Nagging chest pain and prostate cancer

Dear Dr. G,

I would like to take the opportunity during the Pink October month to ask about some peculiar nagging pain happening to my chest.

I am a man in his 60’s and encountered some strange sensations in my chest since I started treatment for prostate cancer.

I was unfortunately diagnosed with Stage 3 prostate cancer and was treated with hormonal suppression and radiotherapy two years ago.

Although I was given the all clear from the urologist during the last follow-up, I am constantly faced with nagging discomfort on my chest.

Apart from man boobs common in most middle-aged men, there is no real lump that I can feel on my chest.

My wife is worried the prostate cancer may have spread to my chest and asked me to seek medical help from the breast specialists.

Of course, it felt weird to go to a breast specialist, who usually looks after women.

The doctor told me I have mastalgia, and this could be due to hormone treatment for my cancer.

The breast cancer specialist assured me this is nothing serious, however if the pain persists, I may need to have radiotherapy.

In the spirit of Pink October, I would like to put Dr. G on the spot for some clarifications on the issues of my nagging chest pain.

Can you tell me the meaning of mastalgia?

What can cause my breast pain? What are other causes of mastalgia?

What treatment is available for me? Can the pain lead to cancer?

Please help me to get this nagging pain off my chest.

Regards

Nagging Pain Nathan

Mastalgia derives from the word “Mast-“meaning breast, and “-algia” denoting some kind of pain. Mastalgia can range from mild tenderness and discomfort to severe throbbing and stabbing sharp pain in the chests.

The true prevalence of mastalgia is unknown, however most of the presentation is mild and transient. Both men and women are born with breast tissues and mammary glands. The development of these glands become active in girls after puberty. On the other hand, breast tissues in adolescent boys do not progress despite hormonal surges. Although the breast tissues in men are effectively functionless, men still have risks for conditions affecting breast tissues.

Mastalgia is common amongst women which can involve one or both breasts especially before the menstrual period. Other causes of breast pain in women are related to oral contraceptive pills, early pregnancy and onset of menopause. On the other hand, painful breasts in men are uncommon. Common causes of mastalgia in men include muscular strains and trauma.

Muscular strain after heavy lifting and press-ups is another common cause of breast pain in men. The strains to the pectoralis major and minor muscle groups can induce nagging pain of the breasts, as the musculature attachments to the bone are at risks of tear and injury. Although the pain may not originate from the breast tissues itself, the muscles and tendon pain in the area may emanate from the breasts. Muscular skeletal injury like this usually requires rest and stretching exercises to facilitate healing and pain relief.

Breast necrosis occurs when breast tissue is badly damaged, especially after sporting activities or road traffic accidents. While the tissues undergo cell death and regeneration, the process can result in painful lumps in the chests. The skin around the lump may appear red or bruised, this will also cause dimpled which mimics cancerous changes. Fat necrosis of the breasts is usually self-limiting, as the dead tissues will dissolve over time. In severe cases, surgical removal of the dead tissues may be necessary.

Other breast conditions that may be associated with mastalgia include breast cysts and fibroadenoma. Breast cysts are common in women but rare in men. Fibroadenoma is a non-cancerous lump in the fibro-glandular tissues of the breasts. Both these lumps may or may not be palpable externally, however the common symptoms may be breast discomfort.

Gynecomastia and breast cancer can certainly be a cause of concern for men encountering mastalgia.

Gynecomastia is the benign overgrowth of breast tissues in men, caused by the imbalance of male and female hormones. The condition is usually painless, however many men feel self-conscious of the man boobs and encountering breast discomfort. On a more serious note, the overgrown tissues may have the underlying breast lump which may be the onset of breast cancer. Only 2% of breast cancer in women presented with breast pain. Breast cancers in men are rare, but usually present as a lump with skin puckering and dimpling, which requires urgent surgical removal.

Malstalgia itself is benign, mild and transient in presentation. Men with constant discomfort may opt for medical treatment such as tamoxifen, radiation or even mastectomy to eradicate the pain they experience. Men suffering from prostate cancer may not have the option to stop hormonal treatment, therefore radiotherapy intervention may be more appropriate.

Breast pain is a condition experienced by many women throughout their lives. The monthly changes of hormones during the menstrual period and stages of pregnancy are just part and parcel of women’s life that can present as mastalgia. In the spirit of Pink October, it is important to be breast cancer-aware, but also more importantly, demonstrate empathy.