by Devra Krassner, N.D.
The women’s self-help health movement was started in the 1970’s by lay women who set out to demystify women’s bodies by sharing information with other women. Key players in this movement were the Feminist Women’s Health Centers, the Boston Women’s Health Book Collective (which published Our Bodies, Our Selves) and numerous other grass roots organizations. I myself was a part of Women’s Community Health Center, a center run by and for women in Cambridge, Massachusetts in the late 1970’s and early 1980’s.
Now, in the age of the internet and social media, we as women have more access to information. It is also more accepted to be a strong advocate for one’s self when seeking medical care. However, there is not a clear consensus among health care providers about many of the health issues critical to women. One example, which will be addressed later in this article, is who should get mammograms and how often. It is therefore just as important as ever that we be familiar with our bodies and be proactive about our health care.
Breast self-exam remains an important first step towards maintaining breast health. Just as we would notice a new pimple on our skin, so should we be aware of any changes in our breasts. Examining your breasts visually in a mirror allows you to look for any differences in size or shape, as well as changes in color, dimpling, nipple discharge or new lesions. Feeling your breasts gives you information about the normal texture and consistency of your breasts, so that any changes can be identified. The best time to examine your breasts is just after you have finished your period. This is because your breasts are less likely to be tender or lumpy at that time. Complete instructions in breast self-exam are beyond the scope of this article, but are easily accessed through your health care provider.
Tender and lumpy breasts are in fact very common, and often do vary with the menstrual cycle. ‘Fibrocystic breast disease’ is an out-dated term for what we now simply call fibrocystic breasts. The term disease is misleading and is part of a general tendency to medicalize normal parts of a woman’s life cycle such as pregnancy and menopause. Tender, lumpy breasts do not mean that women are at an increased risk for breast cancer. Changes in estrogen and progesterone account for many of the breast changes that occur. In addition, breasts contain many structures including milk ducts, glands, fat and connective tissue which account for the variations in texture. If, however, you notice a lump that is on one side only, does not vary with the menstrual cycle, and persists over time, it may be a good idea to have a health professional evaluate it.
Cyclic breast pain and swelling can be minimized in some cases by lifestyle changes. Elimination of caffeine makes a big difference for some women. It is also important to support the liver, which plays a major role in the metabolism of estrogen. Estrogen dominance due to compromised liver function can contribute to changes in the texture and density of breast tissue. Ways to support the liver include minimizing the intake of toxins (such as alcohol, chemicals and pesticides) and using herbs which support the liver. Examples of herbal medicines used for liver support include milk thistle, burdock root and dandelion root. Avoiding exposure to cigarette smoke as well as quitting smoking yourself is of course a first step towards decreasing exposure to toxins. Supplements which have been helpful in managing cyclic breast tenderness include vitamin E (typically mixed tocopherols at a dose of 400-800 IU) and evening primrose oil.
Healthy lifestyle is key to maintaining breast health as well as overall health. There is an association between alcohol consumption (even with intake as low as three drinks a week) and an increased risk of breast cancer. Therefore, limiting alcohol intake is a prudent step to take, especially if you have a family history of breast cancer and/or a personal history of menopausal hormone therapy.
Increasing your intake of fruits and vegetables as part of a high fiber diet is also recommended. Eating organic produce decreases your exposure to pesticides. The Environmental Working Group (EWG) is an excellent resource for information about food, skin products, cleaning products and other factors which affect our health and the environment .The EWG website provides you with the ‘dirty dozen’ and ‘clean fifteen’, respectively the most and least sprayed fruits and vegetables. This information will help you decide when to buy organic produce, and which conventionally grown items are relatively acceptable.
It is important to buy hormone and antibiotic free meat and dairy whenever possible. Hormones are fed or implanted in animals to induce faster growth and greater milk production. When you consume these products, you are exposed to hormone residue, which may increase the risk of breast and other reproductive cancers. Minimizing your intake of meat and dairy can help off-set the increased price of buying hormone-free products. Plant sources of protein such as nuts, seeds, legumes (beans) and grains as well as fish low in mercury are excellent alternatives to meat and dairy. Fish that are lowest in mercury include haddock, fresh salmon, trout and tilapia.
What about soy? There are many varying opinions on soy consumption. Tori Hudson, N.D. is an excellent resource on this topic. On her website, drtorihudson.com, Dr. Hudson has archived numerous articles on soy with references cited. Based on several studies, we can now say that it is safe (and beneficial) for women to consume soy, even those with a past or current diagnosis of breast cancer. In fact, there is some evidence that soy-rich diets in Western women may help to prevent breast cancer. Because soy is frequently genetically modified, it is best to eat soy products that are organic, non- genetically modified (non-GMO) and less refined. Excellent choices are tofu, tempeh and edamame. Soy offers health benefits for bones and the cardiovascular system, as well as being a good source of calcium and protein.
The importance of regular exercise cannot be over-emphasized with respect to breast health and overall health. The amount and type of exercise will be different for each individual. A recent article in Up to Date, an on-line resource for physicians, recommends at least 150 minutes of moderate intensity activity a week, and 75 minutes of vigorous exercise. For weight loss, interval training is extremely effective. Interval training involves alternating between short bursts of high intensity exercise with a ‘hard rest’, when breathing and heart-rate are slowed before the next burst of vigorous activity. A simple program to follow is four minutes of warm-up, 30 seconds of high intensity activity followed by 90 seconds of low intensity activity. The goal is to work up to repeating this cycle eight times.
Some risk factors for breast cancer cannot be changed, or modified. One example is a family history of breast cancer, especially on the maternal (or mother’s) side of the family. However, the presence of an increased cancer risk does NOT mean that cancer is inevitable. Healthy diet and exercise as discussed above are examples of modifiable risk factors, which are factors that you have control over.
Other lifestyle measures that support breast health are maintaining a healthy weight, avoiding unnecessary exposure to radiation, and finding ways to manage stress effectively. Working the night shift can also place women at an increased risk for breast cancer. Although we do not know exactly why this is, one hypothesis links this phenomenon to melatonin, a hormone that is normally produced at night. Even if you cannot avoid night shift work, placing an emphasis on getting enough sleep can still be a priority. Adequate sleep, both the quality and quantity of sleep, has a huge impact on all aspects of health. It is best to keep electronic devices out of your bed, and to place them at a distance from where you are sleeping.
On a similar note, please do not carry cell phones in your bra! Some breast surgeons have raised concerns that the electromagnetic radiation (EMR) that is emitted from cell phones may be linked to an increased risk of developing breast cancer. The effects of storing cell phones next to your breasts are still being studied. However, to be on the safe side, it is best to find a place other than your bra to carry your cell phone.
Environmental factors play a large role in breast health. Pesticides and hormones in food are not the only toxins that we are exposed to. In addition, chemicals in water bottles, food containers and plastic wrap can build up in our bodies over time. Even BPA- free plastics may contain synthetic estrogens, phthalates, and other harmful chemicals. These chemicals are called endocrine disrupters because of their negative effects on our hormonal systems. Buying foods in glass containers and using water bottles that are glass or stainless steel can minimize your exposure to those substances.
Diagnostic imaging is another area where conflicting opinions prevail. Mammography is still the most common method of screening for breast conditions. Mammograms use radiation to visualize the breasts. Most medical organizations recommend routine screening in women age 50 or older. There are variable recommendations for women from age 40-49, for when to discontinue screenings, as well as how often mammograms should be done. Ultimately, this decision should be made on an individual basis, weighing the pros and cons for each woman. As with many medical decisions, the risks and benefits of each procedure or treatment must be individually considered. The obvious benefit of mammograms is in early discovery of breast lesions. A consideration with more frequent screening, especially in younger women, is that more false positives may occur, leading to follow-up mammograms and often biopsies. In addition, women with the BRCA 1 or BRCA2 gene mutation may want to avoid additional exposure to radiation given their increased risk for breast cancer. Women with very dense breasts often find themselves needing follow-up studies as mammograms are not as effective at visualizing breast abnormalities in these women.
Some women looking for alternatives to mammography and a decreased exposure to radiation have turned to thermography as a screening technique. Thermography involves taking pictures (using a special camera) of the heat produced by the body as infrared radiation. These pictures are then analyzed by trained thermologists. Thermography can be a useful tool in identifying various breast conditions in the body including fibrocystic breasts and mastitis (inflammation of the breast tissue). Thermograms can also be used in young women and women with breast implants. Some people feel that thermography can even detect early signs of breast cancer, based on the idea that cancer gives off more heat than normal tissue. While thermograms can provide information about changes in breast tissue, there is controversy about whether or not they can be relied on as a sole technique for detecting cancer early.
There are no perfect screening tools, as all available methods have pros and cons.
For this reason, I am a strong advocate for breast self-exam and body awareness. The more information you have about your breasts and about healthy lifestyle, the more control you can take over your bodies and your health care in general. In closing , therefore, I would like to encourage you to know your breasts and know yourselves. Self-awareness, continuing to learn about advances in medicine, shared decision-making with your health care provider and being your own health care advocate will help you make good decisions for you as an individual.
by Devra Krassner, N.D.