Breast Health at Menopause and Beyond

By: Red Hot Mamas

Published: May 26, 2010

Let’s talk breasts! As women, we all need to be concerned with breast health, but as we age and especially after menopause, breast health becomes an even greater concern.

Breast cancer is one of the leading causes of death for women. The average woman has a one in eight chance of developing breast cancer during her lifetime. It is the most common type of cancer among American women. In fact, each year almost 200,000 women in the United States are diagnosed with breast cancer. Two-thirds of them will be over age 50.

While breast cancer cannot currently be prevented, if detected early, it can be treated. Early detection is the key to survival. For this reason breast examinations are of extreme importance to all women. Conducting breast exams helps increase your chances of detecting breast cancer in its earliest stages. Only about 20 percent of biopsied breast lumps are cancerous. And, if cancer is found early, there are choices for treatment. In fact, most women treated for early breast cancer will be free from breast cancer for the rest of their lives.

The National Cancer Institute (NCI) suggests a three-point breast cancer detection plan. Mammography is the key to detecting breast cancer at its earliest stage because it can find a cancer up to two years before it can be felt.

NCI currently recommends that women should start having this test at age 40. For women of all ages, other important exams include a breast examination by a doctor or other health professional and breast self-examination. These guidelines should be considered along with your background and medical history.

Mammography

Beginning at age 40, all women should be encouraged to have a mammogram every year if there is a family history of breast cancer and every two years if there is not. A mammogram is an x-ray of the breast. It can reveal tumors too small to be felt and can show other changes in the breast that may suggest cancer.

In mammography, the breast is pressed between two plates; some pressure is applied to get a clear picture. Usually, two x-rays are taken of each breast, one from the top and one from the side. Although some women are concerned about radiation exposure, the risk is very small.

Doctors recommend routine mammography because it is effective in finding breast cancer early. Long-term studies have shown that using mammography along with a breast exam by a health professional can reduce deaths from breast cancer among women.

The Physical Breast Exam

Both your gynecologist and your general health practitioner should perform regular breast exams on you, but it is even more important that you perform them monthly on yourself. It is important to begin a routine of self exams at an early age, because even though the incidence of breast cancer is extremely low in women in their teens and twenties compared to their thirties, forties, and fifties, it does occur. Also, it is necessary to be able to decipher what is normal breast tissue for you and what is not.

Breast tissue is naturally lumpy, and it takes a little bit of time to become familiar with what is normal for you. Abnormal clumps or lumps of tissue are potential symptoms of problems and need to be detected and dealt with. It is these types of lumps that you are checking for while doing breast self exams.

The consistency of your breasts will often change throughout the menstrual cycle, and during/after menopause, becoming lumpier just before menstruation, and unpredictable during/after menopause. Therefore the best time to examine your breasts is soon just after you finish your period or, if no longer menstruating, at least on a monthly basis. It’s wise to set up a schedule of breast self-exam once a month. You should examine your breasts at approximately the same time each month in order to monitor yourself effectively.

Women should have breast examinations by their physicians during routine checkups. Women age 40 and older should have them annually.

The next step in early detection is breast examination by a health professional. You may find it convenient to schedule this exam during your routine physical checkup. If a breast exam is not done during that checkup, ask for one.

Breasts come in all sizes and shapes, just as women do. Your own breasts will even change throughout your life. Your monthly menstrual cycle, menopause, childbirth, breast feeding, age, weight changes, birth control pills, and other hormones may change the shape, size and feel of your breasts.

It is important to learn what is normal for you. This can be done by doing breast self exams. It is easy to do, and as the name implies, you do it yourself. It’s also important to notice if there is any discharge from the nipples, especially if it contains blood. Sometimes this might show up as “crust” on the nipple.

Other Methods Used For Early Detection

Currently, manual breast exams and mammography are the most common and useful techniques for finding breast cancer. However, several other methods are also being used.

Ultrasound detects breast changes by sending high-frequency sound waves into the breast. The pattern of echoes from these sound waves is converted into an image of the breast’s interior. Ultrasound may be helpful in distinguishing between solid masses and cysts (fluid-filled sacs). Unlike mammography, ultrasound cannot detect small calcium deposits that may be present in the breast and that sometimes indicate cancer, nor does it identify small tumors.

Thermography measures heat patterns given off by the skin. Changes in the image, including “hot spots,” may suggest the presence of a breast problem. There is no known risk of using thermography, but it is not reliable enough to replace mammography.

Diaphanography, or transillumination, shines a bright light through the breast. Transillumination can show the difference between a solid tumor and a cyst. Current studies indicate that this method does not identify the very small cancers that can be detected by mammography.

MRI or magnetic resonance imaging is a new technique to detect breast cancer. The procedure involves your being placed on a table; your breasts will be placed in depressions in the scanning table that house the breast coils (the equipment used to detect the magnetic resonance signal). The table will then be moved in a tube-like device containing the magnet. You will be asked to remain quiet, breath normally and lie still on your stomach inside the magnet. Ear plugs will be given to you to reduce the noise level; however you will still be able to have verbal communication with the technologist over the intercom. You may feel warm during the MRI procedure. You will be asked to remain still for up to 15 minutes at a time while magnetic resonance imaging of one or both breasts is performed. It is very important that you stay still while the pictures are being taken.

Genetic Testing

New tests have been developed to test for breast cancer. They are called BRCA 1 and BRCA 2. These tests are only done on women who have a strong family history of breast disease to see if they have a gene that puts them at an increased risk of developing the disease. It is not necessary for a routine screen. If you have several family members who have breast disease, talk with your doctor about this test.

Fibrocystic Breasts

If you do find a lump or notice any change in the appearance of one or both breasts, you should make an appointment to have your breasts examined by a clinician.

Women in the childbearing age (18 to 45 years) commonly have lumpy breasts due to normal fibrocystic changes. In the past this was referred to as FIBROCYSTIC BREAST DISEASE, but this is not a disease, but a normal change seen in the majority of women. Other names that have been used to describe this change are “mammary dysplasia,” “chronic cystic mastitis,” and “benign breast disease.”

Fibrocystic breast changes include a b
road range of findings from painful breasts with solid lumpy patches to cysts (sacks filled with fluid). Fibrocystic breast(s) may feel painful, dull, and full. When examined with the fingers, the lumps may be tender, firm, and slightly movable. Often, a trained medical professional can distinguish between the changes that are suggestive of malignancy or those of a nonmalignant breast disorder.

If you have fibrocystic breasts, regular breast self exams allow you to become very familiar with your breasts and increase the chances that you will be able to identify a change earlier. Breast self exam is also important if you are in the high risk group for breast disorders. High risk is defined as those women who have a family history of breast cancer or benign breast disease, particularly a mother or a sister. It also includes women who have had no children, who are of Ashkenazi Jewish decent. There is some speculation at this time that smoking, a high fat diet, and alcohol consumption (greater than 3 drinks per week) may be associated with a higher risk of breast disease.

Fortunately, many times fibrocystic breast discomforts can be easily managed, depending on the character of the lumps, the amount of discomfort, and the family history. Conservative measures include wearing a well-fitting supportive bra and loose-fitting clothing. Ice packs or warm compresses applied to the tender areas may give relief. The elimination or substantial reduction from the diet of caffeine (found in coffee, tea, cola drinks, and chocolate) for several months has resulted in diminished symptoms for up to 80% of the women studied. Reducing the amount of fluid your body retains before your period can also ease discomfort. This can be done by reducing the intake of salty food, especially the week before your period. A few studies have suggested that a daily supplement of vitamin E (600 IU or one tablet) and a B multivitamin preparation may also alleviate symptoms. Other generally healthful measures in this regard include reducing the amount of fat in the diet, drinking less alcohol, and no smoking.

For very severe cases your physician may prescribe hormones such as progesterone, oral contraceptives, or the drug danazol. Rarely, surgery is performed if the lumps are very large or troublesome, or if the family history is positive for malignant disease.

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