Breast Health Awareness
When we talk about breast health, most women think of cancer as their #1 concern. While breast cancer is a very serious health problem in the United States, it is not the only reason to be concerned about the health of your breasts. The majority of breast “problems” experienced by women are not necessarily associated with breast cancer.
The most common reasons that women seek medical attention are because they have found a lump or are experiencing pain in their breasts. Typically, these conditions do not indicate cancer, but it is probably best to discuss them with your healthcare practitioner.
Finding a lump in your breast can be very frightening, even when it is labeled benign. It can leave you feeling vulnerable, fearful of finding another lump, and wondering what you can do to avoid becoming a breast cancer statistic. Understanding the anatomy of your breasts, how they function, and what types of disorders can occur is the first step in minimizing that feeling of vulnerability.
The “Normal” Breast
Before we delve into anatomy, it might be beneficial to discuss the “normal” breast. In her book Women’s Bodies, Women’s Wisdom, Dr. Christiane Northrup notes that “breasts are a very charged part of our anatomy, both physically and metaphorically.” The cultural ideal that is perpetuated by our society through beauty pageants, Barbie™ dolls, and Hollywood makes the vast majority of women who don’t match this ideal think that there is something wrong with them.
The reality is that breasts come in all different sizes and shapes, as do nipples. Some are large, some are small, some are lumpy, some are smooth, some are firm, and some sag. Most women have one breast that is slightly smaller than the other, and some women’s breasts change from month to month. One of the most important messages Dr. Northrup tells her patients is to start caring for your breasts “instead of comparing them with an impossible ideal.”
Caring for your breasts begins with an understanding of their anatomy. This will help you visualize what you are feeling, both externally and within, so you are better equipped to identify any changes. Dr. Northrup explains that because female breasts are “designed to provide optimal nourishment for babies and to provide sexual pleasure for the woman herself,” they are glandular organs that are loaded with hormone receptors. This makes breasts very sensitive to even the smallest hormonal changes in the body. Breasts go through cyclical changes that coincide with the menstrual cycle, pregnancy, and childbirth. They also contain extremely sensitive nerves, which account for their sexual response, connecting them with the female genital system.
Breasts contain multiple lobes, which are divided into smaller lobules that contain glands for producing milk (see figure). The area between the lobes is cushioned with fat and fibrous connective tissue that attaches the breast to the chest muscles.
Breast tissue extends up into the armpit or axillary area, which also contains lymph nodes that help eliminate bacteria, dead cells, and other harmful substances.
Breast tissue is not typically homogeneous. In other words, one area may feel denser during examination than another area simply because it contains more fibrous connective tissue than soft fat. It is also not unusual to find that the ratio of connective tissue to fat changes as a woman ages.
Each month, the breasts prepare for the possibility of pregnancy, in response to the ebb and flow of female hormones, primarily estrogen, progesterone and prolactin.
During the first half of the menstrual cycle, the ovaries produce estrogen hormones in increasing quantities, which stimulates the growth of new cells in the glands, ducts, and fibrous tissues of the breasts. This increase in cell activity leads to an increase in blood flow to the breast, which some women experience as fullness or tenderness.
In the middle of the menstrual cycle, the ovary releases an egg, stimulating the release of progesterone into the bloodstream. The progesterone provides additional stimulation to the gland cells, further increasing the blood flow and amount of fluid seeping from the ducts into the breast tissue, which makes some women’s breasts feel heavy or painful, three to four days before their period. During pregnancy, the body produces prolactin, which triggers the production of breast milk at delivery.
When menstruation begins (if pregnancy does not occur), the hormone levels shift again. The changes in the breast that the hormones stimulated are reversed. The swelling of tissue diminishes and the breast softens. In a healthy breast, new cell growth and fluid production subsides and the thickening, lumps, and pain usually disappear fairly quickly.
Lumps that persist or reoccur could indicate a breast condition worthy of investigation. For this reason, the best course of action is to report any breast lump, pain, or concern you have to your healthcare practitioner.
Many healthcare practitioners place breast lumps and pain in the catchall category of “fibrocystic breast disease,” while others hesitate to do so because these conditions are so common. Many of the women told that they have this “disease” are simply experiencing normal changes in breast anatomy.
Fibrocystic breast disease (also sometimes called cystic mastitis) is believed to be associated with an elevated estrogen-to-progesterone ratio. In their book For Women Only, Null and Seaman claim that it “is caused by over congestion from foods that clog the system, such as wheat, dairy products, refined foods, and fats. Caffeinated products such as coffee, tea, chocolate, and soft drinks are hard on the body and add to the problem, as does a sluggish thyroid gland, which makes metabolism more difficult and leads to constipation, causing buildup of toxins. Toxic accumulations worsen congestion and can manifest as breast lumps (cysts). Stress worsens the condition.”
The three most common breast disorders are more accurately described as fibrosis, cysts, and problems with the milk ducts. Fibrosis is the thickening of the breast’s connective tissue. Typically, in and of itself, fibrosis is not painful. However, it is often accompanied by the formation of cysts because the tissue growth blocks the milk ducts,
causing them to swell up into tender, fluid-filled sacs, which may feel like lumps. Other pains and lumps are usually the result of hormonal changes, which can be aggravated by diet, stress, or other life factors.
Tenderness or Pain
Breast pain, sometimes called cystic mastalgia, typically comes and goes with the menstrual cycle. It is usually caused by an increase in hormonal stimulation of the breast from an excess of the estrogen hormones, an excess of caffeine, or chronic stress.
In some women, breast pain can become a month-long problem or be very severe premenstrually. According to Dr. Robinson Baker, director of the Breast Clinic at Johns Hopkins Hospital, in the Complete Book of Vitamins and Minerals chapter called “Guide to Healthy Breasts,” chronic or severe breast pain is most likely to be related to a hormone imbalance, usually either too much estrogen or too little progesterone. It can also be influenced by other body chemicals resulting from stress or stimulated by certain foods, as well as other hormones. For this reason, he advises hormone level testing if you continue to have chronic breast pain even after making changes to your diet.
Lumps or Cysts
What women sometimes perceive as lumps are often simply thick connective tissue or fluid filled glands. Occasionally, one of these glands may swell and feel like a hard “pea.” Women who have a more generous supply of fat or denser connective tissue are more likely to mistake normal breast anatomy as something to be concerned about.
Lumps from small cysts often diminish over time. For younger women, a healthcare practitioner might suggest watching it for several menstrual cycles to see if it goes away. Larger lumps may be aspirated (drained with a needle) or surgically removed. Cysts are usually not cancerous, with 8 out of 10 being benign.
In Natural Hormone Balance for Women, Dr. Uzzi Reiss says that “there is no connection between the common lumps and breast cancer, as long as a woman is not in estrogen dominance.” He promotes a progesterone supplement to balance the excess estrogen.
Nipple discharge can be alarming but it is not dangerous. After nursing a baby, it may take a year or more for the milk-producing glands to stop completely. Some women experience a nipple discharge (liquid that can be anything from a greenish clear to a pale milky substance) during the stimulation of sexual contact or lovemaking. Bloody discharge is not normal and should be reported to your practitioner immediately.
Promoting Breast Health
Maintaining breast health requires regular monitoring of your breasts so that you can quickly identify anything unusual. It may also require changes to your lifestyle, such as making sure your bra fits correctly so it does not hamper circulation, modifying your diet, alleviating stress, and getting more exercise. Working with your healthcare practitioner is vital to caring for and maintaining healthy breasts, just as it is with a healthy heart or any other important part of your body.
Monitoring Your Breasts
There are several ways for monitoring your breast health, including breast self-examination (BSE), clinical breast exams performed by a healthcare practitioner, mammography, and a newly emerging practice of thermography or digital infrared imaging. Although mammograms are promoted to detect breast growths, women often detect a breast problem on their own.
Statistically speaking, women find the vast majority of breast abnormalities themselves, while examining their breasts. Because benign breast conditions can occur at any age, it is important for young women to get in the habit of examining their breasts at an early age, preferably soon after they begin menstruating but certainly by the time they reach 18 years of age.
Breast self-exams are best performed right after the menstrual flow stops (or 7 to 10 days after it starts if the flow is abnormal), when hormonal effects are least apparent. Even if you are no longer menstruating, it is still important to perform a BSE every month. Pick a day of the month to maintain a regular schedule of examining your breasts.
So, why do so few women practice breast self-exams regularly? A lack of confidence, not knowing what to look for, the fear of finding something “wrong” and potentially losing a breast, limited tactile sensitivity, or a discomfort in touching ourselves are just a few of the reasons. None of these reasons are insurmountable.
Some women prefer to examine their breasts in the shower or bath with soapy water, or apply skin lotion or oil to reduce friction and heighten the sense of touch. A reusable BSE Pad, which consists of a lubricant sealed between two plastic sheets, is also now available to enhance the sense of touch during a breast exam. The BSE Pad exaggerates the size of a lump and can help detect a lump as small as a grain of salt.
If you are not sure how to perform a breast self-examination, or how to distinguish between what’s normal and what’s not, ask your healthcare practitioner to practice with you at your next visit. Repeat the exam right after the practitioner’s examination of your breasts. That way, if you feel something unusual you can ask about it right away, and he or she can also coach you on your technique. The more often you do it, the more natural it will feel and the more confident you will become with the findings of your own self-exam.
Mammograms and Thermograms
Additional methods of monitoring your breast health are mammograms (x-rays of a compressed breast) and thermograms (digital infrared images of the breast). Mammograms are endorsed by most cancer organizations and many healthcare practitioners for any woman over age 50, and are encouraged for women over the age of 40 if there is a history of breast cancer or other breast disorders.
Some practitioners believe that mammography can give women a false sense of security because it may miss detecting breast cancer. For example, mammograms do not show tumors that are “out of the picture” such as those deep in the armpit or up near the collar bone, where the lymph nodes are located. They are also not suitable for women with particularly dense breasts because visibility of growths may be reduced. Another potential hazard of mammography is the cumulative risk associated with the radiation itself.
In contrast, thermograms do not require radiation, contact, or breast compression. They work by detecting minute variations in blood vessel activity and displaying an infrared
image, which is used to target potential precancerous sites or the presence of an early tumor that is not yet large enough to be detected by exam or mammography.
No matter how a lump or suspicious area is detected, your healthcare practitioner will most likely want to pursue a diagnosis to ensure that it is not breast cancer. They might request a noninvasive procedure, such as an ultrasound, diagnostic mammogram, or thermogram to further differentiate the growth. A definitive diagnosis usually requires aspiration and biopsy of the tissue cells.
Effects of Diet
Assuming your breast lumps or pain are not due to cancer (as is the case most of the time), there are a number of things you can do to reduce pain or tenderness in your breasts or nipples. One recommendation is to change your diet to reduce or avoid aggravating troublesome breast symptoms. Specifically:
- Eliminate caffeine to reduce breast pain and lumps. Research and anecdotal evidence indicate that eliminating foods containing caffeine (such as coffee, colas, some teas, and chocolate) reduces breast pain and cysts in most women within a few months.
- Increase fiber to stimulate digestion. A low fiber diet and chronic constipation are also associated with breast problems. Researchers discovered that women with severe constipation (defined as less than three bowel movements per week) are five times more likely to show signs of possible abnormal cell proliferation. This may be because estrogen secreted by the liver is more readily reabsorbed by women with sluggish digestion.
- Eat a healthy diet, avoiding the trans fats found in many processed foods such as crackers, chips and baked goods. Trans fats are especially bad because they introduce free radicals into our bodies, potentially leading to cell damage. There is a strong association between fat consumption and the incidence of breast cancer. Unsaturated fats also deplete the body of iodine, further compromising breast health (see Iodine below ). Foods recommended for healthy breasts include fresh or dried fruits, vegetables, whole grains, beans and legumes, and some fish. Drinking 8 to 10 glasses of water per day will help cleanse the body of toxins.Some healthcare practitioners also recommend supplements of vitamins E, A and B to reduce breast pain and lumps. However, there are interesting findings regarding breast health and iodine.
Iodine is an essential trace element that is necessary for the production of all hormones in the body, including thyroid hormone. It is also necessary for proper functioning of the body’s immune system.
Because sources for iodine are rare in a typical diet, optimum iodine levels are difficult to achieve and maintain. For this reason, iodine was added to salt (iodized salt) in the 1920s in the United States specifically to curb the incidence of diseases brought on by an iodine deficiency, such as goiter, which were prevalent. During the 1960s, iodine was also added to baked goods, primarily as a dough conditioner. However, in the 1980s iodine was replaced with bromine because the National Institute of Health (NIH) had concerns about the population getting too much iodine. Unfortunately, the addition of bromine further compounded the problem of iodine deficiency because it also interferes with iodine absorption into the body.
In his book, Iodine: Why You Need It, Why You Can’t Live Without It, Dr. Brownstein reports that approximately 90% of his patients today are iodine deficient. He (and other practitioners and researchers in the field) believe that the current dietary standards for iodine are the bare minimum required for thyroid function, leaving no additional iodine for the benefit of the rest of the body. With the addition of bromine, Dr. Brownstein states that “Iodine deficiency has been accelerated and iodine is now inhibited from binding to its own receptors.” Iodine receptors are found throughout the body, with a high concentration in the thyroid gland and another concentration in the breasts, which are a primary storage site for iodine.
Diet and lifestyle choices can further contribute to iodine deficiency, specifically low-salt diets and those that include a high level of baked goods that include bromine, such as ready-to-eat cereals, breads, and pastas. In Breast Cancer and Iodine, Dr. Derry reports that unsaturated fat also depletes the body of the little iodine that is ingested. When there is an iodine deficiency, the thyroid gland and breasts compete for what little iodine is available, which may help explain the relationship known for years between breast problems and low thyroid function.
The Encyclopedia of Natural Medicine reports on research demonstrating that thyroid supplements decrease breast pain and lumps among patients whose thyroid function tests normal. These results “suggest that subclinical hypothyroidism and/or iodine deficiency may be a causative factor” in fibrocystic breast disease. An iodine deficiency may make the breast cells more sensitive to estrogen stimulation, whereas iodine supplements seem to change the way that estrogen binds to breast tissue.
Both Dr. Derry and Dr. Brownstein agree that iodine supplements have been extremely effective at treating fibrocystic breasts and that symptom relief generally occurs very rapidly if iodine deficiency is treated. They also both caution that the use of iodine, or any other supplement, requires careful laboratory and clinical monitoring to achieve optimum levels for your needs.
Stress, Exercise, and Your State of Mind
Women who have a breast condition frequently mention that their symptoms are aggravated by stress. It seems that fibrocystic breasts are more responsive to changes caused by adrenaline, which is produced during stressful situations.
Reducing stress by exercising seems to have a positive effect on reducing or eliminating breast problems in multiple ways. While alleviating stress, exercising also reduces body fat. (Remember, estrogen is stored in fat cells, which are present in the breasts.) When women have a high percentage of body fat, estrogen production can be enhanced, causing even more breast tenderness.
Women who consistently exercise also tend to have fewer breast problems and a lower rate of breast cancer. Regular exercise (even yoga, meditation, and simple breathing exercises) may reduce the incidence of breast disorders primarily by improving circulation and metabolism, as well as by contributing to an overall sense of health and well-being.
- Breast Cancer and Iodine by David M. Derry, MD, PhD; Trafford Publishing, Victoria, BC; 2001.
- The Complete Book of Vitamins and Minerals by the Editors of Prevention magazine; Wings Books, distributed by Outlet Book Company Inc., a Random House Company, by arrangement with Rodale Press, Inc.; New York, NY; 1992.
- Encyclopedia of Natural Medicine by Michael Murray, ND, and Joseph Pizzorno, ND; Three Rivers Press; New York, NY; 1998.
- For Women Only by Gary Null and Barbara Seaman; Seven Stories Press, new York, NY; 1999.
- The Hormone Survival Guide for Perimenopause by Nisha Jackson, PhD; Larkfield Publishing; Santa Rosa, CA; 2004.
- Iodine: Why You Need it, Why You Can’t Live Without It by David Brownstein, MD; Medical Alternatives Press, West Bloomfield, MI; 2004.
- Natural Hormone Balance for Women by Uzzi Reiss, MD/ OB GYN, with Martin Zucker; Pocket Books, a division of Simon & Schuster; New York, NY; 2001.
- Women’s Bodies, Women’s Wisdom by Christiane Northrup, MD; Bantam Books, New York, NY, 1998.