Could Burning Breast Pain Be a Sign of Breast Cancer?

The burning pain in Sarah Dickinson's right breast started when she was pregnant. Doctors explained it as a side effect of her developing milk ducts, but an ultrasound revealed the truth.

This article is part of Health's series, Misdiagnosed, featuring stories from real women who have had their medical symptoms dismissed or wrongly diagnosed.

Sarah Dickinson was just two weeks pregnant when she started to develop a burning feeling that affected her entire right breast. At first, she assumed it was a weird symptom of pregnancy, but the pain persisted.

"It was on and off, mainly in the evenings," Dickinson told Health. "It would take my breath away—the intensity of the burning sensation would just knock the wind out of me." The first-time mom found that applying heat to her breast helped, and she chalked up her symptoms as "just hormonal."

But the burning sensation continued. Dickinson brought it up when she went to her prenatal appointments, which was often. Because she was 35 at the time, hers was considered a "high risk" pregnancy, which meant having monthly prenatal appointments. "I saw four different providers and told each one about the burning," said Dickinson. Every time, they did a manual breast exam and then concluded that the burning sensation was the result of her milk ducts coming in to prepare for breastfeeding.

Dickinson, who at the time worked as a clinical trial manager for a cancer research organization, brought up the possibility of breast cancer a few times. "I asked about it, and I always got the answer that 'breast cancer doesn't hurt,'" said Dickinson. "I never really thought I had cancer. It just made sense to me that it could be an explanation."

Other Symptoms

At the same time, Dickinson presented other symptoms; the nipple on her right breast was changing. That nipple had already been "kind of inverted," said Dickinson, but it became puckered whenever she had a bout of pain. It also turned dark purple.

The burning sensation continued through her pregnancy, and Dickinson said she kept mentioning it at prenatal visits. "It was always just as intense, and I was always told that it was my milk ducts coming in and that breast burning is common in the early stages of pregnancy," said Dickinson. "It made sense to me—and I had never been pregnant before."

When she was five months along, Dickinson saw a new ob-gyn, who sent her to get an ultrasound of her breast, just in case it turned out to be something more serious than developing milk ducts. "They found a cyst, about a centimeter in size, right away," recalled Dickinson, but the ultrasound indicated that the cyst was "completely normal," or benign.

According to the American Cancer Society (ACS), it's common for females to have noncancerous breast lumps that turn out to be caused by benign fibrous tissue or fluid-filled, round, or oval cysts. While both can occur at any time, they're most common in people of childbearing age.

Even though Dickinson's cyst was considered normal, her new healthcare provider wanted to do follow-up scans. Dickinson had another breast ultrasound done when she was nine months pregnant. According to the ultrasound, the cyst hadn't grown and still continued to appear benign.

Burning Stopped, but Growth Didn't

Dickinson had her baby—a boy she and her husband, Andrew, named Fin. "The burning stopped immediately," said Dickinson. "As soon as Fin was born, it was just gone." She began breastfeeding Fin, but only through her left breast. He wasn't able to latch on to her right breast, which had the inverted-looking nipple, said Dickinson.

Dickinson was scheduled for a follow-up ultrasound of her breast three months after she had Fin, but due to the COVID-19 pandemic, her scan was pushed back a month. "I thought it was fine; I wasn't concerned at that point," said Dickinson. "The burning was gone. I figured they just wanted to make sure the cyst was OK."

But things weren't OK, as Dickinson realized when she had her visit. "As soon as the ultrasound technician put the wand on me, the color drained out of her face," recalled Dickinson. "She brought in the doctor, who said, 'It's grown. There's something else there we need to see.'"

Dickinson was immediately sent for a mammogram and underwent more ultrasound scans of her breast. "Then I waited in the room for about 10 minutes. When the doctor came in, I knew it wasn't good," said Dickinson. "I instantly started crying. I already knew it wasn't good."

Dickinson was told she needed a biopsy for her cyst, which was tucked under her nipple. "That's why it was undetectable to me and the doctors who were feeling for a lump," said Dickinson. Four days later, her doctor called with the results: She had stage one HER2-negative breast cancer.

According to the ACS, HER2-negative breast cancer means the cancer cells don't have a large amount of a protein called HER2 on their surface. Cancer cells that are HER2-negative may grow more slowly and are less likely to come back or spread to other parts of the body than cancer cells that have a large amount of HER2 on their surface. Stage one indicates that Dickinson's cancer hadn't spread to other areas of her body.

According to 2020 research published in the journal Cancers, the survival rate at four years for various breast cancers—depending on the stage and molecular makeup of the cancer—is 92.5-77%. The earlier the cancer is caught, the better the chances of survival.

While Dickinson said she had a pretty good idea she had cancer before she got the call, she was still stunned by the diagnosis. "It just took my breath away that this was actually happening," said Dickinson.

She was also upset that no doctor ordered an ultrasound earlier in her pregnancy. "It's frustrating to think that someone could have ordered an ultrasound sooner," added Dickinson.

Treatment

Dickinson was referred to an oncologist, who was unsure of how long the tumor had been in her breast. "They think it either just popped up or it had been there for a long time and the hormones from pregnancy lit it up," said Dickinson.

Dickinson underwent surgery to remove the tumor. A month later she had a second surgery to remove her nipple and put in a port for chemotherapy. She was warned that chemo could leave her infertile, so she underwent IVF to try to give Fin a sibling in the future. "For the fertility preservation, we chose to freeze embryos, as the success rate during the defrosting process is much higher than freezing eggs," said Dickinson.

Dickinson underwent four rounds of chemotherapy, followed by five weeks of radiation therapy. For her type of cancer, medical specialists often prescribe tamoxifen, a breast cancer drug that blocks the effects of estrogen in breast tissue to help prevent the cancer cells from coming back following chemo and radiation.

Breast Cancer in Younger People

Dickinson had mixed feelings about her journey to a diagnosis. "It's a confusing feeling because I know the doctors were doing the best job they could," said Dickinson. "They did all of the normal things other than an ultrasound, but I do feel that I should have been sent for an ultrasound sooner. I kept bringing this up."

Dickinson said she's aware that she's not the first young woman whose cancer was missed early on. "I know that some women get blown off because of their age," said Dickinson. "If I hadn't seen [my new doctor] and if the burning hadn't happened or stopped during my pregnancy, I never would have gotten that ultrasound. My cancer could have been more advanced by the time it was detected."

According to the Centers for Disease Control and Prevention (CDC), about 9% of new cases of breast cancer are in women under the age of 45. The CDC also states that in younger women, breast cancer is more likely to be hereditary, found at a later stage, and more aggressive and difficult to treat.

Dickinson believed that her baby helped lead to her diagnosis. "In a way, Fin saved my life," said Dickinson. "Without the pregnancy, I never would have had that burning sensation."

Dickinson said she was also "grateful" that she was diagnosed after Fin was born. "I feel like I really enjoyed my pregnancy, and this is happening on a better timeline for me," said Dickinson. "Fin is young, and he won't remember this."

Dickinson urged other women to speak up if something doesn't feel right. "You know your body better than anyone," said Dickinson. "If things don't feel right, there's something wrong. If you're not getting the answer that feels right to you, speak up more often. Otherwise, your fight could be so much harder and longer."

If you have a story to share about being misdiagnosed, email us at misdiagnosed@health.com and join our Misdiagnosed Facebook community to talk to women who share the same struggle.

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