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Your Health
During Menopause


What Is Menopause?
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34 Signs of Menopause
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Bioidentical Hormones
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About Your Hormones
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Your Lifestyle
At Midlife





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BREAST HEALTH




Also read Promoting Healthier Breasts

All too often we ignore our breasts - find ourselves saying, "Oh, I'll have my breasts examined next time I go for a Pap smear." Right? How often do we put off going for that Pap smear? Many recoil at the thought of setting our legs up in those stirrups and having our breasts squeezed and smashed during a mammogram. How many of us really perform BSE [breast self-examination] on a regular basis? Let's talk about breasts! We need to be concerned with breast health. During and 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 one chance in eight (or about 12 percent) of developing breast cancer during her lifetime. It is the most common type of cancer among American women.

Each year, more than 193,000 women in the U.S. learn that they have breast cancer. Two-thirds of them will be over age 50. But breast cancer also occurs in younger women. And in men, too.

While breast cancer cannot currently be prevented, it can be treated, if detected early. Early detection is the key to survival. When it is detected early enough, it is often successfully treated; when it is not detected early, it is often fatal. For this reason breast examinations are of extreme importance to all women. Practicing 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.

With prompt, appropriate treatment, the outlook is good. 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.

Mammography screening for breast cancer offers no long-term survival benefit for women in their 40s, but that the test saves lives among women age 50 and older.

Currently, the American College of Physicians does not recommend mammograms for younger women.

NCI, however, 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.

NCI currently recommends the following plan:

KNOW WHEN TO OBTAIN A MAMMOGRAM

Beginning at age 40, all women should be encouraged to have a mammogram every year.

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.

These guidelines may change as new scientific information becomes available. The final decision, however, regarding mammograms, should be made on an individual basis.

A doctor also may suggest a mammogram if a symptom of breast cancer is found, whether through breast self exam (BSE), an examination by a physician, or by chance.

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 regularly 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. 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.

Breast tissue is naturally lumpy, and it takes a little bit of time to become familiar with what is normal for you. The consistency of your breasts will often change throughout the menstrual cycle, and during/after menopause, becoming more lumpy just before menstruation, and unpredictable during/after menopause. Therefore the best time to examine your breasts is soon 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.

REGULAR BREAST SELF-EXAMINATION

BSE [breat self-exam] is done once a month so that you become familiar with the usual appearance and feel of your own breasts. Familiarity makes it easier to notice any changes in your breasts from one month to another.

Early discovery of a change from what is normal is the whole idea behind BSE. The best time to do BSE is 2 or 3 days after the end of your period, when your breasts are least likely to be tender or swollen. A woman who no longer has periods may find it helpful to pick a particular day, such as the first day of the month, to remind herself that it is time to do BSE.

If you discover anything unusual, such as a lump, a discharge from the nipple, or dimpling or puckering of the skin, you should see your doctor at once.

Recent research on the benefits of mammograms for women younger than age 50, however, is currently being analyzed by NCI and other health organizations.

If you have had a hysterectomy or no longer menstruate, examine your breasts on the first day of each month.

For a detailed description of how to perform BSE, breast self-examination, and photos, go to the Breast Health Information Site by clicking here and clicking on "Screening" and Breast Self-Exam.

Breast self-examination is a valuable, preventive health practice for women. Developing a regular pattern will enhance your skills and help you notice changes. If you find a lump or changes in your breast, contact your health care provider.

Women, during menopause, are even more vulnerable - especially those taking hormones... and should give extra attention to their breasts. Become familiar with your breasts - their shape and texture. OWN your breasts as part of the body you OWN.

Many women have irregular or "lumpy" breasts. The term "benign breast condition" refers to those changes in a woman's breasts that are not cancerous. Many doctors believe that nearly all women have some benign breast changes after age 30. But any change is best diagnosed by your doctor.

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.

Reference:

  • U.S. Dapartment of Health & Human Services, National Cancer Institute
  • Denton, S., & Miller, K.A. (1982). Breast cancer. In R.A. McNeeley (Ed.),
  • CounSELFile: A self-health management guide. Tucson, AZ: W.K. Kellogg
    Foundation and the University of Arizona.
  • DoD Health Services Region IV
    111 G Street Bldg 5901
    Keesler AFB, MS 39534-2428
    Parma Rishel, MSN, RN
    Regional Breast Care Coordinator


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.

Most breast lumps are discovered by women, themselves, incidentally or during the BSE. 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 broad 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 examiner (physician or nurse practitioner) can distinguish between the changes that are suggestive of malignancy or those of a nonmalignant breast disorder. There are also several procedures which are helpful in the differentiation of breast lumps: mammography, an x-ray of the breast; ultrasound, which uses sound waves to make a picture of the structures inside the breast; and needle aspiration, in which a fine needle is inserted into the lump and any fluid present is withdrawn and analyzed.

If you have fibrocystic breasts, regular breast self exams (see above) 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.

If you are concerned about any difference in your treatment plan and the information in this handout, you are advised to contact your health care provider.

For additional information about fibrocystic breasts, go to http://psaweb.pcola.med.navy.mil/breasthealth/ and click on Fibrocystic breasts.

For additional information about breast health in both men and women, visit The Dept. of Defense Health Services Breast Health Information Web Site .


 

        

 

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