Last week on March 8,  was women’s day. I was slow with the pen, and probably with the mind, so I thought I could recover a little this week and write on this.
In about the 1980s, women’s issues or the gender agenda began to take root in Zambia and much of Africa.
Many men were skeptical about the value of this, as were many of the more elderly women.
Married women were suspicious of the motives of many young women who had become part of the rather vocal and vibrant women’s groups.
The women were stigmatised as being either divorced, unmarried or generally hating menfolk. Some of these misunderstandings have dissipated with time and many of these organisations have attained a high level of esteem and respectability in the eyes of the public.
I struggled myself with the “Gender Agenda” for many years especially in the years when it was more popularly called the women’s lib movement.
When I got older I realised that the “Gender Agenda” was all about development.
It was about addressing the fact that in most rural parts of Africa, women are the key drivers of the economic activities and yet they have little influence on the economic decision making.
It is a call for women to share in the process of development, which would allow a more balanced  direction of development.
From the medical perspective it can be seen as trying to give women better access to health care as well as increasing volumes of women who make decisions about the health care of women in our health systems.
Women in their role of rearing and caring, bear a lot of ill health. Much of which comes from the process of birth and delivery.
There are many other health care needs among women, however, and one of the forgotten or neglected health care issues is Breast pain.
It is neglected probably because it is not regarded as germane as the more urgent matters of maternal mortality due to home deliveries.
However many women suffer silently and quietly from this problem.
When I was a struggling young trainee surgeon, trying to get a foothold in surgery, I did some research work on Breast lumps. I set up a breast clinic, and discovered in the process, to my surprise, the much ignored problem of Breast pain.
Many women, believe they have a Breast lump primarily because they had experienced Breast pain.
So in respect to Women’s day, I thought to discuss the much neglected problem of Breast Pain or Mastalgia.
1.What is Breast pain?
2. What causes Breast pain?
3. How can it be treated ?

1. What is Breast pain?
Or perhaps we should begin, by asking the more obvious question, what is the Breast. Many people mistakenly believe only women have Breasts. In fact men too have Breasts, only that the male breast is like a shrub, while the female breast is like a fully mature tree.
During the prepubertal period, below 10 years old, the boys and girls have the same size of  Breasts.
However with the rise in female hormones after 10,  the female Breast begins to branch, which the male breast does not.
Having dispensed with that myth, the  Breast can be defined as a special gland of the skin found on the chest wall that has a branching system of ducts, which in women produces nutrition for babies.
The gland increases in size with female age reaching a peak size in the second decade. With pregnancy the Breast increases in size in preparation for providing milk to the new born.
Having answered the second question we can now revert to the first.
What is Breast pain? Breast pain is an ill-defined discomfort of varying levels from the area of the Breast and its adjoining tissues.
This may range from mild discomfort with tingling sensation which can be ignored to severe pain which requires pain killers and disturbs work.
The pain may affect one breast but is often bilateral. Breast pain is uncommon in men and is more common in women.
This is probably because the male Breast remains relatively vestigial and does not change much from its preteen year’s size. Someone may ask, so now that we know what Breast pain is, what is the big thing about it?
Well just like the issue of women’s rights and the gender agenda was neglected for many years, so too, Breast pains is an often neglected problem. It is a fairly common problem, which rarely receives due attention.
It is said to be the most common Breast complaint among women, up to 70per cent  of women experience Breast pain.
So if you are a woman and reading this article, chances are that,  you will have had Breast pain at one point or another.
In as many as 15 per cent  of women this pain is severe enough to warrant some form of medical treatment. If this problem is so common, why is it so neglected?
Well they may be several reasons, however among them I would certainly cite social and  cultural reasons.
The Breast is a very private organ, and women would rather not draw undue attention to their Breast, unless absolutely necessary.
The second reason like the first is the self-effacing nature of women generally and their leaning to the well-being of others above their own.
In this context it makes sense for us to discuss this matter in the vicinity of women’s days.
2. What causes Breast pain?
There may be many causes of Breast pain. However, for ease of understanding,  these maybe divided into two major groups.
These are the Breast pain related to the periods (menstrual cycles), this is called cyclical Breast pain. This occurs during the times of the monthly menstrual flow.
The second is noncyclical Breast pain.
This pain occurs at any time and does not follow the cycle of the monthly periods.
Cyclical Breast pain is the most common, and represents up to 75 per cent of the causes of Breast pain.
The reason for pain in cyclical breast pain, are the changes in the female hormones at about the time of the periods.
The Breast tends to accumulate fluids and swell at this time, this gives some discomfort especially with activities of the hands and chest.
The pain tends to get relieved after the periods and will generally disappear in women in Menopause (when women stop having periods in their 40s and 50s). Noncyclical Breast pain is less common and accounts for 25per cent of all Breast pain.
This type of pain has many causes which include contraceptive pill (family planning pills) usage, tightly fitting bras, accidental breast injury, sudden weight gain, diseases of the joints of the chest wall(Costochondritis) and swollen blood vessels on the Breast(Thrombophlebitis of veins of the Breast- Mondors Disease).
This type of pain may be in one Breast but not another, and may last for long periods, occuring in older women.
Previous operations of the Breast including Breast biopsies (removal of some breast tissue to test for cancer) may also result in Breast pain.
Young women who are newly pregnant for the first time may also experience Breast pain.
This is both because of the enlargement or fullness of the Breast to Breast milk accumulation.
However occasionally with the commencement of breast feeding, the nipples may get cracked and some germs enter the breast leading to collection of pus in the Breast or what is called a Lactational Breast Abscess (Collection of pus in a Breast feeding mothers Breast).
The main concern that most women have with Breast pain, especially when their Breast also has a lump, is whether they have Cancer of the Breast. In fact Breast cancer very rarely will give Breast pain as its first symptom.
The first symptom of Breast cancer is often a Breast lump or a bloody nipple discharge (blood from the breast nipples). Only in advanced cases of cancer of the breast will a woman come with Breast pain.
On the other hand in men, in whom Breast cancer is quite rare, Breast pain as a sign of breast cancer, is more common. This is because the Breast tissue is so small and the disease spreads so quickly.
3. How can Breast pain be managed?
The first piece of advice is to chart the pain.
Decide if this pain is cyclical or non cyclical breast pain. Create a table of when you have the pain, when it starts and when it ends.
Many women have a diary of their period cycles, and for them it will be easy to pencil in the breast pain attacks.
If as in many cases the Breast pain is cyclical, the following things can be recommended.
1.Bra size change
2.Dietary advice
3.Nutritonal supplements
4.Salt intake
5.Fluid control
6.Drugs
Choose a good fitting bra during this period that will not be too tight.
Try to lose some weight and this will reduce the fat content of the breast.
You can do this by reducing the volume of carbohydrates in your diet, increase the amount of good fats (vegetable fats), eating white meat and minimise frying of food in preference for roasting.
Use some Vitamin supplements such as Vitamin B and Vitamin E. Reduce the amount of salt in your diet, which will serve to reduce the extent of fluid in your body and help to reduce the fullness of the Breast. Minimise your fluid intake during this period.
The more fluid you take in, the more of it will be retained and this serves to increase the extent of breast fullness.
Some, off the counter drugs, can be used if the pain is moderate to severe, these include oil of primrose tablets and pain killers such as Diclofenac and Brufen.
The oil of primrose serve to provide some essential fatty oils that decline in the body during this period and are associated with breast pain.
Noncyclical Breast pain tends to have a specific trigger point.
The sight where the pain is mostly centred. If there is a specific problem at that site, such as a lump, swelling or a diseased joint, has to be treated to resolve the problem.
However, if there is no specific identifiable problem at the trigger point site, then a similar approach to Breast pain can be used as  described above for cyclical breast pain. Do not hesitate to see your Doctor for Breast pain.
A number of tests will often be done to ensure that no underlying serious illness of the Breast exists.
These include Ultrasound scan (Breast scan) and or a special Breast  X ray(Mammography). If a woman is below 35years a scan is best, if above 35 years a mammogram will be preferred.