A GUIDE TO BREAST CARE

Development in the teenage years

During the early teenage years, breast growth progresses in stages, stimulated by hormone activity. The hormones involved are the same ones that bring about periods and fertility, the visible evidence of a transition from childhood to womanhood.

In most young women breasts reach their developed state during their teenage years. This development is normally uncomplicated and only a few women experience breast problems before their first pregnancy.

Monthly changes

Many women having periods are aware of the changes in their breasts at different times in the monthly cycle.

These cyclical changes mean that in some women their breasts enlarge in the 10-14 days prior to a period and return to their original size after the period begins. These variations occur in a large number of women and appear to be quite normal.

Changes in pregnancy

More than at any other time of maturity, during pregnancy there are profound alterations in breast size, structure and function.

The visible enlargement known to all women who have experienced a pregnancy is accompanied by an increase in the amount of breast tissue, by the development of milk ducts and by the formation of new blood vessels. It has been noted that breast size doubles and blood flow increases by 180%.

Breast problems

From puberty to the menopause, women are experiencing monthly hormone fluctuations. At certain ages this activity is accentuated, particularly when periods first begin, during pregnancy and in the approach to the menopause.

Breast tissue is sensitive to these hormones and therefore likely to produce varying responses at different times. Such variations are now regarded by doctors as normal and only considered abnormal when the changes are extreme, or when they interfere with day to day activities.

In such cases doctors will often recommend a course of treatment suited to each woman's needs.

Common breast conditions

Doctors separate breast disease into 2 groups of conditions:

• Those that are benign and not in any way related to cancer;
• Those that are malignant, (or cancerous).

Quite understandably the thing women fear most when they have a breast problem is cancer. However, more than 90 out of every 100 women consulting their doctor with breast symptoms have a benign (non-cancerous) problem.

Breast cancer is more common in older women and the new screening programmes for the over 50's will help to detect cancer. early and at a treatable stage,

This booklet has been produced for those women whose breast problems are benign.

Common benign breast disorders

Listed below are 7 common, benign and harmless breast disorders experienced by many women:

• Mastalgia; breast pain which occurs at certain times in the monthly cycle or at any time. it is most common between the ages of 30 and 50 and frequently occurs premenstrually.
• Nodularity; lumpiness of the breast. This may come and go during the cycle but again it is most common premenstrually.
• Fibroadenoma; a simple smooth movable mass which usually occurs in young women.
• Cysts: fluid filled capsules. (Fluid cysts can often be drained through a needle attached to a syringe).
• Breast duct problems; the ducts can become enlarged or inflamed. There may be a discharge (mastitis) from the nipple and sometimes abscesses form.
• Breast abscesses associated with breast feeding.
• Excessive breast size in adolescence.

Breast pain

Of all breast conditions, pain is the one that women seek help and advice for most often. Frequently this pain is not confined just to the breast: it may be felt at the top inner part of the arm.

It appears that about half of all women attending special breast clinics and three quarters of women attending screening clinics have breast pain. Often anxiety about cancer is as much of a problem as the pain itself.

However, it is important to note that the combination of breast pain and cancer is uncommon. The possibility of the cause of the pain being cancer can be excluded by examination and further investigation where necessary.

Cyclical and non-cyclical breast pain

From now on in this booklet the description 'breast pain' is reserved for the pain that is not associated with another underlying cause or condition.

This breast pain falls into one of two patterns: either cyclical i.e. having a definite relationship with the menstrual cycle and occurring premenstrually; or non-cyclical (occurring at any time).

Premenstrual breast pain is much more common than non-cyclical pain. In general, premenstrual pain tends to affect women in their late twenties and thirties whereas non-cyclical pain is more common in women aged 40 and over.

Both respond to treatment although premenstrual pain is sometimes more responsive than non-cyclical pain.

The cause of breast pain

Until recently the cause of breast pain was something of a mystery. Although a direct relationship might have been expected between the pain and hormone levels, in fact most women with breast pain have normal levels of circulating hormones.

It is now accepted that the problem is not one of high hormone levels but of abnormal sensitivity of breast tissue to normal hormone levels.

This increase in sensitivity is linked with the pattern of fatty acids in the blood stream. Fatty acids are substances present in all fats and oils which can affect the way the body responds to its own hormones. Women with breast pain have low levels of gamma-linolenic acid (GLA; an important and necessary polyunsaturated fatty acid), and high levels of saturated fatty acids that increase and prolong the effect of hormones on the breast and appear to cause pain.

Low levels of GLA are not caused by dietary deficiencies but by an inefficient conversion process in the body.

Treatment with GLA overcomes this inefficient conversion, raises levels of polyunsaturated fatty acids towards normal and relieves breast pain.

Breast care

'Taking good care of your breasts involves a simple, monthly examination. By following a few, easy steps you will soon know what is normal for you and will quickly be aware of any changes.

If you find a lump or other change note down where or what it is and make an appointment to see your doctor as soon as possible,.

Self examination by looking and feeling
How to look

• Stand up straight in front of a mirror with your arms loosely by your sides.
• Raise your arms above your head and move from side to side so you can see your breasts in the mirror, from different angles.

What to look for

• A change in the size of either breast.
• A change in the shape or position of either nipple.
• Bleeding or discharge from the nipples.
• Unusual dimpling or puckering.

How to feel for changes

1. Lie flat on your back with your head on a pillow. Put a folded towel under the shoulder on the side of the breast you are checking. This helps to spread the tissue so that it is easier to feel.
2. Examine one breast at a time.
3. Put the hand on the same side as the breast that you are going to examine under your head.
4. With your other hand flat and fingers together, use the flats of your fingers to feel round the breast in small, circular movements, in an anticlockwise direction.
5. Cover the whole of the breast including the nipple.
6. Check your armpit for lumps in the same way, starting in the hollow and moving down towards the breast.
7. Now examine the other breast in the same way.
8. If you think you have found something, feel the same area on the opposite breast. If there are the same it's probably just your shape, but if you are at all worried, do visit your doctor.