Expert: Claes-Gustaf Nordquist, M.D. - 1/3/2006

Question
Hi, I am a 27 year old healthy woman.  I have suffered from painful sore breast on and off since I started my period at the age of 12.  I have 2 children a 6 year old and a 20 month old.  About 4 years ago when my son was 2 my breast pain in my left breast became very painful and very lumpy.  The lumps hurt and felt achy. They hurt right before my period and then the pain would get better after my period but the lumps stood there.  The lumps did move and felt more like glands.  I went to the doctor and they sent me for a ultra sound.  The ultra sound showed that these lumps were all fluid filled.  They also told me that my breast really have no fat on them just my layer of skin and muscle, so everything I felt in my breast felt more lumpy and exaggerated than someone else who has more skin and fat. My right one had a little more fat on it, which is why it looks a little bigger, so it did not feel as lumpy as the left one. For the last couple of years I have not thought much about my breast.  I had my daughter almost 2 years ago, suffered throughout the pregnancy with painful breast, since i had her I been on the pill.  I have been fine until this past week.  My left breast again has that achy feeling and just sore.  My right one is sore too but not as lumpy.  The pain goes up too my arm pit.  It almost feels like a muscle ache but I know the pain is coming from the breast.  When i press the lumps they hurt.  I am due for my period 5 days from today.  I also must confess that during the holidays I have been drowning myself in chocolate and soda and wine and just not a healthy diet at all.  Could this help make the breast more lumpy and sore? The lumps that I feel are usually the same ones that are always in my breast but now they are very painful. They do move around.  Even though I had the same symptoms 4 yrs ago and everything was fine, I still always fear cancer.  My next question is, are breast suppose to not have any lumps in them at all, because I always have lumps and I go for my annual check ups once a year and they always check my breast. NOthing ever comes up as a problem.  I don't have any family history of cancer but I do have a family history of fibrocystic breast.  Should i be concerned about cancer right now?  Should I get check after my period?  My next annual breast exam is in May.  What does cancer feel like in the breast?  Is cancer painful?  Can my doctor tell by feeling my brest if it could be cancer.  I really don't want to go for a mamogram yet, can they send me for an ultrasound first like last time?  I do appreciate any advice.  It's a new year and I just get so emotional when I look at my children and fear that these lumps could oneday take me away from them.  I have had alot of stress lately, I had a girlfriend 35 who feared she had breast cancer she had to go for a series of test before finding out she did not have cancer but the wait was very stressful and scary which brought my breast back to my attention.  Well i Hope to hear from you soon.  Thank you.

Answer
This is a rather common female problem. The fibrocystic disorder of the breasts is hormone related. That is why you have these symptoms related to your menstrual cycle etc. It usually passes away after menopause. Some studies have found a certain connection between this condition and breast cancer, but other studies dispute that. If there is a connection it is most probably a weak one and other factors like heredity are much more important. However the lumpiness makes checks for breast cancer much more difficult. It also interferes with mammography making it more difficult -the breasts are denser to X-rays making tumours more difficult to see. A combination of ultrasound, conventional X-ray mammography and MRI-mammography (not yet available everywhere) - if needed in combination with thin needle biopsies - however makes diagnoses much better and more secure even with fibrocystic disorder present.  The best time to check is after the period when least lumpy - and always on the same day in the menstrual cycle. Diet is of very little consequence. Since you have a problem with this I do suggest regular check ups! Good luck!