Page 2 2012 Vol 1
Looking after your breasts
Studies show around two-thirds of women experience some breast pain during their cycle – again usually normal
Our breasts change during our lifetime but there are things you can do to enjoy the best breast health possible.
Is it normal to have one breast slightly larger, or for hair to grow around your nipples? Are tender breasts before a period commonplace? Is it normal for nipples to look different on each breast? And what are the signs of breast health issues such as cysts, fibroadenomas, mastalgia (painful breasts) and mastitis?
Asymmetry is more the norm than the unusual, according to Dr Stewart Hart, breast cancer surgeon, former director of the Monash BreastScreen service and chairman of the executive committee of Cancer Council Victoria. “Usually there’s a minor difference – about 10% is not unusual,” he says. “As girls are developing in their late teens you can also get asymmetrical development which later catches up with itself. Very occasionally you get a larger difference that requires surgical assistance.”
Nipple size, colour or shape can vary and nipples may be inverted (turn inwards). Bumps on the areola (the darker area around the nipple) are also common and usually nothing to be concerned about. They are most often due to sebaceous glands in the skin that open into the ducts just below the nipple, forming harmless swellings. “Some nipple discharge can occur on squeezing and in small amounts it’s quite normal,” says Ms Jane O’Brien, specialist breast and oncoplastic surgeon at the Epworth Breast Service, Richmond.
The menstrual cycle
The menstrual cycle can lead to breasts being temporarily tender, engorged and lumpier. Studies show around two-thirds of women experience some breast pain during their cycle – again usually normal. “Most often symptoms peak just before the period and improve with the onset of bleeding,” says Jane. “Symptoms appear to peak in adolescent girls and again in perimenopausal women, possibly because of fluctuating hormone levels. Normally pain is mild and women simply require reassurance that there’s no cause for concern.”
If pain and tenderness are more severe, evening primrose oil may be recommended – around four grams or four capsules per day. “There is some limited scientific evidence of the benefit of evening primrose oil and it’s virtually side-effect free,” says Jane. “It’s believed to act by increasing the level of one of the essential fatty acids in the breast tissue and has a cumulative effect, so you need to take it daily over several months to see maximal benefit. Around 60% of women may obtain some relief from evening primrose oil.”
Breast health issues
There is a range of other breast health issues women may face during their life, such as lactation mastitis, cysts and fibroadenomas that are all relatively common. Breast cancer is also a concern for some women.
This is an inflammation of the breast that can be caused by blocked milk ducts or by a bacterial infection. Symptoms include tender or painful breasts and breasts that become hot, hard, swollen or red in appearance. Women may also develop flu-like symptoms such as a fever, aches and pains. Treatment may include antibiotics and anti-inflammatory medication to relieve pain. It’s also important to continue breastfeeding or expressing milk as draining the breast helps clear the blocked ducts.
“As women age, the milk duct systems tend to become a little degenerative so they get weak spots and you can get a collection of fluid, or cysts,” says Stewart. Ultrasounds are effective at distinguishing between a fluid filled lump – a cyst – and a solid lump. Cysts are most common in women aged 30 to 50 and can come and go. When they become larger they form a smooth, soft lump that moves easily. If cysts aren’t causing symptoms they usually need no treatment. They aren’t cancerous and they don’t increase the future risk of breast cancer.
Fibroadenomas are smooth oval or round lumps in the breast. They are not cancerous and may be left untreated unless uncomfortable. They may become tender before a period and are most common in women between the ages of 15 and 25, but they can appear in middle age. Around one in six women has a fibroadenoma at some time in her life.
“As women get older, breast pain related to the menstrual cycle can last longer, a week or more,” says Stewart. “Evening primrose oil may help and there is a theory that the pain is due to sensitivity to oestrogen and so women may be given progesterone to counterbalance the oestrogen effect. But there’s no absolute answer.” It’s unusual for breast cancer to cause or present with pain or discomfort. “Usually we’d investigate by examining the patient and arranging a mammogram or ultrasound or both to ensure nothing serious is going on,” Stewart continues. “That reassurance alone is often helpful in managing the symptom. It relieves the anxiety often attached to breast pain.”
Around one in nine women is diagnosed with breast cancer before the age of 85, according to government statistics. If a woman detects a breast lump she should see a GP who may refer her to a breast specialist. “We use a triple test for a lump – it has to feel innocent, be innocent looking on a mammogram/ultrasound and also be innocent on needle biopsy,” Jane explains. “If all three elements of that triple test are innocent, the chances of missing a cancer are very small. If a lump fails any of the three components of the triple test, we recommend taking investigations further and perhaps even removing the lump.” The key message with any breast lump is to see your GP promptly, to clearly explain what is worrying you and to ask for information. Onward referral to a breast specialist may be required.
The key message with any breast lump is to see your GP promptly
Breast health tips
- “From your 20s onwards, become familiar with your breast shape and the feel of your breasts,” says Stewart. “Practise this regularly – once a month after your period.”
- Older women also need to check their breasts once a month. If you’re familiar with the way your breasts look and feel you will be able to spot any changes.
- Stand in front of a mirror with your arms in the air to stretch the skin and see the contours of the breasts. Look for skin that is dimpled or flattened or looks different to before.
- Use the flat part of your fingers between your palm and the last joint of your finger – make your hand like a plate – and feel your breasts with the flat of your hand. Don’t use your fingertips and poke at the breast. If you detect a new lump, see your doctor.
- Wear a correctly fitted sports bra during exercise. Breast tissue is strong but your breast ‘hangs’ on to your chest with connective tissue and skin. If that tissue and skin become loose, breasts will sag. A bra should not be too tight or too loose, contain your breasts in the cups and the back strap should not cut into your skin.
- There’s no convincing evidence that using deodorants increases the risk of breast cancer. Neither does wearing an underwire bra.
- Women aged 50 or over should have a mammogram every two years if they are at average risk of breast cancer. Women between 40 and 50-years-old can also have a free mammogram if they wish.
- Women with a family history of breast cancer, a past history of breast cancer or who are identified as being at increased risk should follow a tailored screening program developed
Content Updated February 2012