A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Are you at risk of breast cancer? Learn about BRCA positivity and take charge of your health. Explore insights and guidance at Meri Sehat for a proactive approach.

BRCA-Positive: Are You At Risk Of Breast Cancer?

Humza Khizer

Breast Pain FAQs

Introduction

Whether it&#39;s a dull ache, sharp stabbing sensation, or a feeling of heaviness, breast pain is a common and often frustrating symptom that many women experience at some point in their lives.

Breast pain, or mastalgia, is a common complaint among women of reproductive age in the US, with about 70% of women experiencing it at some point in their lives. However, only 30% seek medical help<a href="#accordion">[1]</a>. 
&nbsp;

This is despite the fact that it has a negative impact on a woman&#39;s life, including interference with sexual and physical activity, work, and social activities. The prevalence of breast pain varies among ethnicities, with women of Asian ethnicity reporting it less frequently than British women<a href="#accordion">[1]</a>.

While it can be alarming to experience pain in the breasts, in most cases, it is not a cause for concern. However, there are times when breast pain can indicate a more serious underlying condition, so it is essential to understand the different types of breast pain, their causes, and when to seek medical attention. 
&nbsp;

Breast pain can have various causes, some of which are more serious than others. Here are some common causes of breast pain: 
&nbsp;

<ul>
	<li>Hormonal Changes: Breast pain is a common symptom of hormonal changes during the menstrual cycle, pregnancy, or menopause.</li>
	<li>Injury Or Trauma: An injury or trauma to the breast or chest can cause breast pain.</li>
	<li>Breast Cysts: Breast cysts are fluid-filled sacs that can cause pain and discomfort.</li>
	<li>Fibrocystic Breast Changes: This is a condition where the breast tissue becomes lumpy and feels tender or painful to touch.</li>
	<li>Mastitis: Mastitis is an infection of the breast tissue that can cause pain, swelling, and redness.</li>
	<li>Medications: Certain medications, such as hormonal contraceptives, can cause breast pain as a side effect.</li>
	<li>Breast Cancer: Breast pain is not usually a symptom of breast cancer, but it can be in some cases. 
	&nbsp;</li>
</ul>

Note: Consult a doctor if you experience persistent breast pain or if you notice any other changes in your breasts. They can determine the cause of your pain and recommend the appropriate treatment. 
&nbsp;

Understanding frequently asked questions about breast pain

The incidence of cyclic mastalgia is highest in women aged 20-40 and decreases with age and early pregnancy<a href="#accordion">[1]</a>.

A week or so before their menstruation, many women experience pain in one or both breasts. This pain can range from minor to severe. The breasts feel tender and painful to the touch; there&rsquo;s heaviness, burning, prickling, stabbing pain, or tightness.

Cyclic breast pain is breast pain that occurs regularly based on the woman&#39;s menstrual cycle and the hormonal changes that ensue. Usually, it is not considered a cause forconcern<a href="#accordion">[7]</a>. 
&nbsp;

Non-cyclic breast pain is breast pain that is not related to a woman&#39;s menstrual cycle. The pain can be constant or sporadic and can occur in one or both breasts. It is usually caused by a non-hormonal factor, such as an injury, infection, fibrocystic breast change, etc<a href="#accordion">[4]</a>. 
&nbsp;

The diagnosis of breast pain involves a physical exam and medical history review by a healthcare provider. Additional tests may be ordered depending on the suspected cause of the pain. These tests include: 
&nbsp;

1. Mammogram - An X-ray exam of the breast to evaluate any areas of concern, such as a lump, thickening, or pain.

2. Breast Ultrasound - A test that uses sound waves to create images of the breast tissue and is often used with a <a href="https://merisehat.pk/article/mammograms">mammogram</a> to evaluate a specific area of pain, even if the mammogram appears normal.

3. Breast Biopsy - A procedure to remove a small sample of breast tissue from suspicious lumps or areas of thickening for lab analysis to determine whether the area is cancerous or benign. 
&nbsp;

The treatment for breast pain depends on the underlying cause of the pain. Here are some common treatment options for breast pain: 
&nbsp;

<ul>
	<li>Over-The-Counter Pain Relievers: over-the-counter pain relievers, such as ibuprofen or acetaminophen, are usually recommended for mild to moderate breast pain.</li>
	<li>Hormonal Therapy: hormonal therapy, such as birth control pills, or hormone replacement therapy can be recommended if breast pain is caused by hormonal changes.</li>
	<li>Prescription Medication: A medication, such as danazol and tamoxifen, is prescribed to treat severe breast pain associated with fibrocystic breast changes.</li>
	<li>Antibiotics: Antibiotics are given to treat the underlying infection causing breast pain.</li>
	<li>Surgery: Surgery is an option only in rare cases when the breast pain is due to a cyst, which needs to be removed. 
	&nbsp;</li>
</ul>

Vitamins and dietary supplements help some women reduce the severity and frequency of their breast pain<a href="#accordion">[7]</a>.

<ul>
	<li>Evening Primrose Oil: One of the causes of cyclical breast pain is said to be low levels of GLA, an essential fatty acid. Evening primrose oil has reportedly alleviated breast pain in some cases. 
	Even though there are usually no side effects, it&rsquo;s not advised for women who are pregnant or trying to get pregnant.</li>
	<li>Vitamin E Supplement: Studies suggest that vitamin E may be helpful for premenstrual women experiencing cyclic breast pain. In one study, using 200 IU of vitamin E twice daily for two months improved symptoms. However, it&rsquo;s recommended to stop using it if there is no improvement after 4-6 months<a href="#accordion">[6]</a>. 
	&nbsp;</li>
</ul>

Note: More research is needed to corroborate the results. Ask your doctor whether these alternative remedies are safe to use in your case, how much you can use, and for how long. 
&nbsp;

Several self-care remedies can be effective in alleviating breast pain<a href="#accordion">[6]</a>.

<ul>
	<li>Use hot or cold compresses on your breasts</li>
	<li>Wear a firm support bra</li>
	<li>Wear a sports bra during exercise</li>
	<li>Try relaxation therapy to lower anxiety levels</li>
	<li>Limit or eliminate caffeine</li>
	<li>Follow a low-fat diet </li>
	<li>Eat more complex carbohydrates 
	&nbsp;</li>
</ul>

Breast pain can sometimes be a symptom of breast cancer. It is a more common symptom of benign breast conditions, such as fibrocystic breast changes or breast infections.

Regular breast self-exams, along with routine clinical breast exams and mammograms as recommended by your healthcare provider, can help with the early detection of any breast-related issues. 
&nbsp;

Note: If you experience breast pain, it is essential to pay attention to any other associated symptoms or changes in your breast, such as lumps, skin changes, or nipple discharge, and report them to your healthcare provider. 
&nbsp;

<h5>When Should I See A Doctor For Breast Pain?</h5>

If the breast pain persists for three weeks or longer, consult a healthcare professional immediately. 
&nbsp;

Conclusion

Breast pain is a common condition that can have many causes, ranging from hormonal changes to injury or infection. While breast pain can be uncomfortable, it is usually not a sign of breast cancer or another serious condition. Self-care remedies, such as using hot or cold compresses, wearing a well-fitted, supportive bra, reducing or eliminating caffeine from your diet, and practicing relaxation techniques, can help alleviate breast pain. Over-the-counter pain relievers may also be effective for some women. It&#39;s important to consult with your healthcare provider if your breast pain persists or worsens, or if you have any concerns about your breast health. 
&nbsp;

Key Takeaways

<ul>
	<li>Breast pain, also known as mastalgia, is a common condition characterized by discomfort, tenderness, or pain in one or both breasts, often accompanied by swelling or inflammation.</li>
	<li>While it can be alarming to experience pain in the breasts, it is not a cause of concern in most cases.</li>
	<li>There are times when breast pain may indicate a more serious underlying condition, so it is essential to understand the different types of breast pain, their causes, and when to seek medical attention.</li>
	<li>The diagnosis of breast pain involves a physical exam and medical history review by a healthcare provider. Additional tests may be ordered depending on the suspected cause of the pain.</li>
	<li>Self-care remedies, such as using hot or cold compresses, wearing a well-fitted, supportive bra, reducing or eliminating caffeine from the diet, and practicing relaxation techniques, can help alleviate breast pain. Over-the-counter pain relievers may also be effective for some women.</li>
</ul>

[1] Mastalgia - StatPearls - NCBI Bookshelf.

[2] Breast pain. Mayo Clinic.

[3] Breast pain (mastalgia): Causes, treatment & prevention. Cleveland Clinic.

[4] Herndon J. Breast pain: Types, causes, and treatments.

[5] 11 common causes of breast pain and how to manage them.

[6] Home remedies: Tending to breast tenderness - mayo clinic news network. Mayo Clinic.

[7] Breast pain. Breast Cancer Now.

Sarah Mhowwala

Online Consultation

Ismail Munir

How Common Is Breast Cancer?

&nbsp;In Pakistan, breast cancer is particularly common and affects women from all socio-economic backgrounds, especially in rural areas where access to medical facilities is limited due to gender-based discrimination. Illiteracy further compounds the problem because women lack awareness about personal <a href="https://merisehat.pk/article/post-coitus-practices-to-adopt-for-good-health-and-hygiene">hygiene</a>.

Screening programs such as mammograms are available but are too expensive for many women to afford. However, breast self-examination is a simpler technique that can be taught by trained medical practitioners and nurses to detect breast cancer at an early stage.<a href="#accordion">[1]</a> 
&nbsp;

Understanding about breast Cancer

There are several factors that can increase a woman&#39;s risk for breast cancer, including:<a href="#accordion">[2]</a>

Age: The risk for breast cancer increases as a woman gets older, with most cases being diagnosed after age 50.

Genetic Mutations: Inherited changes to certain genes, such as BRCA1 and BRCA2, can increase a woman&#39;s risk for breast and ovarian cancer.

Reproductive History: Starting menstruation before age 12 or entering menopause after age 55 means a woman is exposed to hormones for longer periods, thereby, increasing their risk for breast cancer.

Dense Breasts: A woman with dense breasts has more connective tissue than fatty tissue, making it harder to detect tumors on mammograms. They are also more likely to get breast cancer.

Personal History: A woman who has had breast cancer or certain non-cancerous breast diseases is at higher risk of developing breast cancer again.

Family History: A woman with a first-degree relative (mother, sister, or daughter) or multiple family members with breast or ovarian cancer is at higher risk. A first-degree male relative with breast cancer is also a risk factor.

Radiation Therapy: A woman who received radiation therapy to the chest or breasts before age 30 has a high risk of developing breast cancer later.

Exposure To DES: A woman who is exposed to the drug diethylstilbestrol (DES) has a higher risk of breast cancer.

Lifestyle Factors: Being physically inactive, overweight or obese after menopause, drinking alcohol, and taking hormone replacement therapy, or taking oral contraceptives can also increase a woman&#39;s risk for breast cancer. 
&nbsp;

<h5>High-Risk Groups</h5>

Both men and women with a strong family history of breast cancer or inherited genetic mutations are at higher risk for breast and ovarian cancer. They should talk to their doctors about ways to reduce their risk, including medication and surgery. 
&nbsp;

<h5>Maintain A Healthy Lifestyle</h5>

Maintaining a healthy weight, being physically active, and quitting alcohol can help lower the risk. 
&nbsp;

<h5>Hormone Therapy</h5>

It is essential to talk to the doctor about the risks and benefits associated with hormone replacement therapy or oral contraceptives. They can advise on whether or not these medications are right for the patient. 
&nbsp;

<h5>Breastfeeding</h5>

Breastfeeding is not only beneficial for the child but can also lower the mother&#39;s risk of breast cancer. Therefore, breastfeed, if possible. 
&nbsp;

<h5>Family History</h5>

It is crucial to talk to your doctor about ways to lower the risk if there&rsquo;s a family history of breast cancer or inherited changes in the BRCA1 and BRCA2 genes. 
&nbsp;

<h5>Staying Healthy</h5>

A healthy lifestyle can reduce the risk of developing cancer and improve the chances of surviving cancer if it occurs.<a href="#accordion">[3]</a> 
&nbsp;

Breast cancer is much less common in men than in women, but it can still occur. According to the American Cancer Society, about 1 in 833 men will develop breast cancer in their lifetime compared to about 1 in 8 women.<a href="#accordion">[4]</a>

Men who are older, have a family history of breast cancer, or have high estrogen levels due to medical conditions such as Klinefelter syndrome or obesity are at higher risk of developing breast cancer than those who don&rsquo;t.

Other factors including inherited mutations in the BRCA1 and BRCA2 genes, radiation exposure to the chest (such as for lymphoma), liver cirrhosis, heavy drinking, and testicular conditions (such as mumps or orchiectomy) are also responsible for causing breast cancer in men.

Breast cancer in men often presents as a firm lump in the breast tissue, nipple retraction or discharge, or skin dimpling or puckering. It&#39;s important for men to be aware of the symptoms and to see a doctor if they notice any changes in their breast tissue. 
&nbsp;

While there is no guaranteed method to prevent breast cancer, certain actions like genetic counseling, preventive surgery, and close observation for early signs of breast cancer not only reduce the risk but also help to detect the condition when it is most treatable.<a href="#accordion">[5]</a> 
&nbsp;

Survival rates can provide an estimate of the percentage of people with a specific type and stage of cancer who are still alive after a certain period (typically 5 years) from the time of diagnosis. While they cannot predict an individual&#39;s life expectancy, they can offer insight into the probability of treatment success.

It is important to note that survival rates are based on data collected from large groups of people with the same type of cancer and may not reflect the outcome for a particular individual. The doctor then helps the patient interpret these statistics in relation to their own situation.

For instance, if the 5-year relative survival rate for a particular stage of breast cancer is 90%, it means that women with that cancer have a 90% chance of living for at least 5 years after diagnosis, compared to women without cancer.<a href="#accordion">[6]</a> 
&nbsp;

Breast cancer is one of the most common cancers among women worldwide. While the incidence of breast cancer varies by country and demographic factors such as age, race, and family history, it is estimated that about 1 in 8 American women develop invasive breast cancer over the course of their lifetime. Additionally, while breast cancer is rare in men, it still affects approximately 1 in 1,000 men.<a href="#accordion">[7]</a>

While there are certain risk factors for breast cancer, including age, gender, family history, and inherited genetic mutations, there is no sure way to prevent it. However, maintaining a healthy lifestyle and discussing individual risk factors with a healthcare provider can help reduce the risk of developing breast cancer and improve the chances of successful treatment if it occurs. 
&nbsp;

<ul>
	<li>Breast cancer is the most common cancer in women worldwide.</li>
	<li>Men can also develop breast cancer, but it is rare.</li>
	<li>Age is a significant risk factor for breast cancer, with most cases occurring in women over 50.</li>
	<li>Family history and genetic factors can also increase the risk of breast cancer.</li>
	<li>Lifestyle factors, such as alcohol consumption, obesity, and lack of physical activity, may also contribute to the development of breast cancer.</li>
	<li>Early detection through regular mammograms and breast exams is crucial for successful treatment.</li>
	<li>Treatment options for breast cancer may include surgery, radiation therapy, chemotherapy, and hormone therapy.</li>
	<li>Surviving breast cancer is possible with early detection, proper treatment, and ongoing monitoring.</li>
</ul>

[1] Menhas R, Umer S. Breast Cancer among Pakistani Women. Iran J Public Health. 2015 Apr;44(4):586-7. PMID: 26056679; PMCID: PMC4441973.

[2] What are the risk factors for breast cancer? Centers for Disease Control and Prevention.

[3] What can I do to reduce my risk of breast cancer? Centers for Disease Control and Prevention.

[4] Key statistics for breast cancer in men. American Cancer Society.

[6] Survival rates for breast cancer. American Cancer Society.

[7] Male breast cancer.

[5] Breast cancer risk factors and prevention methods. Breast Cancer Risk Factors and Prevention Methods.

They not only repair your DNA, but they also prevent cancerous changes in your cells. This is why they are also known as tumor suppressor genes.

However, if they stop working properly, they can increase your risk of cancer. 1 in 300-800 people has a faulty copy of the BRCA1 or BRCA2 gene.<a href="#accordion">[1]</a>

It is also possible that these damaged copies of the BRCA1 or BRCA2 genes are inherited, increasing your chances of developing cancer, particularly <a href="merisehat.pk/disease/breast-cancer">breast cancer</a>. A child has a 50/50 chance of inheriting the mutation from either parent.

Hereditary cancers account for 5-10% of all cancers, with BRCA1 and BRCA2 accounting for nearly 50% of the genetic causes of inherited cancers.<a href="#accordion">[2][3]</a>&nbsp;But they are not the only ones. Other gene mutations, such as PALB2, PTEN, CHEK2, ATM, CDH1, and TP53, may also cause breast cancer, though they are less common.

Anyone can have these mutations. However, you are more likely to develop cancer due to harmful BRCA variants if you&rsquo;re a woman, while men are often just silent carriers.<a href="#accordion">[3]</a>&nbsp;Following a positive test, the likelihood of a woman being diagnosed with breast cancer at some point in her life increases from 12% to 87%.<a href="#accordion">[2]</a> 
&nbsp;

Understanding the relation of BRCA - Positive and Breast Cancer

Even though they occur rarely, both BRCA1 and BRCA2 genetic mutations increase an individual&rsquo;s vulnerability to developing certain types of cancer, including breast cancer, prostate cancer, pancreatic cancer, ovarian cancer, and melanoma.

A mutated BRCA1 gene, for instance, increases the risk of triple-negative breast cancer, an aggressive type of cancer.<a href="#accordion">[3]</a>&nbsp;In general, people with BRCA mutations may experience early-onset cancer in both breasts.<a href="#accordion">[5]</a>

A mutated BRCA1 gene in a man increases his risk of breast cancer by 1-5%, while a mutated BRCA2 gene increases that risk by 5-10%. This is notably higher when compared to the average man&#39;s 0.1% lifetime risk of developing breast cancer.<a href="#accordion">[4]</a>

There are no particular symptoms for a genetic mutation. But if the patient presents with certain risk factors, doctors may be able to suggest appropriate tests to help diagnose it. However, the BRCA test is not a routine test; an average risk doesn&rsquo;t warrant the BRCA gene test. It&rsquo;s not recommended that children under 18 especially undergo genetic testing for BRCA1 and BRCA2 variants.<a href="#accordion">[6]</a> 
&nbsp;

<h5>Important!</h5>

<ul>
	<li>If you and your doctor are thinking about genetic testing, you may benefit from genetic counseling as well. It will help you understand which genetic test options are best for you and what the results mean.</li>
	<li>A positive test means all blood relatives are at increased risk of having the variant themselves.</li>
	<li>A positive test, in rare cases, may not be due to an inherited variant. Rather, it may be a new variant.</li>
	<li>A positive test does not mean you&rsquo;ll definitely develop cancer.</li>
	<li>Remember that the results of genetic testing may be negative or uncertain as well. A negative result could mean that you do not have the mutation or that it is present but has not been detected. In these circumstances, your cancer risk remains similar to that of the general population. 
	&nbsp;</li>
</ul>

<h5>Screening Recommendations</h5>

If you have a risk factor, you should opt for regular screening after you turn 25 to be on the safe side. If you are diagnosed with a BRCA1 or BRCA2 mutation, your doctor will probably suggest annual breast MRIs. By the time you turn 30, they might also request mammograms.

It is advised that male BRCA carriers begin self-examinations of their breasts and begin annual clinical breast exams after turning 35 or as soon as they are diagnosed. Doctors may recommend mammograms depending on the patient&rsquo;s individual health. 
&nbsp;

Ideally, you should be tested if you or a relative have:

<ul>
	<li>Cancer in both breasts</li>
	<li>Metastatic prostate cancer</li>
	<li>Both breast and ovarian cancers</li>
	<li>History of male breast cancer</li>
	<li>History of two or more types of cancer</li>
	<li>History of BRCA mutation</li>
	<li>Recurring breast cancer</li>
	<li>Eastern or Central European (Ashkenazi Jewish) ancestry</li>
	<li>A history of breast cancer diagnosed before age 45</li>
	<li>A history of triple-negative breast cancer diagnosed at 60 or younger</li>
	<li>A history of ovarian cancer, fallopian tube cancer, or peritoneum cancer</li>
	<li>A history of pancreatic or prostate cancer, along with two or more relatives having BRCA-associated cancers</li>
	<li>A history of breast cancer diagnosed before 50, along with a second primary breast cancer, a family history of breast cancer, and a limited family medical history 
	&nbsp;</li>
</ul>

In most cases, you&#39;ll get to know the results of your BRCA test in a couple of weeks.

Knowing that you have a BRCA mutation can help you take steps to reduce your risk. It further helps other members of your family understand their own risks.

Additionally, you should speak with your child&#39;s pediatrician if you have tested positive for this genetic mutation. You might or might not get cancer, but you might pass the variant on to your offspring. While most cancers due to genetic mutations only affect adults, they may increase the risk of some childhood cancers. 
&nbsp;

Depending on your general health and other factors, your doctor might recommend one of the following strategies to lower your risk of developing cancer:

<ul>
	<li>Start screening earlier and more frequently because early detection of cancer makes it easier to treat it.</li>
	<li>Chemoprevention medicine, such as selective estrogen receptor modulators, as a nonsurgical alternative to treat estrogen receptor-positive breast cancer in postmenopausal women and prevent breast cancer in high-risk patients</li>
	<li>Preventive mastectomy or having the breasts removed even if they appear to be healthy</li>
	<li>Breast reconstruction after surgery (not necessary)</li>
	<li>Oophorectomy or the removal of the fallopian tubes and ovaries</li>
	<li>Making healthy lifestyle decisions, such as eating a balanced diet and exercising each day 
	&nbsp;</li>
</ul>

Note: Pay close attention to how your breasts normally feel and look. Inform your doctor immediately if you notice any changes. 
&nbsp;

Being BRCA-positive means that you have a mutation in one of the BRCA genes (BRCA1 or BRCA2). A BRCA gene mutation can increase your chances of developing breast cancer. It also increases the risk of an early onset of the disease.

However, it is essential to note that not everyone &mdash; men included &mdash; with a BRCA gene mutation will develop cancer. The presence of the mutation only indicates an increased risk compared to the general population. This is why it requires proactive monitoring and risk management to maintain your health.

[1] Casaubon JT, Kashyap S, Regan JP. BRCA1 and BRCA2 Mutations. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing