Breast Pain Research Helps Mothers Keep Nursing

A new research study led by Anne Eglash, MD, a clinical associate professor at the UW Health Mt. Horeb Clinic, is searching for the best way to care for breastfeeding mothers who suffer with chronic breast pain.

This study, combined with Dr. Eglash's nationally recognized clinical expertise and professional advocacy activities, aims to help mothers throughout the region continue breastfeeding their babies for as long as possible.

The Roots of Chronic Breast Pain

Approximately 20 percent of breastfeeding mothers experience mastitis, or breast inflammation, with accompanying symptoms of pain, fever, and hot, swollen breasts. Infectious mastitis is usually treated successfully with a short course of antibiotics.

A small group of women, however, suffer chronic breast pain without the usual symptoms of acute mastitis. "In the early- to mid-1990s, women were coming to me with continual breast pain that no one could do anything about," said Dr. Eglash, who is also a lactation consultant. "They didn't have a fever, but their breasts just ached. I was often the last stop before they would wean their babies."

Dr. Eglash found no information in the medical literature on the diagnosis and treatment of this type of breast pain. But because her patients' symptoms seemed to indicate a low-grade infection, she tried treating them with long-term antibiotics, and found that the majority improved.

In Search of an Elusive Bacteria

The results of Dr. Eglash's clinical experiences were published in the Journal of Human Lactation in 2006. However, the underlying biological questions remained: what type of bacteria was causing this infection, and how should it be treated?

To begin to answer these questions, Dr. Eglash first evaluated the breastmilk culture results of her patients with chronic breast pain. What she found was surprising: approximately 50% of the cultures came back negative for infection or contained bacteria that could not be specifically identified as a pathogen.

She then contacted Richard Proctor, MD, a former professor of medical microbiology and immunology at the UW, with these findings. With his extensive history and knowledge working with chronic bovine mastitis, he suggested that these lactating women may be experiencing breast infections from small colony variants of staphylococcus aureus. This same clinical syndrome has been identified in lactating cows.

The staphylococcus bacteria may be changing their identifying and behavioral characteristics when pressured by the natural antibiotic properties of breast milk. "Like soldiers who disguise themselves as civilians during a war, the bacteria were changing their behavior so they're not vulnerable," she explained.

Dr. Eglash then teamed up with Pamela Ruegg, DVM, a professor of dairy science at the UW College of Agricultural and Life Sciences. A veterinarian who specializes in bovine mastitis, Dr. Ruegg is helping Dr. Eglash find new culture techniques that may help identify the bacteria.

The first stages of their study, funded by the DFM and the Wisconsin Academy of Family Physicians, will determine ways to sufficiently inactivate breast milk's antibiotic properties so that bacteria will grow in culture.

Refining the culture technique will then enable Dr. Eglash to compare samples from women with chronic breast pain with those from women without those symptoms, thereby getting closer to identifying the source of the infection and pain.

"My big clinical question is, what is the best way to care for women with chronic breast pain?" she said. "Many people around the world are skeptical about treating infections with prolonged antibiotics. I hope to eventually determine whether this is the only treatment we can offer, or if there are there other solutions. We also need to investigate ways to prevent this problem."

Clinical Expertise and Advocacy

For Dr. Eglash, helping mothers continue breastfeeding is a big part of her life's work. Her decision to become a lactation consultant was partly motivated by having suffered chronic breast pain herself while nursing her own children.

Now, her clinical practice has become a destination for women throughout the area with similar problems. "It's become more recognized in the community that chronic breast pain is real and potentially treatable," she noted.

In addition, Dr. Eglash is a co-founder of the Academy of Breastfeeding Medicine and the Mothers' Milk Association of Wisconsin (MMAW), the latter of which is working to establish a human milk bank in Wisconsin.

The MMAW helps potential breast milk donors through the screening process, coordinates breast milk donations from approved donors, and ships the milk in cooperation with Angel Flight to the Mothers' Milk Bank of Ohio (MMBO). The MMBO pasteurizes the milk and distributes it to babies in need throughout the country.