fact that due to too dark tissue in the gland, stagnation occurs and proper blood circulation is blocked. If the harmful effects are not stopped in time, the mammary gland can become the site of the formation of malignant neoplasms.
Should I go to the doctors?
If you are worried about non-cyclical pain in one gland, then this is undoubtedly a reason to consult a doctor. In what cases is it immediately clear why it is necessary not to postpone a visit to a specialist?
- The mammary gland has noticeably changed in size and shape, and asymmetry of the bust can be seen.
- The nipple is changed: it can be retracted into the gland, or it can respond by releasing fluid to pressure.
- When palpated, it is possible to detect a compaction in or around the gland.
- There is pain when pressed.
- The skin of the breast or around it has undergone any noticeable changes: it has become rough, redness, and peeling have appeared.
It is necessary to carefully assess the condition of the bust and if suspicious symptoms appear, do not postpone a visit to a specialist so that the situation does not worsen.
Diagnostics
Pain in one gland is not a symptom of any specific disease, which is why it is necessary to consult a specialist to understand the cause of the disease. The doctor, after listening to the complaints, evaluates:
- Duration of pain.
- Dependence of sensations on the menstrual cycle.
- Localization of pain.
- Are there any seals and where are they located relative to the site of pain?
- Are there any changes in the nipple?
- Could the changes in the glands be associated with taking hormonal medications?
After assessing the patient's general condition and examining the breasts, the doctor will have a rough idea of what tests and diagnostic methods are best prescribed to confirm the suspected diagnosis. Also, after receiving the examination results, it will be possible to choose treatment tactics.
Most often, women complaining of pain in one breast are prescribed:
- General blood analysis.
- Blood chemistry.
- Chest X-ray.
- Mammography.
In some cases, when diagnosis is difficult, they resort to repeating studies using contrast agents.
Treatment
The choice of treatment method for pain that occurs in one breast depends on the specific disease that caused it.
Unsystematic treatment, based on a single symptom and not taking into account the diagnosis as a whole, may not only not relieve a woman of pain, but also aggravate the situation.
You can begin treatment only when an accurate diagnosis has been established and the doctor has chosen a treatment regimen. In some cases, therapy only involves taking medications to achieve a particular result, and sometimes it is necessary to resort to surgery to eliminate the pathology.
If a woman notices pain in her breasts or any changes in its shape and structure, then this is a reason to consult a mammologist rather than self-medicate at home. Examination and proper therapy will help you get rid of pain and avoid more serious consequences.
More than half of all women on the planet are concerned about breast pain to some degree. In this case, sensations can vary from slight discomfort to excruciating heaviness and burning, which significantly reduce the quality of life. Therefore, establishing the cause of such pain and selecting adequate treatment is a primary task.
Anatomy of the mammary glands
A woman's breasts consist of a gland that is divided into lobules by milk ducts, fat and connective tissue. The predominance of connective (fibrous) and glandular tissue depends on the characteristics of the body, body weight, hormonal levels and the age of the woman. However, the mammary gland in every woman is an organ in which changes occur associated with the course of the menstrual cycle. Hormonal changes occur according to the following pattern:
The first two weeks (14 days), provided that the cycle lasts 28 days, the follicles in the ovaries intensively mature. In the middle phase of the cycle, the follicle bursts, thus releasing the egg. This stage is combined with the peak release of estrogen. After the egg is released, a corpus luteum forms at the site of the follicle. During this phase, progesterone is actively secreted. If conception does not occur, the body begins to gradually decline and the levels of both hormones decrease towards the end of the cycle. Menstruation begins.
Estrogen, a female hormone, has a huge impact on the condition of the mammary glands. It provokes an increase in connective elements and the number of glandular cells. Connective cells line the surface of all breast ducts. With an excess of estrogen, groups of glands can degenerate into cysts. In most cases, cysts are harmless and do not require treatment.
Progesterone, the level of which increases in the second part of the cycle, provokes swelling and improves blood circulation, which causes pain in the premenstrual period. This is explained by the fact that the glandular cells of the mammary gland undergo preparation before the possible release of milk in the event of pregnancy.
Mastodynia (cyclical pain) – pain before the onset of menstruation
The largest number of complaints about pain in the mammary glands is associated with cyclical changes in the female body. This condition is characterized by:
significant reduction or complete disappearance of pain during pregnancy or after menopause;
subsidence of pain at the beginning of menstruation and its complete disappearance at the end of menstruation;
the onset of pain a few days before the onset of menstruation.
Such complaints are most often present in women aged 17 to 40 years with large and medium-sized breasts. Breast pain that occurs during ovulation is usually bilateral, with the most severe pain localized in the outer upper quadrants of the breast.
Pain as a sign of PMS
Cyclic pain that occurs monthly may be part of premenstrual syndrome. Other signs of this unpleasant condition include:
bloating and abdominal pain;
increased appetite;
anxiety and restlessness;
sudden mood swings and irritability.
The main feature of premenstrual pain in the mammary gland is the absence of symptoms before ovulation. The first half of the cycle is absolutely painless, and after two weeks the above complaints begin to increase. The peak of pain occurs 2-3 days before the start of menstruation.
The presence of certain signs of premenstrual syndrome is present in 80% of women. And for almost everyone, breast pain is one of the main symptoms. This condition is not dangerous to the health and life of a woman. There is an opinion that women who suffer from monthly pain and breast hardening are more at risk of developing cancer pathologies. There is currently no evidence of a connection between breast cancer and cyclic breast tenderness.
Most often, pain develops against the background of the presence of diffuse fibrocystic mastopathy. This condition is not a disease, it is a special condition of the mammary gland, in which there is a uniform proliferation of fibrous and glandular tissue. This condition has no consequences, except for discomfort.
Non-cyclical pain
when taking medications (antidepressants, hormonal drugs);
after operations and injuries;
in the presence of benign or malignant tumors;
for breast cysts.
In rare cases, the pain may not be related to menstruation. Typically, discomfort occurs due to injuries, tumors, cysts and other pathologies that occur in the breast area. Non-cyclic pain is most often localized and unilateral. In other words, a woman is able to identify the place where there is discomfort (for example, pain in the right breast in the nipple area).
Paget's disease;
malignant tumors;
lactocele;
acute mastitis;
reaction to the implant;
inflammatory processes;
fibroadenoma;
breast cyst;
nodular formations.
Breast cyst
A breast cyst is a cavity that is filled with fluid. It is generally accepted that almost every woman has one or more small cystic formations. Normally, they appear during the menstrual cycle, but sometimes such cysts grow to large sizes, which causes pain and discomfort to the woman.
If a thorough ultrasound examination does not reveal a threat of cancer, small cysts in most cases are not touched, and the therapy is the same as for diffuse mastopathy. If cystic formations are suspicious (inflamed, large, have a parietal component) and at the same time provoke severe pain, it is necessary to perform an operation to remove them.
Fibroadenoma
Fibroadenoma is a benign tumor that is localized in the mammary gland. It is a round formation, which in most cases is painless, mobile and smooth. However, depending on the size and location of this node, discomfort and pain may appear that force the woman to see a doctor.
Fibroadenomas usually develop due to hormonal fluctuations, most often in young women who have reached childbearing age. Fibroadenomas, unlike diffuse fibrocystic mastopathy, require a biopsy. In order to exclude the presence of a cancerous tumor, a needle is inserted into the node and some of the cells are pumped out through it, which are subsequently examined under a microscope. After the diagnosis of fibroadenoma is confirmed, the formation is removed. Along with the tumor, anxiety about possible cancer and pain go away.
Lactocele
A lactocele is a cyst in the breast that is filled with breast milk. Due to injury or congenital anomaly, as well as an inflammatory process, a scar forms in the breast, which prevents normal lactation. The milk begins to accumulate and stagnate, subsequently forming a cyst. The cyst grows and gradually provokes a feeling of fullness and pain in the breast area. In some cases, suppuration and an abscess may occur at the site of its formation.
A lactocele is a mobile soft formation. When punctured, milk is released from it. In order to relieve pain, puncture is sometimes not enough; in such cases, surgery to remove the cyst is necessary.
Lactostasis
Unlike lactocele, the main reason for the development of lactostasis is the lack of a feeding regimen. Increased milk production and low milk consumption by the child cause congestion in the chest. Symptoms of this pathology usually appear quite quickly, these are:
aching chest pain;
feeling of fullness and tension;
lump in a certain part of the breast.
In rare cases, a slight increase in body temperature may also accompany the feeling of pain. Such symptoms occur only in the first 3-4 months after delivery, when the child and his mother have not yet entered into the same feeding rhythm.
The main therapy for lactostasis is active breastfeeding. The first portion of milk should be expressed to make it easier for the baby to suck. In the first months, you need to feed the baby on demand, regardless of the time of day or night. If, in the presence of lactostasis, you stop feeding the baby from the “sick” breast, the amount of milk in it will decrease, which may become a problem in the future.
Mastitis
Mastitis is an inflammation of the mammary gland. In most cases, there is a lactation variant of the disease, which occurs during breastfeeding. Also, in most cases, the precursor to mastitis is lactostasis. Stagnation of milk and the presence of cracked nipples allow bacteria to multiply very actively. An infection occurs, and the mammary gland begins to swell, redness, fever and severe pain appear. The general condition of a woman is characterized by weakness, which occurs against the background of a temperature that sometimes reaches 39 degrees.
Diagnosing mastitis is not a difficult task. It is much more difficult to cure this pathology while maintaining normal lactation of the gland. First line drugs are antibiotics. But they can be prescribed only after examination by a doctor. If treatment fails or the condition becomes severe, surgery may be required to drain the resulting pus. In any case, you need to maintain lactation at a certain level.
Breast injury
Injury to the mammary glands is a fairly rare occurrence. Usually there are abrasions or bruises that appear after accidents, falls and other incidents. If a hematoma (bruise, accumulation of blood) occurs in the mammary gland due to injury, discomfort and pain may appear even after a significant period of time. Therefore, if there is a breast hematoma, its removal or puncture is required in order to prevent the development of the inflammatory process.
Pain in the implant area
After breast augmentation or reconstruction surgery, pain is normal. It will take time to get used to the new size and for the scars to heal. However, sometimes the installation of an implant causes an acute or chronic inflammatory reaction or begins to compress nerve endings. In such cases, you should consult a plastic surgeon, and repeat surgery may also be required.
Cracked nipples
Almost all women experienced discomfort in the nipple area after giving birth. A constantly hungry baby demands to be fed hourly, and there is still very little milk. Friction causes burning, itching and pain in the nipples. However, the most unpleasant are the cracks. As the skin of the nipples dries out, it begins to crack, and this is a very painful condition. Wounds and ulcers do not have time to heal in the periods between feedings, and recovery is delayed. In such situations, it is recommended to lubricate the nipple cracks with Depanthenol, Bepanten and other creams of similar action. They do not affect the baby’s health and quickly cope with cracks. If there are severely infected wounds, the baby should be kept off the breast until symptoms subside completely.
Pain that is not associated with the mammary glands
postherpetic neuralgia;
Tietze syndrome;
intercostal neuralgia (with ARVI, rheumatoid diseases).
Tietze syndrome
Tietze's disease is not widespread, but it does occur occasionally. It manifests itself in the form of swelling and pain in the area of the cartilage of the ribs. The causes of this pathology are not clear, and stress or inadequate physical activity can aggravate the condition. In women, a similar syndrome is often disguised as pain in the mammary glands. It is quite simple to exclude the presence of this pathology: you should conduct an X-ray examination of the chest and pay close attention to the cartilage between the ribs. Tietze syndrome has no specific treatment, and for severe pain, NSAIDs are used. Quite often, changing your physical activity routine is the best treatment.
Shingles
The Herpeszoster virus, when it first enters the body, provokes chickenpox and leads to shingles on the body. This is a very painful condition, which is accompanied by blistering rashes, itching and burning pain. Most often it affects the nerves and skin of the lumbar region (hence the name of the pathology). When a rash appears in the chest area, pain and itching can be confused with manifestations of mastopathy. Therefore, it is very important to examine the chest for redness and blisters. The pain of such rashes disappears after 2-3 weeks, and antiviral therapy (herpes ointments, Acyclovir) will help to significantly alleviate the general condition.
Mammary cancer
The most dangerous among all causes of breast pain is breast cancer. This is a neoplasm that occupies a leading position among cancer diseases in women. In addition to the fact that such cancer is widespread, it is also dangerous due to its high mortality rate, since many women postpone visiting the doctor until the last moment.
Risk factors for breast cancer
oncological processes of the intestines, ovaries or breasts in close relatives (grandmothers, mother, sisters);
previous oncological processes listed above;
age over 60 years;
obesity;
absence of pregnancy and childbirth, late menopause, early menstruation.
Among all the factors, the main one is the effect of hormones on the body and mammary gland, in particular estrogen. It must be remembered that the presence of diffuse mastopathy and cyclic premenstrual chest pain are not considered risk factors for the development of oncological processes in the mammary gland.
Heredity, which is aggravated by cases of oncology, requires a particularly attentive attitude to one’s own health. About 10% of breast cancers are the result of a genetic defect. The presence of the BRCA2 and BRCA1 genes increases the risk of cancer by several tens of times. Therefore, painful sensations in the chest in women who have/had relatives with cancer of this organ require special attention and special research.
Symptoms of breast cancer
Small tumors without metastases most often do not cause pain or discomfort. Pain can only occur when the tumor compresses the nerve endings. Therefore, self-diagnosis of the mammary glands is a very responsible and important stage of diagnosis. A special form of breast cancer is Paget's cancer. It differs in that the tumor is localized in the nipple area and causes its elongation and deformation, as well as pain to the right or left of it.
Breast cancer treatment
In the initial stages, cancer that has not yet spread beyond the nearest lymph nodes or breast usually undergoes complex therapy. It includes surgery to remove the tumor, radiation and chemotherapy. Depending on the type of tumor, hormonal medications may be used. Sometimes, if there is a large tumor, it is first shrunk with chemotherapy and then surgically removed. The scope of surgical intervention in our country is usually large-scale: the mammary gland with regional lymph nodes and underlying muscles are removed. In European countries, such pathology is diagnosed much earlier, so it is possible to perform partial resection of the mammary gland with the application of cosmetic sutures.
Breast examination methods
If painful sensations appear in the mammary gland, it is necessary to conduct a series of studies. They allow you to determine the cause of such discomfort and exclude the presence of life-threatening conditions. Diagnostics also helps to select the most optimal treatment option.
Breast self-examination.
Lying down - in order to examine the right chest, place a pillow under the right shoulder blade, and place the right arm behind the head. Using the fingertips, the entire breast is probed from the periphery to the nipple.
Standing – the examination is performed in two positions with arms raised and lowered.
Points worth paying attention to:
the presence of ulcers on the skin of the chest;
pain on palpation;
changes in skin temperature and color (blueness, redness);
change in the skin of the breast according to the “lemon peel” type;
change in the size of the mammary glands (asymmetry);
the presence of discharge from the nipple of any shade (the exception is milk during lactation);
nipple retraction;
seal of any size and shape. Especially if it is large, motionless, and has uneven contours.
All of the above signs are a signal that you should consult a specialist. Such a specialist is a mammologist, therapist or gynecologist. If the doctor identifies a threat to the woman’s health, she will be sent for additional examination and consultation with an oncologist. Feeling and examining the breasts helps a woman detect cancer in the early stages. However, it should be noted that most of the formations identified independently are benign and most often do not even require special treatment.
Breast examination if pain occurs
Mammography is an X-ray examination of the mammary glands. This method is the standard for diagnosing breast pathologies among women over forty years of age. It makes it possible to assess the growth pattern of the malignant process, the prevalence of the disease and the condition of the breast tissue. However, if the glandular dense component dominates in the breast, mammography is not very informative. Therefore, breast ultrasound is more relevant for young women.
Ultrasound of the mammary glands – ultrasound examination of the mammary glands is required in the following cases:
for differential diagnosis of cysts;
in all women who complain of pain (addition to mammography);
in young women for prevention purposes;
in pregnant women and during lactation.
MRI and CT of the mammary glands - magnetic resonance and computed tomography - are additional examination methods. It is not advisable to use them as a preventive test or during the first visit to the doctor. Typically, such methods are resorted to when there is an unclear diagnosis or when there is an unclear picture on ultrasound and mammography. In addition, CT and MRI help to assess the condition of neighboring organs and diagnose metastases in distant parts of the body, in the presence of malignant neoplasms.
Aspiration biopsy - with a painless or painful formation in the breast, especially in the presence of aggravating heredity or during menopause, one x-ray is not enough. To confirm the diagnosis, it is best to examine the pathological cells under a microscope, which will determine the degree of their malignancy. In such cases, aspiration biopsy is most often used. In some cases, this stage is omitted and they immediately proceed to tumor removal and subsequent histological examination of the resulting material.
If necessary, the doctor may prescribe additional tests to determine an accurate diagnosis.
Treatment of breast pain
Treatment for chest pain depends on the cause that causes it. Therefore, the first step is to contact a specialist for a detailed examination.
Treatment of cyclic pain
Diffuse mastopathy with premenstrual pain is a benign and safe phenomenon. At its core, this is a common reaction to a normally occurring ovulatory cycle. However, if a woman is very bothered by such pain, several methods are used.
Conversation with a doctor.
Oddly enough, quite often a simple conversation with a doctor is enough to relieve symptoms. After qualified explanations about the safety of mastopathy and the patient’s absence of cancer, the patient’s condition improves dramatically and the discomfort goes away.
Selecting the right underwear.
A tight bra of the right size and shape can reduce discomfort and cyclic pain.
Dosed physical activity, proper rest and aromatherapy for PMS.
Losing weight and limiting fatty foods.
Oral contraceptives.
Taking combined-action oral contraceptives is an option to temporarily “turn off” ovulation. There is no ovulation, which means there are no hormone surges. Therefore, pain and discomfort when using COCs are either significantly reduced or disappear completely.
Non-steroidal anti-inflammatory drugs (Paracetamol, Ibuprofen).
Tamoxifen is a drug that is used in the presence of severe mastopathy with severe pain. The drug has side effects, so it is prescribed only if there are strict indications.
It is important to remember that any homeopathic remedies that supposedly relieve mastopathy are pure quackery. The effect of such drugs is based on self-hypnosis. Therefore, it makes no sense to use drugs with unproven safety and effectiveness; you can simply limit yourself to talking with a doctor, taking a bath and getting proper rest.
Treatment of non-cyclic pain
If inflammatory processes, tumors and cysts are detected, a doctor’s consultation, detailed diagnosis and, if necessary, surgery are required. After resection of benign lesions, drugs for the treatment of PMS can be used. After treatment of oncological pathologies, many drugs are contraindicated. Pain in breast cancer with distant metastases is very severe, painful and cannot be relieved with NSAIDs. Sometimes narcotic analgesics are required to relieve such pain.
Treatment of pain that is not related to the breast
An intelligent doctor determines the source and cause of such pain and prescribes additional studies. Treatment is selected according to the nature of the pathology.
The most popular questions from a doctor when collecting data
Before going to see a doctor, you need to carefully consider the answers to the questions that he will probably ask.
In which breast is the pain felt?
What type of pain is present? (stabbing, bursting, aching).
How long does this pain last?
How severe is the pain if you rate it on a 10-point scale?
Do one or both breasts hurt?
Are there any patterns when pain occurs (breastfeeding, exercise, menstruation)?
When was the last time you had a mammogram?
Are there any other symptoms (nipple discharge, breast lump)?
Have you recently had a miscarriage or abortion, are you breastfeeding or pregnant?
Do you have a history of breast surgery or chest trauma?
Has any of your close relatives suffered from colon, ovarian, or breast cancer?
Many women experience pain in the mammary gland (mastalgia), especially at a young age and in the period preceding the onset of menopause.
Pain often accompanies the menstrual cycle and manifests itself most intensely at its initial stage.
In addition to physiological processes in a woman’s body, which are accompanied by unpleasant sensations in the chest, pain in the mammary gland can be a sign of pathological disorders - both various diseases localized in the gland and beyond.
When pain occurs, it is necessary to determine the cause of its occurrence. To do this, if you experience any unpleasant sensations (discomfort or pain), you must contact a specialist who will conduct an examination and determine their nature.
After this, treatment will be prescribed if necessary (for pathology), or recommendations for pain relief will be given (for physiological reasons).
Anatomy of the breast
The mammary gland is a type of apocrine gland, is a paired organ and is located on the anterior chest wall from the 3rd rib above to the 7th rib below. Its base is adjacent to the pectoralis major muscle.
On the most protruding part of the gland, which is called the body, there is a pigmented zone - the nipple field (areola), in the center of which is the nipple itself with small openings: the milk pores and the main milk duct in the center of the nipple.
In its internal structure, the mammary gland is an alveolar-tubular gland, consisting of many alveolar microscopic formations that are located in its parenchymal tissue. Each such formation (alveolar gland) has its own duct, which ends in the nipple area. The alveolar glands are grouped and form the lobes of the mammary gland, being their secretory apparatus. Individual lobules are combined into segments, the total number of which is 18-20 for each mammary gland. These segments are separated by a connective tissue component.
The “free” spaces of the gland are filled with ordinary adipose tissue.
Between the right and left glands there is a kind of depression - the sinus, which is projected onto the area of the body of the sternum.
The size of the mammary gland varies from person to person, but during the menstrual cycle, pregnancy and subsequent lactation (breastfeeding) and some diseases, the gland significantly increases in size.
The skin of the mammary gland is quite delicate, especially in the area of the nipple and the surrounding areola.
Nature of pain
Based on the frequency of occurrence, a distinction is made between periodically occurring pain in the mammary gland (cyclical) and non-cyclical (continuously disturbing). Non-cyclical pain syndrome can spread to the breast area, radiating to this area with intercostal neuralgia (increased sensitivity of nerve fibers), pain in soft tissues (muscle fibers).
- Cyclic mastalgia worries most women a few days before the start of the menstrual cycle. There is a feeling of fullness. Visually, a slight increase in breast volume may be observed. Pain sensations spread symmetrically (on both sides), increased sensitivity and pain are observed both on the outer and inner parts of the chest.
With the onset of menstruation, discomfort and unpleasant sensations subside.
- Noncyclic mastalgia is usually asymmetrical. Localized in a specific area of the right or left breast. Rarely, pain is felt throughout the entire area, radiating to the armpit. Accompanied by a burning sensation and increased sensitivity. Usually diagnosed in patients over 40 years of age.
Pain syndrome:
- Spicy. Typically, such cyclic mastalgia occurs before the onset of the menstrual cycle and is considered within the physiological norm. Otherwise (pain does not appear before the onset of menstruation, during the non-reproductive period) it may be a sign of a more dangerous disease, if it occurs, you should seek advice from a specialist - a mammologist.
- Burning mastalgia. Disturbs when at rest. Intense, spreads from the mammary glands to the back or neck. The intensification and subsidence of pain is not associated with physical activity and body position; palpation increases pain.
- Stitching pain has a pronounced localization, occurs in the form of attacks, constantly decreasing and increasing.
- Aching mastalgia, due to its low intensity, is the most dangerous. Despite the fact that it worries constantly, many women do not consider it (due to its mild manifestation) as a need to see a doctor. Although the favorable prognosis of most diseases depends precisely on the timeliness of treatment.
Causes
Cyclic – pain before menstruation. Constantly, periodically occurring cyclic mastalgia usually indicates a disturbance in hormonal levels. Since they “disappear” during pregnancy and menopause (when there is no monthly change in hormonal status), this theory confirms the nature of their occurrence – hormonal.
Pain sensations spread over the entire surface of the mammary glands and are usually aching, “muffled” in nature. Rarely, pain of high intensity is observed, up to restriction of movements of the upper limbs.
Unevenness (the appearance of tubercles) in the soft tissues is determined by palpation. The pain subsides almost completely with the onset of the menstrual cycle or “transition” to the non-reproductive period.
Such pain may occur after (or during) taking medications (for example, hormone therapy). When treated with progesterone or estrogen, cyclic pain syndrome may persist even after menopause. Less commonly, pain can be a side effect of long-term use of antidepressants.
Non-cyclical. Pain is associated with changes in the anatomical structure of the mammary glands (for example, implants), violation of the integrity of the skin (nipple cracks), infectious and oncological diseases. Mastalgia can be a consequence of traumatic effects on this area, radiating from nearby organs and systems (nerve fibers, joints).
The main difference between non-cyclic mastalgia is its pronounced, asymmetric localization. The character, as a rule, is more intense (for example, cutting, piercing).
Cracked nipples. Violation of the integrity of the skin of the mammary glands, localized in the nipple area. The main reasons for this defect are:
- Incorrect position of the baby during feeding (the nipple is not fully grasped), the head is not fixed well enough. As a result, the nipple area is constantly irritated by the moving (during feeding) jaw and lower lip.
- “Excessive” compliance with breast hygiene. With frequent washing (especially with cosmetics), the natural protective environment - the lubricant produced by the Montgomery glands - is washed away from the nipples along with bacteria.
- Wearing pads that impede air access is justified only when milk is released. Otherwise, they only contribute to the development of an unfavorable bacteriological environment and irritate the sensitive skin in the nipple area.
- The cause of cracks may be a general weakened state of the body - for example, vitamin deficiencies; Features of the anatomical structure of the mammary glands - retracted, very small nipples.
The presence of cracks is clearly visualized; the main symptom is pain in the damaged area. When they deepen (into the lower layers of the skin), bleeding is possible.
It can constantly bother a nursing woman, but in most cases it manifests itself (with varying intensity) while putting the baby to the breast.
The most dangerous complication is infection of the skin at the site of crack formation. This can cause an inflammatory process with the formation of pus; fungal microorganisms can trigger the development of mastitis.
Breast cyst. A pathology in which cavities form in the mammary gland (the boundaries of the formations are the connecting capsule) filled with liquid or gruel.
Cysts are:
- single;
- multiple. For example, with polycystic disease, cavities of different sizes can form entire conglomerations (these are multi-chamber cysts).
The formations vary in depth and size: from a few millimeters to 5 cm in diameter.
Clinical picture
The development of the cyst is asymptomatic; small cysts are diagnosed accidentally: for example, during routine examinations. Large formations can cause visible deformation of the breast and cause discomfort. The pain is tugging, but not sharp, but aching in nature. There may be a feeling of burning and heaviness.
There are no clear reasons for the formation and growth of cysts. But the following are considered “threatening” factors:
- hormonal imbalance (natural or associated with medication);
- plastic surgery of the mammary glands;
- hereditary predisposition;
- a cyst can develop against the background of diseases of the mammary glands that affect the size of the ducts and the condition of the glandular tissue (for example, fibrosis, mastitis, etc.).
Fibroadenoma. Benign formation of the mammary glands, elastic and mobile on palpation (no connective tissue capsule). “Grows” from lobules, as a rule, asymmetrically (in one mammary gland). The size of fibroadenoma, like cysts of this localization, ranges from 2-3 mm to 5 cm.
Risk factors for educational development:
- Significant changes in hormonal levels (for example, during adolescence and menopause). Moreover, only after the girl’s body has completed “maturation”, the tumors resolve without any treatment, on their own.
- Contraceptives (orally), artificial termination of pregnancy - abortion.
The clinical picture does not differ in the “bouquet” of characteristic symptoms. As the tumor grows, the mammary glands increase in volume (with the exception of menopause and menopause). Pain sensations are completely absent or mildly expressed.
Lactocele. A rare pathology in which the cysts that form are filled with breast milk. Reasons: the ducts “incorrectly” get rid of milk, resulting in their complete obstruction. A closed cavity is formed from the milk arriving in the duct. Cysts filled with milk can reach significant sizes. Over time, their contents can become infected and inflamed.
The reasons for the formation of lactocele are associated with the anatomical feature of the structure of the mammary glands, namely their ducts. Pathology can be caused by stagnant, non-excreting milk, which thickens and becomes more viscous.
Symptoms:
- pain syndrome is mild or absent;
- patients complain of discomfort;
- large formations can be palpated.
Lactostasis. This is milk stagnation and can occur in one or another area (sometimes several) of the mammary gland. The reason is an incorrect breastfeeding regimen, in which milk remains in the mammary glands; physical or emotional stress.
Symptoms:
- soreness;
- the tuberosity of the skin is visualized in the projection of milk accumulation;
- skin is hyperemic.
The main complication of lactostasis is mastitis (inflammation of the mammary gland), which develops after congestion in almost 90% of cases.
Pain in the implant area. Pain syndrome can occur independently or appear against the background of the following complications:
- Pain syndrome after implantation sometimes occurs due to compression of nerve endings or disruption (by a foreign body) of normal contraction of muscle fibers. Its intensity varies from slight to intense. The reasons are the size of the prosthesis being too large, incorrect installation, etc.
- Infection. Pain and discomfort are associated with the development of the inflammatory process and are accompanied by the appearance of characteristic symptoms of inflammation: increased temperature (general and local), weakness, etc.
- Hematomas (collection of blood) or seromas (excessive concentration of serous fluid) localized in the area of violation of the integrity of the soft tissue or around the implant. Infection is possible at the site of their origin or the formation of a fibrous capsule. Clinical picture: swelling of the operated area, pain, bruising.
Injuries. Symptoms largely depend on the nature and severity of the traumatic impact, violation (or preservation) of the integrity of the skin and soft tissues.
A bruise (closed injury to soft tissue) is characterized by:
- Formation of a hematoma located under the skin or deeper, for example, in muscle or connective tissue.
- Pain and swelling persist for a long time, and clear discharge may appear (if the milk ducts are damaged).
- A zone forms on the damaged area, which is palpably determined to be denser.
Closed injuries are dangerous due to their consequences - the likelihood of developing a malignant process, especially if the patient has a history of nodular mastopathy.
Mastitis. The inflammatory process of the mammary gland can occur in acute and chronic forms. The most reactive form of development is the disease that occurs during breastfeeding - it occurs 2-3 days after the appearance of stagnant milk.
The clinical picture differs depending on the type of disease, each of which is accompanied by a specific set of symptoms.
- pain syndrome – high intensity;
- when touched, the breasts are painful, hot (due to a local increase in the temperature of the skin), more dense;
- compactions are determined by palpation, which can be concentrated in a limited area or distributed over the entire surface of the mammary gland;
- an increase in the size of the gland is associated with its swelling;
- with a severe inflammatory process, enlargement of the lymph nodes is possible (for example, with abscess of the mammary glands and phlegmous mastitis);
- body temperature – elevated (up to 40 degrees);
- rapid heartbeat is characteristic of infectious mastitis;
- symptoms of general intoxication and changes in the shape and contours of the breast are inherent in the phlegmous form of the disease.
In the chronic form of the disease, it is characterized by a sluggish inflammatory process. The lumps are detectable, but all the main symptoms are smoothed out: pain and temperature are minor, there is no swelling or redness of the skin.
Mammary cancer. Oncological diseases of the mammary glands, depending on the stage of the process, manifest themselves with local and systemic symptoms.
Local:
- neoplasms determined during self-diagnosis (palpation of the mammary glands);
- discharge of any color and consistency from the nipples;
- wounds and ulcers on the skin of the chest that do not heal over a long period;
- changes in the shape, size, structure of the mammary gland, color or surface of its skin: for example, the appearance of denser or wrinkled areas, deformation of the nipples (retraction), etc.;
- enlarged and painful lymph nodes (especially in the armpit);
- pain of varying intensity, breast tenderness when touched.
General symptoms:
- elevated temperature;
- weakness, fatigue;
- poor sleep and appetite.
Intercostal neuralgia. This is irritation of nerve endings (due to their compression, pinching) in the spine or intercostal space.
The main symptom is pain, which has its own “characteristics”:
- intense, burning, non-spasmodic;
- localized between the ribs, but can spread throughout the damaged nerve: to the back, lumbar region;
- pain increases with movement (including inhalation and exhalation), sneezing, coughing;
- -the most painful area is determined by palpation - the damaged nerve, when pressed, “reacts” with an increase in pain;
- Referring pain may be accompanied by other uncomfortable sensations: burning, loss of sensitivity, tingling.
In some cases, neuralgia is accompanied by a change in skin color (pallor or redness) and involuntary muscle contractions.
Mastopathy. Benign disease. Pathological changes in the mammary gland (all its tissues) are caused by excessive proliferation of connective tissue.
Depending on the “involvement” of certain areas in the process, the disease manifests itself in different ways: cysts, epithelial dysplasia, benign tumors of various etiologies, etc.
Mastopathy happens:
- Diffuse. Breast tenderness increases with palpation. Subcutaneous formations (nodules, small cysts) are identified that resolve independently during the menstrual cycle.
The pain syndrome is a constant concern, but its manifestations are minor. The patient complains of a feeling of heaviness in the chest.
- Nodal. Tumor-like nodes (single or multiple) are determined by palpation. The formations are not painful, mobile, their maximum size is up to several centimeters. Lymph nodes (in the armpits) are not enlarged. Unlike the diffuse form, neoplasms do not go away during and after menstruation, but increase in size over time.
Common symptoms identified in various types of mastopathy are:
- pain;
- nipple discharge;
- nodular formations of various sizes and “concentrations”.
Breast abscess. Purulent foci in the soft tissues of the mammary gland.
The first manifestation of the disease is a general increase in temperature. The mammary gland becomes painful, sensitive to the slightest touch. Areas located near the lesion swell and become denser.
Gradually, the inflammatory process affects unaffected areas, which is manifested by a local increase in the temperature of the skin, its hyperemia and the formation of an abscess - an abscess.
Pathological forms:
- Superficial abscess. The accumulation of pus is localized around the nipples, in the skin layers.
- Intramammary. The disease is usually a complication of mastitis.
- Retromammmapny. When the posterior part of the gland is affected by purulent foci.
In any form, the body temperature remains above normal until the abscess ruptures.
When the pain is not related to the mammary gland
Pain syndrome can radiate to the chest area in diseases of other organs and systems of the body, resulting from an imbalance of certain substances (for example, fatty acids) in the soft tissues that form the mammary gland.
Shingles. A disease caused by the activation of the chickenpox virus.
Symptoms:
- elevated temperature (up to 39 degrees);
- discomfort (itching, burning, pain) are localized in areas of “forming” rashes (including in the area of the mammary glands);
- the rash that appears is accompanied by pain;
- symptoms of general intoxication: chills, headaches, etc.;
- Exanthema (rash) first appears as spots. Then it resembles vesicles filled with serous fluid, the base of which is inflamed and swollen;
- in most cases, the lymph nodes become enlarged and painful.
The rash is localized “along the course” of the affected nerve: for pain in the mammary gland, this is the intercostal nerve. After a few days, swelling and hyperemia subsides, the contents of the bubbles become cloudy. Gradually, the exanthema dries up and the resulting crusts fall off. Low-grade fever and signs of intoxication persist for several days.
Tietze syndrome. A disease characterized by morphological (structural) changes in the ribs (second, third or fourth) of a benign nature.
Manifests:
- rib deformation. Upon examination, slight swelling is visualized in the soft tissues surrounding the affected rib;
- painful sensations - acute or increasing in nature, localized in the chest area (upper part). The pain syndrome can spread to the area of the upper limb and become more intense with loads and movement;
- The affected rib is painful on palpation. A spindle-shaped formation measuring about 4 cm is determined.
Breast disease risk group
- Age. After 35 years, every woman needs to undergo preventive examinations and consultation with a mammologist at least once a year.
- Early onset and cessation (menopause) of the menstrual cycle.
- Genetic predisposition. The risk of malignant tumors of the mammary glands increases if it is detected in one of the family members or close relatives.
- Lifestyle. An important factor is proper nutrition and lifestyle: with moderate physical activity and the absence of overexertion (physical and emotional) and bad habits.
- To prevent diseases that often develop during breastfeeding, it is necessary to adhere to the correct breastfeeding regimen: from the position of the child, hygiene to the prevention of congestion.
Diagnosis and differential diagnosis
Diagnostic measures for pain in the mammary gland must begin with basic things - taking an anamnesis, examination and palpation. Sometimes this is enough to establish the cause of pain without exposing patients to more complex diagnostic methods, which often have side effects (for example, ALLOWABLE radiation exposure during mammography).
The examination is carried out in two positions - standing (with arms raised and lowered) and lying down. Pay attention to the color and condition of the skin, especially in the nipple area, the presence or absence of visible damage, and possible abnormalities in the development of the gland.
During palpation, which is carried out over all quadrants of the gland, general pain and the presence or absence of compactions are noted. Formations can be with clear edges or not, mobile or fixed, with pain on palpation or its absence. Most often, compactions are palpated in the upper outer segments of the gland, which are the most biologically active.
To clarify the diagnosis, instrumental diagnostic methods are used - ultrasound, radiographic methods and radiothermometry.
The most accurate and informative method for diagnosing breast diseases is mammography. This radiographic technique (without the use of contrast agents) in approximately 95% of cases allows one to clearly determine the presence of a pathological process in the mammary gland. Mammography is performed in two projections: frontal and lateral. If necessary, targeted radiography is performed, which helps to avoid diagnostic errors.
In young women during pregnancy and lactation, the main diagnostic method is ultrasound. This study is absolutely safe and is characterized by the absence of radiation exposure to the body.
Differential diagnosis is carried out with heart diseases, myositis.
Pain treatment
The treatment strategy for breast pain depends on the reasons that caused the pain.
For cyclical pain during the menstrual cycle (diffuse mastopathy), sometimes it is enough just to talk with your doctor, choose an appropriate bra that will not compress the breasts, fix the mammary gland in one position and limit the intake of fatty foods.
For more intense pain, analgesics (non-steroidal anti-inflammatory drugs) are used.
Taking combined contraceptives (after prior consultation with a doctor) gives a good effect.
Treatment of non-cyclic pain should begin only after consultation with a doctor and examination. Eliminating the cause of the pain comes to the fore. This may include removal of a benign or malignant tumor in the mammary gland, special hormonal therapy, vitamin therapy, or effective drug treatment. Most often, an integrated approach is used.
What do doctors do
First of all, the doctor determines the cause of the pain. For this purpose, the entire range of diagnostic measures is used. After this, a specialist is determined who will further deal with women’s health: sometimes it is an oncologist (if a tumor is detected), sometimes a gynecologist (if the pain is premenstrual in nature) or a general mammologist who deals with diseases of the breast itself.
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