Maggie McKay (Host): Welcome to HealthWorks Here. I'm your host Maggie McKay. Dr. Dana Xu, Emerson Health General Surgeon who specializes in breast health is here to share the facts about breast pain and why your breasts hurt. Thank you so much for being here and making the time.

Dana Xu, MD: Hi Maggie. Thanks for having me.

Host: Of course. How common is breast pain?

Dana Xu, MD: It is exceptionally common. Over 70% of women experience pain in their breasts at some time and point.

Host: And why does it happen?

Dana Xu, MD: There's a large number of reasons. I think the easiest way to think about it, and the way we categorize it, is there's three main categories. First one, and most common about two thirds of the population, is you get pain right near your period. And that happens because your body, your hormones are changing and your body is priming your breasts to get ready to get pregnant.

So there's going to be swelling, there's going to be stretching on the tendons, there's going to be proliferation or enhancement of the breast. That's why around your period you go, oh, they're bigger and ow not great. And that's exceptionally common. The other type that we that women go through, is the ones that are completely not related to your cycles, and that can be due to a large number of issues, which we can go over.

It goes from are you properly fitted? I think one thing that I commonly see is patients after breastfeeding, after pregnancy, you got babies, you got toddlers, you're too busy and you're trying, you're either still wearing that maternity bra or you're trying to squeeze back into the toy clothes that you had from before you had pregnancy.

And without the appropriate support you are going to have breast pain. Especially for women who have larger breasts, you have these lovely ligaments called the Cooper's Ligaments that keep everything up. And when you don't have that support, that stretch can often cause pain. You have a number of other things that can also cause pain, not related to your cycles.

It can be anything from something like prior injury, to cysts, fibrocystic breast disease is exceptionally common, to very rarely an infection. And least commonly less than 2% of the time, it's going to be something more dangerous like a cancer. But typically, cancers don't hurt.

Host: So if I have breast pain, should I worry?

Dana Xu, MD: No, it depends on how much it's affecting your lifestyle. If you are experiencing mild pain around your cycles, it's one of those things where, yep, that's frustrating, but it's completely normal and it's kind of silly, but a lot of times knowing that it's normal and knowing that it's not dangerous can oftentimes help the pain itself.

Tylenol, Ibuprofen are going to be your best of friends with needed. There are things that is great for your general health and can also help with breast pain, which is increasing your fiber intake. Everybody should be taking about 30, 35 grams of fiber a day. I don't care what type of supplement you take, they come as cookies, they come as gummies, they come as powders you can hide in your drink.

Choose the one that works for you and your lifestyle. It's a nice natural inflammatory and it gives you some good regularity. Okay, good hydration. Diet, exercise, the endorphins can help. But those are all things that everybody knows. Other things that have been demonstrated to kind of help with the pain, but we're not quite sure of the mechanism, is the combination of evening primrose oil along with vitamin E and that has in some small studies, demonstrated, actual improvement in the breast pain. Other last thing that we recommend, but I leave it up to you, is cutting out caffeine. In that situation, you've really proved to me how bad your pain actually is.

If you can give up your coffee for four weeks, then your pain is real. And if it helps, wonderful. If it doesn't, God bless it. Take your coffee and survive the day.

Host: I think you pretty much answered this, but it's worth asking again. Is pain ever a sign of breast cancer? Very minimally, right? Maybe percent.

Dana Xu, MD: Very rarely. Yes, it can be. But typically breast cancers do not cause pain. The way a breast cancer usually presents is most commonly on your screening mammogram, get your routine screening. The second most common way is your own self breast exams. And when you feel a small lump or a nodule that wasn't there before, or it's hard and it's firm and it's not moving, but very rarely, unless it's in a difficult location or really advanced, at which point, it's not subtle; it does not classically cause pain.

Host: And if I have breast pain, when should I visit you or another specialist?

Dana Xu, MD: I think the first best avenue for breast pain, given how common it is, is talk to your primary care. If you have a primary care that you trust, go over your symptoms. See, is this related to my cycles? Is this not? When was the last time I got a bra fitting? Is it responsive to, anti-inflammatory like ibuprofen?

Am I doing everything I can to help optimize my general health? Am I hydrating adequately? Do I really want to give with caffeine? Sure. But if it's not, the time you come is when it's not going away and it's not getting better. First thing you always do is as always, you do your screening to make sure that's nothing more dangerous.

And then you come see me. I do a good exam. I make sure that I don't feel anything dangerous, and if everything's completely reassuring, I give you a lovely little sheet that shows you all the local bra fitters, all the different vitamin supplements you can take. And just a good old kick in the butt for yes, self-care and sorry, it'll get better with time and age. Genuinely it will.

Host: I think you are the first doctor I've ever heard of that gives a list of bra fitters, which is brilliant, and everybody should because they say, go do it. But now you know, you go to maybe a high-end department store where they used to have professional bra fitters and they don't have them anymore. So you really have to seek them out.

Dana Xu, MD: Not only that, but like every, I think a lot of the higher end bra places have changed their sizing. So what you get fitted in one place isn't necessarily how you get fit in another place. So no, I do not recommend that you go to and buy a 50, 60, a hundred dollar bra. What you do is you go get fitted and you know what feels right and is comfortable for you.

So you know what a good fit is. Then you take that knowledge and when you try on other bras, even if it's not the exact size, they tell you, you know, what the fit feels like. That's what matters.

Host: You're so right and it's shocking how when you do put it off and you don't go for a few years, how much the size has changed one way or the other after you have a baby, after menopause, whatever. It's just shocking. Anyway. Dr. Xu, what do you wish women knew about breast pain and breast health?

Dana Xu, MD: How common it is, how it's absolutely okay to talk about it and how it's absolutely not fair that we have it. That is also classically completely okay. Unfortunately, common and ultimately, typically not dangerous.

Host: In closing, what else would you like to stress that maybe we mentioned or maybe we didn't?

Dana Xu, MD: My biggest emphasis is that at the end of the day, you are the constant in your health. Know yourself. Know your breasts. Do your routine self-breast exams once a month, whether in the shower or at night when it's one of those nights you can't fall asleep and you just want to get back on your phone. That's a good time to say, oh yeah, I might as well do this. Do a good breast exam. Everybody has lumpy breasts. Everybody has breast pain. But know what's normal for you, know what's different for you. And when you have that, something that's changed or something that's focal, that's when you go, huh, I should dig into this further.

And that's it.

Host: Thank you so much for sharing your expertise. This has been really informative and helpful.

Dana Xu, MD: Thank you for having the time.

Host: Again, that's Dr. Dana Xu. Visit Emersonhealth.org/breasthealth or call 978-287-3547 to learn more and to make an appointment with Dr. Xu. Again, that's 978-287-3547. Thanks for listening to Emerson's Health Works Here podcast. Make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple Podcasts, Pandora, Spotify, or wherever podcasts can be heard.