Breast Pain (Mastalgia)

Nipple Problems and Discharge

Breast Pain (Mastalgia) | Johns Hopkins Medicine

Nipple conditions are a common noncancer (benign) breast condition that affect many women. Some problems are related to lactation. Others are not. all breast conditions, any nipple problems should be reported to your healthcare provider right away. This can help you get a prompt diagnosis and start treatment.

What is ectasia?

As a woman nears menopause (around her late 40s or early 50s), the mammary ducts located under the nipple become dilated (widened). This normal process of dilation of the milk gland is called ectasia.

Ectasia is a noncancer breast condition. In some cases, it can lead to a blockage of the ducts. Then fluid may become pooled and leak into the nearby tissue.

This causes infection, chronic inflammation, or a pus-filled infection called an abscess. If there is an infection (called periductal mastitis), it may cause scar tissue to form. This draws the nipple inward.

This infection may also cause breast pain and thick, sticky nipple discharge.

Treatment for ectasia

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for ectasia generally involves treating the symptoms. This may include warm compresses or antibiotics. In some cases, surgery is needed to remove the affected breast ducts.

What is intraductal papilloma?

An intraductal papilloma is a small, wart- growth that bumps out into the breast ducts near the nipple. This causes a bloody or sticky discharge. Any slight bump or bruise near the nipple can also cause the papilloma to bleed. If the discharge becomes annoying, the duct can be surgically removed. This can often be done without changing the look of the breast.

Single papillomas most often affect women nearing menopause. But multiple intraductal papillomas are more common in younger women. They often happen in both breasts. Multiple intraductal papillomas are more ly to be linked to a lump than with nipple discharge. Any papilloma linked to a lump is surgically removed.

What about other types of nipple discharge?

Nipple discharge can be alarming to many women. But discharge that occurs only when the nipple and breast are squeezed may not be a cause for concern. The risk of cancer when nipple discharge is the only symptom is fairly low.

A lump with the discharge will be of primary concern to your healthcare provider. But keep in mind that breastfeeding women may experience a lump under the areola, and a discharge. This can be caused by lactational mastitis that occurs with a pus-filled infection (abscess).

Galactorrhea is a milky discharge from both nipples, when a woman is not breastfeeding. This is often due to an increase in the hormone prolactin, which produces milk. Galactorrhea may occur if you take sedatives or marijuana.

Or it can be caused by high doses of estrogen. Women who have this often have irregular menstrual periods. Or their periods have stopped. In some cases, galactorrhea may be caused by a pituitary gland tumor.

Your healthcare provider may order blood tests and an MRI if he or she thinks you have this.

Nipple discharge that is due to a benign noncancer breast condition may be treated by keeping the nipple clean, among other treatments. Nipple discharge that occurs because of infection may require hospitalization.

How is nipple discharge diagnosed?

Your healthcare provider will ly want to find out if the discharge is coming from 1 duct or several. Multiple duct discharge is nearly always benign. It is ly due to changes such as ectasia. Discharge coming from a single duct may be more significant. But if mammography shows no abnormality, surgery may not be needed.

Nipple discharge can be different colors and textures. Your healthcare provider may take a sample of the discharge and have it checked in a lab to confirm a diagnosis.


Johns Hopkins Breast Center adds MarginProbe® to Breast Care Program

Breast Pain (Mastalgia) | Johns Hopkins Medicine

July 30, 2019 09:00 AM Eastern Daylight Time

ALPHARETTA, Ga.–(BUSINESS WIRE)–The Johns Hopkins Breast Center at Johns Hopkins Hospital, the #3 hospital in the U.S.

News & World Report’s 2018–19 Best Hospitals list, announced that it will be adding MarginProbe® as a regular part of its program after its participation in Dune Medical’s MarginProbe® Post Approval Study (PAS).

The center was able to validate previous results through the study that demonstrated MarginProbe’s efficacy in reducing re-excision rates during breast cancer surgery.

“I know from experience that one of the most difficult conversations with a patient after breast conserving surgery is the one that tells them 'we didn't get it all,'” stated Dr. Mehran Habibi, Medical Director of the Johns Hopkins Breast Center and Lead Principal Investigator (PI) for the study.

“While we recognize that 10-50% of patients must return to the operating room to ensure clean margins, this is a hard thing to explain to a patient. These are women who have plans for their life after cancer.

A second surgery at best means this life is put further on-hold, so if utilizing MarginProbe as a tool for margin assessment during lumpectomy surgery can assist in reducing re-excision rates, then it’s an avenue we definitely want to pursue.”

The Johns Hopkins Breast Center is part of the John Hopkins Kimmel Cancer Center, a world leader in deciphering the mechanisms of cancer and developing new ways to treat it.

The organization became one of the first to earn recognition as a “Center of Excellence” by the National Cancer Institute, and the innovations that take place within the center often become the standards of care for the industry.

The Johns Hopkins Breast Center seeks to unify the traditionally fragmented systems of care and places all resources and specialists within a single location for a highly coordinated experience to provide the best possible care at an affordable cost.

This approach achieves the primary goals of the Triple Aim of healthcare: to lower the per-capita cost of care, improve the health of populations and create a better patient experience. It’s also why Johns Hopkins Breast Center added MarginProbe to its standard of care.

MarginProbe reduces re-excision rates to improve the health of individuals and populations as a whole.

The reduction in re-excisions helps to improve the cost of care, while avoiding additional surgeries removes a great burden from patients to dramatically improve their experience with treatment.

“We are honored that Johns Hopkins Breast Center is using MarginProbe for lumpectomy surgery,” explained Lori Chmura, CEO of Dune Medical, the company behind MarginProbe.

“Patients are often faced with delays in radiation and sometimes chemotherapy which can further disrupt survivorship, as suggested by some recent studies.

By enabling real time margin assessment in the operating room, we’re allowing surgeons to raise their confidence level that they are achieving clean margins the first time. To date, we’ve had multiple studies with more than 2,700 patients demonstrate that MarginProbe reduces re-excisions by 50 percent or more.”

About Dune Medical Devices

Dune Medical Devices offers surgeons the ability to identify clean margins in the operation room. Our primary technology is developed on a first-of-its-kind RF Spectroscopy platform that can differentiate cancerous from healthy tissue electromagnetic properties.

This approach can help achieve all three goals of Triple Aim by reducing the need for costly and unnecessary surgeries while improving health outcomes that reduce the emotional burden on both patients and families. For more information, contact


Breast Pain: 10 Reasons Your Breasts May Hurt

Breast Pain (Mastalgia) | Johns Hopkins Medicine

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Most women experience some form of breast pain at one time or another. Breast pain is typically easy to treat, but on rarer occasions it can be a sign of something more serious.

Medical director of the Suburban Hospital Breast Center Pamela Wright, M.D., discusses the most common causes of breast pain (mastalgia), their treatments and when to see a doctor:

  1. Hormones are making your breasts sore.

    Hormonal fluctuations are the number one reason women have breast pain. Breasts become sore three to five days prior to the beginning of a menstrual period and stop hurting after it starts. This is due to a rise in estrogen and progesterone right before your period. These hormones cause your breasts to swell and can lead to tenderness.

    “It’s normal to have breast tenderness that comes and goes around the time of your period,” says Wright. “It’s nothing to worry about.”

    If you become pregnant, your breasts may remain sore during the first trimester as hormone production ramps up. Breast tenderness is one of the earliest signs of pregnancy for many women.

    Steps you can take to minimize sore breasts include:

    • Eliminate caffeine
    • Eat a low-fat diet
    • Reduce salt intake
    • Avoid smoking
    • Take an over-the-counter pain reliever
    • Ask your doctor if switching birth control pills or hormone replacement therapy medications may help
  2. You have a breast injury.

    any part of your body, breasts can be injured. This can happen because of an accident, while playing sports or from breast surgery. You may feel a sharp, shooting pain at the time of injury. Tenderness can linger for a few days up to several weeks after trauma to the breast. See your doctor if the pain doesn’t improve or you notice any of these signs:

    • Severe swelling
    • A lump in the breast
    • Redness and warmth, which could indicate an infection
    • A bruise on your breast that doesn’t go away
  3. Your breasts hurt due to an unsupportive bra.

    Without proper support, the ligaments that connect breasts to the chest wall can become overstretched and painful by the end of the day. The result is achy, sore breasts. This may be especially noticeable during exercise. Make sure your bra is the correct size and provides good support.

  4. Breast pain is really coming from your chest wall.

    What feels breast pain may actually be coming from your chest wall. This is the area of muscle, tissue and bone that surrounds and protects your heart and lungs. Common causes of chest wall pain include:

    • A pulled muscle
    • Inflammation around the ribs
    • Trauma to the chest wall (getting hit in the chest)
    • Bone fracture
  5. Breastfeeding is causing breast tenderness.

    Breastfeeding can sometimes be the source of breast pain. Some of the things you can experience while nursing include:

    • Painful nipples from an improper latch (the way a baby latches on to suck)
    • Tingling sensation during letdown (when the milk starts to flow to the baby)
    • Nipple soreness due to being bitten or having dry, cracked skin or an infection

    If you have pain while breastfeeding, it’s best to talk to your doctor or a lactation consultant. They can help you troubleshoot the problem while maintaining your milk supply. 

  6. You have a breast infection.

    Breastfeeding women are most ly to get breast infections (mastitis), but they occasionally occur in other women, too. If you have a breast infection, you may have a fever and symptoms in one breast, including:

    If you think you may have a breast infection, it’s important to see a doctor. Treatment typically includes antibiotics and pain relievers.

  7. Breast pain could be a medication side effect.

    Some medications may cause breast pain as a side effect. Talk to your doctor about the medications you’re on and if this could be the case for you. Some drugs with this known side effect include:

    • Oxymethone, used to treat some forms of anemia
    • Chlorpromazine, used to treat various mental health conditions
    • Water pills (diuretics), drugs that increase urination and are used to treat kidney and heart disease and high blood pressure
    • Hormone therapies (birth control pills, hormone replacement or infertility treatments)
    • Digitalis, prescribed for heart failure
    • Methyldopa, used to treat high blood pressure
  8. You have a painful breast cyst.

    If a tender lump suddenly appears in your breast, you may have a cyst, says Wright. “These fluid-filled lumps aren’t dangerous and often don’t need to be treated as they may resolve on their own. But it’s important to get any lump in your breast evaluated by a doctor.”

    To diagnose a cyst, your doctor may recommend a mammogram, ultrasound or aspiration (drawing fluid from the lump). Draining fluid from the cyst is also a form of treatment. If the cyst isn’t bothersome, you may not need any treatment at all.

    Learn more about breast cysts and other noncancerous breast lumps.

  9. You’re experiencing painful complications from breast implants. 

    Some women have complications with breast implants, whether made of silicone or saline. One of the most common causes of pain after breast augmentation surgery is capsular contracture, when scar tissue forms too tightly around implants. Breast pain can also be an indication that one of your implants has ruptured. Talk to your doctor about any pain you’re having to determine if it could be related to the breast implants.

  10. Breast pain can sometimes be a sign of breast cancer.

    It’s unusual for breast cancer to cause pain, says Wright, but not impossible. Inflammatory breast cancer often causes pain but it’s rare, accounting for 1% to 5% of breast cancer cases in the United States. Symptoms of this aggressive disease often come on suddenly and progress rapidly. Inflammatory breast cancer may cause the breast to become:

    • Red or discolored
    • Swollen or heavy
    • Painful

    Skin on the breast may also thicken or dimple. If you’re concerned about inflammatory breast cancer, see your doctor immediately. 

Although most cases of breast pain are minor problems, it’s important to talk to your doctor about your concerns. “If you have persistent breast pain, you should be evaluated,” says Wright. “And anyone who has a lump — painful or not — should see their doctor for an exam to make sure there isn’t a problem.”


Breast Pain (Mastalgia)

Breast Pain (Mastalgia) | Johns Hopkins Medicine

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Mastalgia is breast pain. There are 2 main types of mastalgia:

  • Cyclical breast pain. The pain is linked to menstrual periods.
  • Noncyclic breast pain. The pain may come from the breast. Or it may come from somewhere else, such as nearby muscles or joints, and may be felt in the breast.

The pain can range from minor discomfort to severely disabling pain in some cases. Many women with breast pain are afraid they may have breast cancer. But breast pain is rarely linked to breast cancer. It should not be considered a possible symptom of breast cancer. 

What is cyclical breast pain?

The most common type of breast pain is linked to the menstrual cycle. It is nearly always hormonal. Some women begin to have pain around the time of ovulation. The pain continues until the start of their menstrual cycle.

The pain may be barely noticeable. Or it may be so severe that you can’t wear tight-fitting clothing or handle close contact of any kind. The pain may be felt in only one breast.

Or it may be felt as a radiating feeling in the underarm area.

Some healthcare providers have women chart their breast pain to figure out if the pain is cyclical or not. After a few months, the link between the menstrual cycle and breast pain will appear.

Researchers continue to study the role that hormones play in cyclical mastalgia. One study has suggested that some women with this condition have less progesterone than they do estrogen in the second half of the menstrual cycle.

Other studies have found that an abnormality in the hormone prolactin may affect breast pain. Hormones can also affect cyclical breast pain due to stress.

Breast pain can increase or change its pattern with the hormone changes that happen during times of stress.

Hormones may not provide the total answer to cyclical breast pain. That’s because the pain is often more severe in one breast than in the other. Hormones would tend to affect both breasts equally. Many researchers believe that the answer may be a combination of hormonal activity and something in the breast that responds to this activity. More research is needed.

What are the treatments for cyclical breast pain?

Treatment for cyclical breast pain will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatments vary greatly and may include the following:

  • Not having caffeine
  • Taking vitamin E
  • Eating a low-fat diet

In some cases, various supplemental hormones and hormone blockers are also prescribed. These may include:

  • Birth control pills
  • Bromocriptine (which blocks prolactin in the hypothalamus)
  • Danazol, a male hormone
  • Thyroid hormones
  • Tamoxifen, an estrogen blocker

Supplemental hormones and hormone blockers may have side effects. In addition, the risks and benefits of such treatment should be carefully discussed with your healthcare provider.

What is noncyclic breast pain?

Noncyclic breast pain is fairly uncommon, feels different than cyclical mastalgia, and does not vary with the menstrual cycle. Generally, the pain is present all the time and is in only 1 specific location.

One cause of noncyclic breast pain is trauma, or a blow to the breast. Other causes can include arthritic pain in the chest cavity and in the neck, which radiates down to the breast.

What are the treatments for noncyclic breast pain?

It’s more difficult to figure out the best treatment for noncyclic breast pain. That’s because it’s hard to know exactly where the pain is coming from. In addition, the pain is not hormonal. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Your healthcare provider will do a physical exam and may order a mammogram. In some cases, a biopsy of the area is also needed.

If it is found that the pain is caused by a cyst, then the cyst will be aspirated. This means that a small needle will be used to remove the liquid contents of the cyst.

Depending on where the pain starts, treatment may include pain relievers, anti-inflammatory medicines, and compresses.

One of the best things you can do to protect and improve your health is to stay informed. Your Health is a FREE e-newsletter that serves as your smart, simple connection to the world-class expertise of Johns Hopkins.


In 1894, William Stewart Halsted published “The Results ofOperations for the Cure of Cancer of the Breast Performed at the JohnsHopkins Hospital from June, 1889, to January, 1894,” in the medicaljournal Annals of Surgery.

In the article, Halsted describes the resultsfrom fifty of his operations on women with breast cancer, performed atJohns Hopkins Hospital in Baltimore, Maryland.

Those operations involveda surgical procedure Halsted called radical mastectomy, which consistsin removing all of the patient's breast tissue, chest muscle, andunderarm lymph nodes.

Halsted's surgery effectively cured breast cancerin a time period when no other effective treatment options wereavailable. The radical mastectomy remained the standard of care from the1890s to the 1970s as a means of treating a type of reproductive cancercommon to women.

Halsted wrote “The Results of Operations for the Cureof Cancer of the Breast Performed at the Johns Hopkins Hospital fromJune, 1889, to January, 1894”, hereafter referred to as “Results ofOperations,” while he worked as a surgeon and professor of surgery atJohns Hopkins University in Baltimore, Maryland.

At Johns HopkinsUniversity, Halsted contributed new surgical procedures and techniques,such as using thin rubber gloves in the operating room and using platesand screws to secure bone fractures as they healed. Additionally, heintroduced a new system of training surgeons during and after medicalschool.

Halsted's radical mastectomy is one of many of his originalprocedures that other surgeons adopted as a standard of care.

In “Results of Operations,” Halsted reviews case studies and presents histechnique for radical mastectomy surgery. First, he presents resultsfrom the fifty radical mastectomies he performed at Johns HopkinsHospital from 1889 to 1894.

Next, Halsted details the previousprocedures for treating breast cancer and their outcomes beforeexplaining the reasoning behind the radical mastectomy. Then hedescribes the specifics of the radical mastectomy and its outcome.

Atthe end, Halsted concludes with brief histories of each patient involvedin the article's fifty operations.

In the introduction of the article,Halsted discusses the successful results of the fifty radicalmastectomies that he performed between 1889 and 1894.

He considers aresult successful when there were no recurrences of the patient's breastcancer, which indicates that the surgery removed the entire tumor andthat the same tumor did not reappear within the area operated upon,known as a local reoccurrence, or somewhere else in the body, which hecalls a regionary reoccurrence. In Halsted's fifty cases, three patientshad local recurrences, only one of which was inoperable. An additionaleight patients suffered regionary recurrences, three of whom underwentsecond operations and lived, and four of whom died of either inoperabletumors or tumors somewhere else in the body. The last patient was aliveat the time the article was written with an operable regionary tumor,but Halsted did not conduct the surgery because she also had aninoperable tumor in her femur. Halsted concludes with percentagespertaining to the forty-six patients whose long-term outcomes could beassessed. Seventy-three percent of the patients did not develop local orregionary recurrences. An even higher percentage, ninety-three percent,did not develop local recurrences.

Halsted then explains other surgicalprocedures for treating breast cancer prior to his radical mastectomy.Those procedures largely involved removing the breast tissue as well asthe lymph nodes of the underarm, but not the chest muscles.

Halstedclaims that surgeons at the time did not think tumors could involve themuscles of the chest. According to Halsted, those surgeons thought thatany tumors found on or near muscle tissue resulted from ducts that carrywhite blood cells throughout the body, or lymphatic vessels, which cancontain cancerous cells.

However, at the time surgeons assumed that themuscles transferred fluids into the lymphatic vessels. Therefore,Halsted reports, other surgeons surmised that any tumors found nearmuscle tissue had infected the layer of tissue above the muscle, whichhad more contact with lymphatic vessels, and not the muscle itself.

According to Halsted, other surgeons inferred that the thin tissuecovering the chest muscles could be cancerous, but not the muscleitself. However, in his articles Halsted states that he had seen casesin which the cancer had spread to the muscles themselves.

Thus, toremove the cancer entirely, Halsted argues for the removal of the largerof the two chest muscles, called the pectoralis major.

After discussingprior methods of surgically treating breast cancer, Halsted details thespecific procedure of the radical mastectomy and he explains why it ismore effective than other procedures. The procedure removes the breasttissue, the pectoralis major chest muscle, and the lymphatic vesselsfrom the chest to the upper arm.

Halsted claims that by removing thepectoralis major, the surgeon can easily remove all tissue that couldcontain cancerous tumors in one piece. Halsted states that removingtumors in piecemeal could leave pieces of cancerous tissue behind.Halsted then details precise surgical instructions of how to remove thepectoralis major.

The main focus of Halsted's radical mastectomy is theremoval of the pectoralis major chest muscle and the breast tissue.Halsted instructs the surgeon to make a continuous incision around thebreast. Then, he describes the incisions the surgeon makes to separatethe pectoralis major chest muscle from the tissue beneath it.

Once thatis done, Halsted instructs the surgeon to remove the pectoralis majorand the tissue resting on top of it, including the breast tissue.Halsted's remaining instructions describe how to remove the lymph nodesand clean the lymphatic vessels by scraping all flesh away from themwith a knife.

All other instructions describe how to close the woundsafely.

After Halsted describes the surgical process, he discusses theoutcomes of the procedure. Halsted states that of the seventy-sixoperations he performed in all, even counting the twenty-six incompleteoperations that are not part of the official fifty results, no patientdied due to the operation.

However, patients did experience some minordisabilities due to how much tissue was removed during surgery. Becausethe surgeons removed pieces of skin near the underarm, some patientswere not able to dress their hair, as lifting their arms above parallelwas difficult.

But, Halsted reports, because loss of muscle did notcause that problem, he relieved the patients' disabilities throughskin-grafting procedures that restored skin to the underarm areas.Additionally, some swelling accompanied the healing process after theprocedure, but once that reduced, the patients retained function oftheir arms.

Halsted ensured patients had that functionality by securinga certain flap of skin in a particular manner during the procedure sothat the arm did not end up fused to the patient's side. However,Halsted claims that even minor disabilities caused by a radicalmastectomy are trivial because no disability is worse than dying.

Hefurther defends the results of his procedure by reasoning that becausemost of the patients are older, averaging fifty-five years of age, theyare no longer very active members of society and so slight disabilitiesdo not matter.

Halsted concludes his “Results of Operations” by statingthat the radical mastectomy, if performed early on, makes breast cancera curable disease. However, he suggests that surgeons practice theprocedure on cadavers before performing it on patients and warns that itis not an operation that surgeons can properly perform after two orthree trials.

He did not specify how much practice he recommended. Afterhis concluding statements, Halsted provides brief histories of all fiftycases he operated on between 1889 and 1894 that he included in theresults section.

The histories include the patients' initials, age,marital status, kind and placement of tumor, type of surgery used toremove the tumor, symptoms of the tumor, the initial prognosisimmediately after the surgery, and an update on the patient's conditionusually a year after the surgery.

Following the histories, Halsted alsoprovides four illustrative plates, including two anatomical diagramsshowing skin incisions and muscle placements, as well as twophotographs, one of an area operated upon just before Halsted removedthe tumor and one of a tumor after Halsted removed it.

As late as 1970,surgeons considered Halsted's radical mastectomy, first outlined in”Results of Operation,” as the conventional surgical treatment forbreast cancer.

Bernard Fisher, a professor of surgery at University ofPittsburgh School of Medicine in Pittsburgh, Pennsylvania, who conductedextensive research on breast cancer, noted that by 1970 surgeons debatedwhether the radical mastectomy remained the best treatment option.

Fisher argued that it was irrational to continue to endorse the radicalmastectomy without considering the fact that surgery had progressed andnew treatment options exceeded the radical mastectomy in treating breastcancer.

Such procedures included mastectomies that removed less tissue,as well as lumpectomies that removed only the tumor from the breast,leaving the body's normal tissue intact. Additionally, Fisher noted thatthose procedures, when used in the appropriate cases, produced the samesuccessful results as the radical mastectomy without the physicaldeformities or disabilities.


  1. Fisher, Bernard, Robert G. Ravdin, Robert K. Ausman, Nelson H. Slack, George E. Moore, and Rudolf J. Noer. “Surgical Adjuvant Chemotherapy in Cancer of the Breast: Results of a Decade of Cooperative Investigation.” Annals of Surgery 168 (1968): 337–56. (Accessed February 25, 2016).
  2. Fisher, Bernard.

    “The Surgical Dilemma in the Primary Therapy of Invasive Breast Cancer: A Critical Appraisal.” Current Problems in Surgery 7 (1970): 3–53.

  3. Halsted, William Stewart. “Developments in the Skin-Grafting Operation for Cancer of the Breast.” Journal of American Medicine 60 (1913): 416–8.
  4. Halsted, William Stewart.

    “The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June, 1889, to January, 1894.” Annals of Surgery 20 (1894): 497–555. (Accessed February 25, 2016).

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Johns Hopkins to Study Alternative Therapies for Breast Cancer, Prostate Cancer

Breast Pain (Mastalgia) | Johns Hopkins Medicine

Can tart cherries alleviate cancer pain? Does prayer help healAfrican-American women with breast cancer? To answer such questions, JohnsHopkins Medicine has been awarded a 5-year, $7.8 million grant from the NationalInstitutes of Health (NIH) National Center for Complementary and AlternativeMedicine to establish a research center to study complementary and alternative

medicine in the treatment of cancer.

The Johns Hopkins Center for Complementary and AlternativeMedicine (CAM) in Cancer will initially pursue four studies of alternativetherapies for breast and prostate cancers, will train and educate physicians andmedical students in alternative medicine and research techniques, and will

review and fund pilot studies of other alternative treatments.

East Meets West

“Our aim is to reconcile scientific method with alternativemedicine treatments—two areas currently in opposition in the West,” saidAdrian S. Dobs, md, mhs, principal investigator of the new center and associateprofessor of endocrinology. The Center will promote collaboration betweenalternative medicine and mainstream scientific communities to determine the most

promising alternative treatments and the most scientific way of studying them.

Among the research projects is an evaluation of PC-SPES (acombination of eight Chinese herbs) for its ability to reduce stress (leading tooxidative DNA damage in cancer cells) and for its ability to improve the immunesystem in prostate cancer patients. Scientists will also study soy and sourcherries for their ability to reduce cancer pain, and investigate the impact ofprayer on the health of African-American women with breast cancer. In addition,

the Center plans collaborations with Johns Hopkins Singapore.

Breast and prostate cancers will be the focus of intitialstudies at the Center, but Dr. Dobs believes that information gleaned from

studying these cancers may be generalized to other forms of cancer.

A Lucrative Alternative

“Often patients ask their physicians about an alternativemedicine treatment that they heard of, but receive little direction one way orthe other because there is little scientific evidence,” said Dr. Dobs, whoalso directs Hopkins’ Clinical Trials Unit and serves as vice chair for thedepartment of medicine.

“Then the onus is on the patient to decide, andthis can be dangerous for patients.

” Despite the lack of scientific proofand safety data on alternative medicine treatments, Americans spent more than$27 billion on alternative therapies in 1997, exceeding out-of-pocket spendingfor all hospitalizations in the United States, according to a survey published

in the Journal of the American Medical Association.

“We have assembled a top-notch team of cutting-edge Hopkinsscientists and leaders in alternative medicine, and we will proceed with an open

mind and a healthy amount of skepticism,” said Dr. Dobs.

The initial trials should begin in about 6 months. Those wishing
to find out more about the studies or volunteer should call 410-847-3550.


Normal Breast Development and Changes

Breast Pain (Mastalgia) | Johns Hopkins Medicine

Breast development is a vital part of a woman’s reproduction. Breast development happens in certain stages during a woman's life: first before birth, again at puberty, and later during the childbearing years. Changes also happen to the breasts during the menstrual cycle and when a woman reaches menopause.

When does breast development begin?

Breasts begin to form while the unborn baby is still growing in the mother’s uterus. This starts with a thickening in the chest area called the mammary ridge or milk line. By the time a baby girl is born, nipples and the beginnings of the milk-duct system have formed.

Breast changes continue to happen over a woman’s life. The first thing to develop are lobes, or small subdivisions of breast tissue. Mammary glands develop next and consist of 15 to 24 lobes.

Mammary glands are influenced by hormones activated in puberty. Shrinkage (involution) of the milk ducts is the final major change that happens in the breast tissue. The mammary glands slowly start to shrink.

This often starts around age 35.

What breast changes happen at puberty?

As a girl approaches her teen years, the first visible signs of breast development begin. When the ovaries start to produce and release (secrete) estrogen, fat in the connective tissue starts to collect. This causes the breasts to enlarge. The duct system also starts to grow. Often these breast changes happen at the same that pubic hair and armpit hair appear.

Once ovulation and menstruation begin, the maturing of the breasts begins with the formation of secretory glands at the end of the milk ducts. The breasts and duct system continue to grow and mature, with the development of many glands and lobules. The rate at which breasts grow is different for each young woman.

Female breast developmental stages Description
Stage 1 Preteen. Only the tip of the nipple is raised.
Stage 2 Buds appear, and breast and nipple are raised. The dark area of skin around the nipple (the areola) gets larger.
Stage 3 Breasts are slightly larger, with glandular breast tissue present.
Stage 4 The areola and nipple become raised and form a second mound above the rest of the breast.
Stage 5 Mature adult breast. The breast becomes rounded and only the nipple is raised.

What cyclical changes happen to the breasts during the menstrual cycle?

Each month, women go through changes in the hormones that make up the normal menstrual cycle. The hormone estrogen is produced by the ovaries in the first half of the menstrual cycle. It stimulates the growth of milk ducts in the breasts.

The increasing level of estrogen leads to ovulation halfway through the cycle. Next, the hormone progesterone takes over in the second half of the cycle. It stimulates the formation of the milk glands.

These hormones are believed to be responsible for the cyclical changes that many women feel in their breasts just before menstruation. These include swelling, pain, and soreness.

During menstruation, many women also have changes in breast texture. Their breasts may feel very lumpy. This is because the glands in the breast are enlarging to get ready for a possible pregnancy. If pregnancy does not happen, the breasts go back to normal size. Once menstruation starts, the cycle begins again.

What happens to the breasts during pregnancy and milk production?

Many healthcare providers believe the breasts are not fully mature until a woman has given birth and made milk. Breast changes are one of the earliest signs of pregnancy. This is a result of the hormone progesterone.

In addition, the dark areas of skin around the nipples (the areolas) begin to swell. This is followed by the rapid swelling of the breasts themselves. Most pregnant women feel soreness down the sides of the breasts, and nipple tingling or soreness.

This is because of the growth of the milk duct system and the formation of many more lobules.

By the fifth or sixth month of pregnancy, the breasts are fully capable of producing milk.

As in puberty, estrogen controls the growth of the ducts, and progesterone controls the growth of the glandular buds. Many other hormones also play vital roles in milk production.

These include follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, oxytocin, and human placental lactogen (HPL).

Other physical changes happen as well. These include the blood vessels in the breast becoming more visible and the areola getting larger and darker. All of these changes are in preparation for breastfeeding the baby after birth.

What happens to the breasts at menopause?

By the time a woman reaches her late 40s and early 50s, perimenopause is starting or is well underway. At this time, the levels of estrogen and progesterone begin to change. Estrogen levels dramatically decrease.

This leads to many of the symptoms commonly linked to menopause. Without estrogen, the breast’s connective tissue becomes dehydrated and is no longer elastic. The breast tissue, which was prepared to make milk, shrinks and loses shape.

This leads to the “saggy” breasts associated with women of this age.

Women who are taking hormone therapy may have some of the premenstrual breast symptoms that they had while they were still menstruating, such as soreness and swelling. But if a woman’s breasts were saggy before menopause, this will not change with hormone therapy.