Breast stress: cancer makes the news, but other breast ailments are more likely. Here's how to cope with cysts, pain and more - Health & healing: wellness solutions from medicine's past, present and future

We worry terribly about our breasts. Bombarded with frightening statistics, we fear that any twinge, tender spot or lump is the first step on the road to the "c" word. The truth is, however, that while any of these complaints might signal cancer, they usually don't. Even with a breast lump, only one in five turns out to be cancerous.

Naturally, any change that's unusual for you needs to be evaluated by your doctor. Whether or not you've had a mammogram within the past year, your physician may order another and possibly follow that with an ultra-sound or other tests (see screening tests).

Once reassured that the trouble is benign, you are faced with another decision--what to do to ease your discomfort. In some cases, that means symptom relief when you're in pain; in others, treatment for an underlying problem is necessary. On the following pages is a guide to the most common causes of breast pain and the best options, both Western and alternative, for resolving them.

premenstrual breast pain

More than half of all American women complain of breast pain; for many, they feel a subtle, bruised soreness in their breasts usually beginning three to five days before the onset of menstruation and lasting for about a week. For about one in 10 women, this cyclic pain is moderate to severe, according to Richard J. Santen, M.D., professor of medicine at the University of Virginia Health System in Charlottesville. The heaviness or soreness can reach into the underarm or extend down the arm--or both.

No one knows exactly why the pain occurs or bothers some women more than others. It's thought by many health experts to be triggered by premenstrual water retention and that hormonal stimulation of breast tissue is the culprit.

During the second half of the menstrual cycle, progesterone and estrogen levels begin to climb; they peak about a week before menstruation begins. That hormonal shift corresponds to the monthly episode of cyclic pain in women who have it. Christiane Northrup, M.D., an obstetrician and gynecologist in Yarmouth, Maine, and author of Women's Bodies, Women's Wisdom, believes women who complain of breast swelling may secrete more estrogen relative to progesterone.

There are additional reasons to suspect a hormonal link. For one, cyclic breast pain subsides when the menstrual period begins and estrogen and progesterone drop to their lowest levels. While cyclic pain is particularly common when hormones fluctuate just before menopause, it disappears after menopause when hormones fall and menstrual periods cease.

Noncylic breast pain, in contrast, usually occurs in one breast and tends to be less generalized. It typically feels more like a sharp or burning pain in one area, and is often caused by another condition such as a cyst.

SOLUTION: Avoid aggravating swollen breasts by wearing a well-fitting bra with no under-wires to press on tender areas or interfere with blood and lymph fluid circulation. Taking an anti-inflammatory such as ibuprofen can help relieve pain and discomfort. The following remedies may also bring relief.

evening primrose oil capsules The seeds of the evening primrose plant (also called evening star) contain gamma linolenic acid, a deficit of which may contribute to premenstrual breast pain. Research on EPO is limited, but one study in Great Britain found that 58 percent of women with cyclic pain and 38 percent with noncyclic breast pain responded to treatment, and side effects occurred in less than 2 percent of those taking it. Santen and Northrup recommend EPO to their patients, as does Jennifer Gass, M.D., director of the Breast Health Center at Women and Infants Hospital of Rhode Island in Providence.

dietary changes

Reducing or eliminating caffeine might help, although study results have been mixed. Even so, Gass often recommends that women try giving up caffeinated beverages and chocolate. "Fifty percent of my patients respond to caffeine reduction," she says. Research suggests that caffeine increases PMS symptoms because it elevates estrogen levels.

prescription drugs

Danazol (Danocrine), a synthetic male sex hormone, is the only drug approved by the Food and Drug Administration for breast pain. Clinical trials have shown it to be effective in 50 percent to 75 percent of women with cyclic breast pain. However, side effects such as acne, irregular periods, weight gain and abnormal hair growth aren't uncommon.

breast cyst

A fluid-filled cyst in the breast can cause pain and tenderness. As the breasts respond to the ebb and flow of hormones year after year, decade after decade, fibrous, almost scarlike tissue may develop, trapping fluid and forming a firm, movable cyst. Eventually the cyst may press against adjacent nerves and inflame surrounding tissue, causing the area to become tender.

Not all cysts are painful, but when they are, they tend to be most uncomfortable during the second half of the menstrual cycle, between ovulation (approximately day 14) and the start of the menstrual period (day 28 or so).