It’s got to go The myth that breast cancer doesn’t hurt causes way too much pain! Like many myths, this one has roots in a fact. Compared to a breast cyst, which is often very tender to the touch, a cancerous lump usually doesn’t hurt when a woman or doctor feels it.
We hear many reports from women that go something like this:
I found this lump in my breast, so I went to see the doctor. It really hurt when he did the exam. He told me not to worry because breast cancer doesn’t hurt, but I am worried. Shouldn’t he have ordered a mammogram or ultrasound to see what it is?
Probably the doctor made a determination based on the shape, texture and tenderness of the lump that it was a cyst. I hope that what he said to the patient was, "Usually a painful lump like this is not breast cancer." However, what the patient took away was the message that breast cancer doesn’t hurt. And yes, he should have ordered an ultrasound. An ultrasound is an easy, comparatively inexpensive test that can usually tell for sure whether a lump is a harmless, fluid-filled cyst.
Our community member Peglove recently wrote a sharepiece describing her experience with a painful lump:
". . . Before I knew my bump was cancer in 2009, it felt tender and hurtsy, but it did not change its shape or hardness. That stayed pretty consistent. I told the first doctor (my GYN that missed the cancer the first time) that it was uncomfortable, and that it “hurt”. She said, “pain is not associated with breast cancer”, and she sent me on my way to come back for my annual next year.
"My breast kept hurting. My tumor was associated with pain. Maybe I was lucky because the tumor was very close to a nerve and pressing on it, which is probably the reason why I felt it in the first place. After my diagnosis, and my therapy, I sent a letter to that first doctor. The one that said that my pain was not cancer. She felt the bump and said it was “nothing”. So it was 8 months before I had it checked again and got my diagnosis. I let her know that she should have sent me to get an ultrasound. She should have sent me on a referral.
"Doctor’s don’t have magic fingers to know that a bump is NOT cancer. They also do not know what it may mean when a woman says, “this hurts”. In my case, it felt uncomfortable, it hurt when I hugged someone, I could not sleep on my stomach because it felt like there was a rock inside my breast with pointy shards of glass in it–or prickly, like a cactus. Maybe when I said that my tumor “hurt” I meant this, maybe I meant that it feels this way. But a doctor thinks about “pain” as a wound or a gash that is gushing blood! Or maybe a broken bone that if you touch it you scream, “OUCH!”. But pain is very different for everyone. , , ,"
Peglove makes two really important points here. A cancerous lump can cause pain because of its position in the breast. It may be pressing on a nerve. As it grows, it will be displacing normal breast tissue, and the woman will realize that something feels weird and different in her breast. As Peglove points out, pain is subjective. One woman may describe the pressure on muscles and breast tissue as an uncomfortable feeling while another uses the word "pain."
Women also need to be aware that breast cancer does not alway present with a lump. Paget’s Disease of the Breast looks like a scaly eczema on the nipple. Dr. Susan Love says, "It can be itchy, hypersensitive, and painful." Believing the "breast cancer doesn’t hurt" myth, too many women dab on some eczema cream and delay calling their doctors. A scaly rash on the nipple needs to be checked, and probably needs a biopsy to rule out Paget’s.
Fortunately, Paget’s is not usually an aggressive form of breast cancer, but sometimes it is associated with other tumors inside the breast. For this reason it is important to see a doctor, especially for a rash on just one side.
Another form of breast cancer that usually does not have a lump is inflammatory breast cancer (IBC). One reason I am so passionate about debunking the myth that breast cancer doesn’t hurt is that pain was my first symptom of breast cancer. For about two weeks, pain was my only symptom; then I felt itching deep inside the breast. When I finally went to the doctor after a month of pain, my breast looked perfectly normal, and my mammogram was fine.
Eventually, I developed other symptoms, but pain was my first signal that something was wrong. I felt silly about going to the doctor for breast pain. I thought I was well-informed on women’s health issues, but I didn’t know that pain can be a breast cancer symptom. IBC is an aggressive form of breast cancer, and its presenting symptoms vary. It is important to see a doctor for any breast changes, not just lumps.
Most breast pain comes and goes with our periods. As our hormones fluctuate, our breasts may swell and feel tender. Usually we feel this type of pain on both sides, but occasionally one side is especially sensitive. Cyclical pain is rarely associated with cancer.
The kind of pain that MIGHT be breast cancer is usually just on one side, and it doesn’t change over the course of the month. The woman can point to the place that hurts. Most of the time this kind of pain is not cancer. According to Dr. Love, "About 5 percent of all target zone breast pain is cancer. So it’s worth having your doctor check it–if only for the relief of being sure you aren’t in the 5 percent."
It would be a conservative estimate to guess that out of the millions of adult women in the United States at least 100,000 will experience this type of pain. That is at least 5,000 women who need to know, yes, breast cancer can hurt.
Love, S. and K. Lindsey. _Dr. Susan Love’s Breast Book, 5th ed. _ Da Capo Press, 2010.