Breast pain

[jules321]

No I haven't. It comes and goes and nothing that comes and goes concerns me greatly and I presumed it was hormonal.

When did you have the mammo ? That is a little strange that it started straight after that and in response to it/.......hmmm

I had my regular annual mammo last August. Up until then, no breast pain at all. A few days later, I got a call that I needed a repeat mammo due to a "spot" they couldn't see clearly in my right breast. My right breast pain then started (before I had the repeat mammo). So I'm not sure if the pain started because the original mammo "injured" me or if my anxiety started. A few days later, I had the repeat mammo plus ultrasound. The spot was determined just to be a regular lymph node and all was fine. A few days later, the right breast pain recurred, so I saw my GYN who sent me to the oncologist who said it's likely hormonal. She gave me the option of getting an MRI but said the MRI often finds benign things that lead to additional invasive testing. She recommended I hold off on the MRI for now and to return if the pain continues.

Now I'm questioning myself as to how often the breast pain has recurred and if it has been off/on or if it's been constant. I'm usually very good about documenting health history, but I've had a lot of other stuff going on. I'm pretty sure it's off and on or I think I would have gotten concerned about it. Over the last few days I've been very aware of it and my HA has peaked about it. I have no other symptoms. IBC?

Thanks for your kind words, too, Unicorn - and hope you're doing ok with your similar BC fears!

[Carys]

OK, the good news is that ultrasound is the tool of choice for anomallies, and if they are certain it was a lymph node they were seeing then they were pretty darned certain. Everything has a very different appearance for radiographers and consultants, and they take many years to train to determine those subtle differences - that you or I wouldn't have a clue about. There wasn't even a query and the talk of a biopsy, and that would have taken place if there was any minute doubt about it. Obviously the 'spot' was slightly inaccessible on the mammo image but the ultrasound on the exact area gave the absolute answer. So, anyway, you still have the option of the MRI, so that is your 'backup' position.

Now, the pain, is it possible - that once you knew you were being recalled, and there was a 'spot' in a certain area (you are lucky to be given that info, in the UK you just get the standard recall letter which makes no mention of why - it could range from the machine being ropey and taking duff images to there being an area of clear concern) that you started pressing that area a good amount ? I ask this, because even overly focusing on pressing and prodding a small area can cause pain, I know it does for me. Could it be that when you forget about it, you stop messing with it, and then the pain resolves ? I throw this out there as a possibility, as if there was damage done by the mammo surely that wouldn't have taken a few days for the pain to appear and it actually started before the next mammo, which you would have been concerned about. I suspect it is on and off, the pain, as you'd surely be aware of it and the fact that you actually can't remember is a pretty good sign that its been on and off. Of course, there is also the possibility that the mammo did 'hurt' this lymph node, or the tissue in that area, and its being aggravated on and off.

Its tricky to know about if to request the MRI or not to be honest, as this was last September, which is now 5 months ago in any of the many BC scenarios (even the lowest grades of tumours) you would feel a physical difference in the breast tissue, in the case of IBC, there would have been a radical and sudden change over 3 months onwards and by now you'd be seeing symptoms. What about a compromise position - return for an ultrasound on the lymph node and see if there are any changes to it and check they are still certain that is what it is ? They will take absolute measurements, or they should have done, in mm, of the node. So , that would maybe give peace of mind ? Having the full MRI, and having it throw up fibroids, cysts or other benign conditions, might still be something you can wait on ?

[jules321]

Thanks for your thoughtful response, Carys. I don't palpate my breasts at all actually and didn't before/after the mammo so that didn't cause the pain. They are very fibrous so self-exams just freak me out. I leave it to the professionals. Having said that, I did feel around yesterday and didn't feel anything unusual. I have trusted that the ultrasound last Aug was accurate. I know many many people who have gone there and get sent for needle biopsies etc so I know they are conservative. I hadn't been worried they missed anything.

I just made a follow-up appt with the oncologist although they can't see me for 3 weeks. That might be good since it will give me some time to objectively track the pain a bit more diligently. I now remember that I also had my annual GYN appt in Oct, and that breast exam was normal as well. I guess I will ask her if she thinks I should get an MRI or a repeat ultrasound. I think she will recommend an MRI but who knows. Maybe she will even suggest a repeat mammo since it's been a while.

So to clarify your last paragraph, you do not think this sounds like any type of BC or IBC? Or you are saying that since this started 5 months ago, that it could be?

[Carys]

IBC progresses very quickly I understand, within 3 - 6 months from initial onset you would have all sorts of redness, swelling, engorgement, itching, skin changes, tissue thickening and other things. Thats generally the characteristic of IBC, quickly obvious and it takes in the whole breast. You had your first odd pains after August, so by now if this was IBC it'd be really obvious - AND - further to that you had an exam in October which was clear !!! So, I don't see it could be on the radar of possibilities ;o) You'd like to think a female health medical professional could spot advancing IBC !

Ok, so no palpating going on - good o (apart from standard monthly checks I presume ?) Generally mammos aren't advised more than once a year, and your last one was August, due to excess radiation risk. Its very good news that even in your last October check all was well. A 3 week wait for the onco/surgeon is nothing at all, and I think it could give you a chance to really track things, as you say, I certainly can track mine to hormone changes - but often those changes are not regular or standard. Cos late peri is a nightmare.

[jules321]

I appreciate you spelling it out for me. My brain gets a little fuzzy when HA is knocking. Yes perimenopause is strange! I have no idea how to tell if the pain is hormone-related since I only get my period a few times per year now. Again - thank you for sitting with me through this right now. It helps.

[Carys]

Ah if your periods are that sporadic then yes it must be hard to know whats going on. Happy to 'share' )

[jules321]

One of the symptoms of IBC is peau d'orange (orange peel skin of the breast). Does this mean the breast would look like an orange peel just when looking at the breast? Or does it mean it would look like an orange peel if you squeeze/palpate the breast firmly? I am panicking as I just examined my right breast more thoroughly by palpating it pretty firmly- and some subtle dimpling appeared (kind of like seeing the pores of the breast). I did the same thing on the left breast and saw similar dimpling/pores. So to clarify, the skin on both breasts looks completely smooth and normal when just looking. When squeezed firmly, I can see the pores a bit on each breast. No idea if this is normal for me or not, as I don't think I'd ever palpated in this particular way before. Is this peau d'orange? I'm panicking. (For what it's worth, I have plenty of cellulite on other areas of my body.) I had thought I had no other symptoms of IBC besides pain, but maybe I do? I have specialist appt in a week.

[Carys]

IN IBC the skin looks like orange peel ALL the time.

What happens is the tissue swells, goes red and becomes inflammed and lymph can't drain from it, it becomes engorged with fluid. The pores remain 'intact' - so you end up with orange peel skin. There is no mistaking it and you'd not have to go looking or pressing - its obvious. If the skin is squeezed firmly, or even lightly, you 'see the pores a bit on each breast and dimpling' THAT is a normal human body.

I don't advise this often, but do a google image search - peau d'orange on breast - and you will clearly see this is NOT what you have! You have no reason to panic, and I think you should stop looking for IBC 'symptoms' as to be frank - if you are having to squint and search and check and question - then it certainly is nothing to worry about. You would KNOW !

[jules321]

Thank you so much. I really appreciate this information. I definitely don’t have the orange peel look all the time.

[jules321]

Well Carys, I was feeling calmer and then decided to look in the mirror again before the shower as my breast was hurting and I wanted to make sure it didn't look any different. I can't believe I had never actually lifted my breast up, but today I did and I found a small red spot a bit below the nipple. Or maybe I have lifted it, and this spot is new. It's quite small, and it's a little raised (or there's a pore nearby that I'm feeling I can't tell b/c the red spot is very small). It almost looks like a little cut, but there's no reason for a cut to be there. I honestly wasn't expecting to see anything, so I feel a bit shocked to see something there - which makes me think I likely have lifted the girl up and this spot wasn't there previously. It doesn't look like a rash. It's basically the size of a freckle but red and a little rectangular like a cut. Is this a sign of IBC?

https://www.nationalbreastcancer.org...-breast-cancer
Here it says it can present as a "small irritation like an insect bite."
Does this qualify?

I'd also like your opinion, Carys, as your advice to me and others feels informed and sensible. I'm going to see a breast specialist at the end of this week. I feel like she will likely recommend an MRI. My understanding is a breast MRI is done with contrast (via IV). Is that your experience? Since MRI's can find false positives, should I ask if I can get a repeat mammo/ultrasound instead? Or will a mammo not be given less than a year apart? My last mammo was 7 mo ago. I also read the only definitive diagnosis for IBC is a punch biopsy. I'm unsure if that would be done right then in the office or in a hospital or how invasive it is. Just trying to think this through as I like to be prepared and know what questions to ask. Thanks for any insight.

(btw I googled peau d'orange on the breast, and I definitely don't have that as you said)