Health: Please doctor, don't dismiss the pain in my breasts: Women with mastalgia get a raw deal from GPs, reports Brigid McConville

LIKE most women, Ann Lee had experienced occasional discomfort in her breasts. But in her early 40s, this discomfort developed into severe pain. 'My breasts were very hard, like bullets, for about 10 days at a stretch,' says Mrs Lee, now 46.

'They were so painful that I couldn't bear my husband to touch me. Things became very difficult; he would say: 'Oh, no, not tonight, not again . . .' The pain was especially intense in my nipples and kept me awake at night. If I turned over in bed, I yelped. I had to go up a bra size. I couldn't even bear my clothes rubbing against me.'

Mrs Lee's symptoms are not uncommon: it is estimated that up to 70 per cent of women in Britain suffer from breast pain, or mastalgia, at some time in their lives. According to the Breast Care Campaign, it is one of the most common symptoms in women attending a breast clinic - and the most frequent reason for breast-related visits to the doctor.

Unfortunately, many GPs either dismiss breast pain as one of the imaginary ailments of 'neurotic women' or believe it is something women have to put up with.

'Doctors are very resistant to treating breast pain,' says Professor Robert Mansel, head of the department of surgery at the University of Wales College of Medicine. Women complaining of breast pain, he says, are often seen as diverting valuable time and attention from efforts to detect and treat breast cancer.

'Some doctors believe breast pain is a woman's lot,' he says. 'There are women who have come to my clinic in tears. They say - I've been all over the country looking for help and no doctor will listen to me, they all say I'm crazy. Some plead with me to give them mastectomies to put them out of their pain.'

Professor Mansel, who wants benign breast disorders taken more seriously by doctors, believes the dismissal of breast pain is linked to the British obsession with the breast as a sex object. In other countries, he says, medical conferences on breast disorders will also look at the breast in terms of art, culture and a woman's sense of self.

Mastalgia can either be cyclical, fluctuating with the menstrual cycle, often becoming worse before menstruation, or non-cyclical, occurring at any time, usually in women over 40. The causes are still unclear, but in many cases, it is thought to stem from abnormal sensitivity of breast tissue to the female hormones. Diet can exacerbate this: women with breast pain tend to have low levels of gamolenic acid and high levels of saturated fatty acids in the blood, which appear to increase the effects of hormones on the breast. Cyclical pain may also be a side-effect of hormone-replacement therapy or oral contraceptives.

Dr Amanda Ramirez, a liaison psychiatrist with the Imperial Cancer Research Fund's clinical oncology unit at Guy's Hospital, London, says that with severe mastalgia 'a woman needs time off work; she can't pick up her children or vacuum the carpet - and it's the end of her sex life'. Dr Ramirez has found that women with severe breast pain experience as much anxiety and depression as women about to undergo mastectomy.

They often suffer immense anxiety about the possibility of cancer. But in most cases, breast pain is a benign condition.

Professor Mansel believes, however, that any woman with breast pain should have her breasts examined by her doctor to exclude malignancy. According to a survey by the Breast Care Campaign, only half of women who go to their family doctors for breast pain are examined. The figures drop to 11 per cent for women over 55. 'It's appalling,' says Professor Mansel. 'Doctors must examine women to feel for lumps to exclude cancer.'

So what should GPs be doing for women who come to them with breast pain? For many, the relief of being told they do not have cancer - after a sympathetic hearing and examination - is all the treatment they want. The Cardiff Breast Clinic found that 85 per cent of women appeared to be satisfied by reassurance and an explanation about mastalgia. Many can also benefit from changing their bra or having it fitted by a specialist bra fitter.

Breast experts also advocate that women cut their saturated fat intake; sometimes a diet may be needed to help reduce obesity. Gamolenic acid, found in evening primrose oil, has been found to reduce symptoms in up to 70 per cent of patients, usually without side-effects.

Women with severe pain may be offered drugs to alter their hormonal balance, such as danazol and bromocriptine; but both can have unpleasant side-effects, including nausea, weight gain and sometimes hirsutism and voice changes.

Later this year Professor Mansel is publishing guidelines for GPs on how to treat mastalgia; he hopes that they will result in a more sympathetic attitude.

But in the meantime, many women, like Ann Lee, are treating themselves. She has never seen a doctor about her symptoms. Instead, she has used evening primrose oil. 'It has given me some relief,' she says. 'I have also reduced the fat in my diet, which has helped too.

'Male doctors, and some female ones, can't sympathise with women who have breast pain,' says Mrs Lee. 'They think it's something women have to put up with, rather than a disorder requiring understanding and treatment. Many women just want to know it's not malignant.'

The Breast Care Campaign, 1 St Mary Abbot's Place, London W8 6LS.