Connection Between Breast Cancer and Shoulder Discomfort: Is There a Relationship?
Breast cancer can sometimes spread to the bones, including the shoulder blade area, causing pain. This occurs when cancer cells spread to the bones in that region, such as the scapula or the spine nearby. The spread leads to bone destruction or weakening, known as osteolytic lesions, or abnormal new bone formation, called osteoblastic lesions, or often both. These changes cause inflammation, bone weakening, and sometimes fractures or nerve compression, resulting in pain in the shoulder blade region.
The metastatic tumor cells interact with bone cells, disrupting normal bone structure and causing bone damage or pathological fractures, which result in localized pain that may be sudden, severe, or worsen at rest. If the metastasis involves nearby spinal vertebrae (cervical or upper thoracic spine), it can compress nerves, leading to radiating pain to the shoulder blade, numbness, weakness, or limited movement in the shoulder area.
Treatment options for shoulder blade pain caused by breast cancer metastasis to bone include:
- Radiation therapy applied locally to the metastatic bone lesions to reduce tumor size, relieve pain, and stabilize bone integrity.
- Analgesic medications such as NSAIDs, opioids, or corticosteroids to control pain and inflammation.
- Bone-strengthening agents like bisphosphonates or denosumab to reduce bone breakdown and lower the risk of fractures.
- Surgery may be needed in cases of pathological fractures, spinal instability, or nerve compression to stabilize bones or decompress nerves.
- Systemic cancer treatments such as chemotherapy, hormonal therapy, targeted therapy, or immunotherapy to control the underlying breast cancer progression and metastatic spread, indirectly reducing bone pain.
- Physical therapy and supportive care to maintain mobility and function while managing symptoms.
It is essential to consult a doctor for advice on how to treat shoulder pain that may occur due to metastasized breast cancer or as a result of related treatments. A doctor may order imaging scans to determine if shoulder blade pain is due to breast cancer that has spread to the bones.
In addition to breast cancer, other conditions can cause shoulder pain or shoulder blade pain. These include Pancoast tumors, which account for approximately 5% of all lung cancer cases, and liver cancer. Post-mastectomy pain syndrome, a condition that can develop after breast cancer surgery, may also cause shoulder pain. Axillary web syndrome (AWS), which develops in about 50% of people after breast cancer surgery, involves the development of tight bands of tissue under the skin that may lead to pain in the shoulder when someone extends their arms. Post-mastectomy pain syndrome affects between 10-50% of people who have breast cancer surgery.
Overall, effective pain management from bone metastasis requires a multidisciplinary approach including oncologists, radiologists, pain specialists, and orthopedic surgeons tailored to the patient’s extent of disease and symptoms.
