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Women’s Health
brea st health awareness
When we talk about breast
health, most women think of
breast 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 breast
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
“breasts are a very charged part of
our anatomy, both physically and
metaphorically”
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.”
Breast Anatomy
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
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go through cyclical changes that
coincide with the menstrual cycle,
pregnancy, and childbirth. Breasts
also contain extremely sensitive
nerves, which account for their
sexual response, connecting them
with the female genital system.
Anatomy of a Breast
Mammary Lobe
Lobule
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.
Hormonal Fluctuations
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,
Breast Disorders
Milk Duct
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.
reason, the best course of action
is to report any breast lump,
pain, or concern you have to
your healthcare practitioner.
Aerola
Nipple
Adipose (Fat) Tissue
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 the breast 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
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 overcongestion 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
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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.
Breast 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 fluidfilled 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
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.
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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.
Breast Self-Exams
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.
Continued on Page 4
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.
(For more information, see the
instructions provided at bse-pad.
com/use.html).
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.
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.
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.
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.
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:
üEliminate 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.
üIncrease 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.
üEat a healthy diet, avoid-
ing 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 on next page).
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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
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
Continued on Page 6
5
with Rodale Press, Inc.; New York,
NY; 1992.
the breasts.) When women have a high
percentage of body fat, estrogen production can be enhanced, causing even more
breast tenderness.
nEncyclopedia of Natural Medicine by
Michael Murray, ND, and Joseph Pizzorno, ND; Three Rivers Press; New
York, NY; 1998.
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.
nFor Women Only by Gary Null and
Barbara Seaman; Seven Stories Press,
new York, NY; 1999.
nThe Hormone Survival Guide for Perimenopause by Nisha Jackson, PhD;
Larkfield Publishing; Santa Rosa, CA;
2004.
Resources
nIodine: Why You Need it, Why You
Can’t Live Without It by David Brownstein, MD; Medical Alternatives
Press, West Bloomfield, MI; 2004.
Resources used during the research and
development of this newsletter include
the following:
nNatural Hormone Balance for Women
by Uzzi Reiss, MD/ OB GYN, with
Martin Zucker; Pocket Books, a division of Simon & Schuster; New York,
NY; 2001.
nBreast Cancer and Iodine by David M.
Derry, MD, PhD; Trafford Publishing,
Victoria, BC; 2001.
nThe 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
nWomen’s Bodies, Women’s Wisdom by
Christiane Northrup, MD; Bantam
Books, New York, NY, 1998.
Connections is a publication of Women’s International Pharmacy, which is dedicated to the education and management of PMS, menopause, infertility, postpartum depression, and other hormonerelated conditions and therapies.
This publication is distributed with the understanding that it does not constitute medical advice for individual
problems. Although material is intended to be accurate, proper medical advice should be sought from a competent healthcare professional.
Publisher: Constance Kindschi Hegerfeld, Executive VP, Women’s International Pharmacy
Co-Editors: Michelle Davenport and Carol Petersen, RPh, CNP; Women’s International Pharmacy
Writer: Kathleen McCormick, McCormick Communications, Inc.
Illustrator: Amelia Janes, Midwest Educational Graphics
Copyright © March 2004, Women’s International Pharmacy. This newsletter may not be reproduced or
distributed without the permission of Women’s International Pharmacy.
For more information, please visit www.womensinternational.com or call (800) 279-5708.
Women’s International Pharmacy | PO Box 6468 | Madison, WI 53716-0468
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