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How Healthy Are Your Breasts?


Why Your Breasts Hurt

What woman doesn't obsess about her breasts? They're too big, too small, they ache, they're lopsided. Then there's the fear that lingers in every woman's mind: Am I at risk for breast cancer? Last year, 269,730 women in the United States were diagnosed with the disease, and the American Cancer Society estimates that there will be 274,900 new cases this year. Sobering numbers, but there is plenty you can do to reduce your risk. Educating yourself on everything from why your breasts hurt to the best bra for you is crucial. So, in honor of National Breast Cancer Awareness Month, FITNESS brings you this special guide. Keep reading for the latest from top experts.

Why Your Breasts Hurt

You feel a sudden sharp pain or a dull ache and immediately assume the worst. Relax — less than 10 percent of all breast pain is due to cancer, says Susan Love, MD, director of the Dr. Susan Love Research Foundation and author of Dr. Susan Love's Breast Book. (An important exception: If the skin on or near your breasts is red and you're experiencing pain, see your doctor right away. These could be signs of inflammatory breast cancer, a rare, advanced form that is more likely to strike young women but accounts for less than 4 percent of all cases.) Here's how to identify and treat the five most common causes of breast pain.

Culprit #1: You're about to get your period.

"As levels of estrogen and progesterone shift, your breasts swell, resulting in tenderness and pain," explains Eleni Tousimis, MD, a breast surgeon at New York Presbyterian Hospital Weill Cornell Medical Center. Over-the-counter pain relievers such as ibuprofen can help. Another research-proven option: evening primrose oil, available in gel capsules, which is a natural form of fatty acid that seems to decrease pain. One study in Wales found that six 500-milligram capsules daily, taken when pain starts, soothed period-related breast pain in 58 percent of women.

Culprit #2: You've got fibrocystic breasts.

If your discomfort is accompanied by a few lumps and bumps, the cause is most likely fibrocystic changes in your breasts, which affect about 60 percent of premenopausal women, says Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology at Yale University School of Medicine. You're particularly prone to this right before your period because your breasts retain water then. Some women also develop fluid-filled cysts, which may be the result of an imbalance of fatty acids within the breast cells, explains Dr. Minkin. In either case, see your ob-gyn to rule out a serious condition. For relief, try a twice-daily 500-units dose of evening primrose oil, which has been shown to reduce inflammation and fluid retention. If that doesn't work, your doctor may prescribe Danazol, a steroid derivative that blocks estrogen and progesterone.

Culprit #3: Your diet.

In a Canadian study, women who got fewer than 15 percent of their total calories from fat were much less likely to experience premenstrual breast tenderness and swelling. One theory is that a restricted-fat diet results in lower levels of circulating estrogen in the body, leading to less swelling of breast tissue and less pain. You may also want to cut back on caffeine, says Dr. Tousimis. Some experts believe that it can make breast tissue swell, causing pain.

Culprit #4: You're overdoing it at the gym.

If you've lifted too much weight, you may have strained your pectoralis muscles, which lie just underneath your breasts. The best treatment is a heating pad and an anti-inflammatory such as ibuprofen. If the pain is located right over your breastbone and worsens with activity, you may have costochondritis, often caused by intense exercise, an inflammation in the area where your ribs and breast bone connect. Again, try ibuprofen. If the pain is severe, consult your doctor.

Culprit #5: Your meds.

The birth control pill relieves pain in some women, but those who are sensitive to estrogen may find that it makes their breasts sore, says Dr. Minkin. Low-dose pills of 20 to 25 micrograms (like Alesse), which contain less estrogen, are least likely to cause tenderness. You should also steer clear of OTC headache remedies that contain caffeine. If you've got asthma, avoid the drug theophylline, which is chemically similar to caffeine and has some of the same side effects.

New Reasons to Get a Mammogram

For the past several years, experts have debated the effectiveness of mammogram x-rays and at what age women should first get them. But research shows that this type of screening is one of the most reliable tools doctors have right now for diagnosing breast cancer. A 2003 Swedish study of more than 200,000 women found that death rates from breast cancer dropped 44 percent from 1978 to 1997, after mammography programs were introduced. "Every woman at average risk should get an annual mammogram beginning at age 40," says Larry Norton, MD, deputy physician-in-chief for Breast Cancer Programs at Memorial Sloan-Kettering Cancer Center in New York City. "But if your mother or your sister had breast cancer when they were 35 to 49, have a mammogram a decade earlier than the age of the one who was youngest at diagnosis." This means that if both relatives had breast cancer, and your sister was diagnosed at 55 and your mom at 45, you should start your screenings at age 35. (Mammograms before age 25 are not useful; if your relative with breast cancer was younger than 35, start your mammograms at age 25.)

Research shows that mammograms are not as reliable in younger women, whose dense breast tissue can make the x-rays difficult to read. If you're 35 or younger or have dense breasts, ask your doctor about getting an ultrasound or an MRI as well, suggests Gabriel Hortobagyi, MD, chairman of the department of Breast Medical Oncology at the University of Texas MD Anderson Cancer Center. In a 2004 Dutch study, doctors found 32 tumors in high-risk patients screened with both a mammogram and MRI — but only 18 tumors using a mammogram alone. Another new option: digital mammography.

What to Do If You Find a Lump in Your Breast

About four in five of all breast lumps biopsied are benign, according to the Mayo Clinic. Still, it's imperative to get it checked out as soon as possible by an experienced health professional, says Dr. Norton. Your doctor will feel the lump and may order a mammogram, MRI, or ultrasound to help distinguish between a solid mass, which is more likely to be cancer, and a fluid-filled mass, which is more likely to be a benign cyst. If you have dimpled or thickened skin, bloody nipple discharge, a rash on the nipple, or redness of the breast, see your doctor even if you don't feel a lump, since these might also be warning signs.

Then, says Dr. Norton, if the lump is solid, the doctor will remove cells using a needle and examine them under a microscope. If the cells are benign, a breast specialist may still advise removal of the lump, depending on the type of benign cells or how the lump feels or looks. If the cells are malignant, your doctor will discuss treatment options, which might include surgery, medication, chemotherapy, or a combination.

Straight Answers to Your Biggest Questions

Q. Does the size of my breasts affect my cancer risk?

A. It may. While all women should be diligent about screenings their doctor recommends, those with large breasts need to be particularly careful. A recent study of almost 90,000 women ages 29 to 47 found that lean women who are a D cup or larger were 80 percent more likely to develop breast cancer than those who were smaller-chested. "The bigger your bust, the more breast cells you have. This may increase your odds for having a potential mutation or malignant change," says study author Karin B. Michels, PhD, an epidemiologist at Harvard Medical School.

Q. One of my breasts is bigger than the other. Should I be worried?

A. No, don't panic. "There are many other risk factors — like being overweight or sedentary — that are much more significant," says Gabriel Hortobagyi, MD. British researchers who compared the mammograms of 252 women who developed breast cancer to a similar group who didn't found that the relative odds of getting the disease went up 50 percent for each 3.38 ounces of breast-size difference. But the experts we spoke to put that statistic in context: "The study specifically looked at women who went to a special breast center for mammograms, which suggests they already had risk factors such as a lump," explains Dr. Hortobagyi. "If the researchers had taken a more random survey of women with asymmetrical breasts, it's likely the results would have been quite different."

Q. Is it really a big deal if I don't do a breast self-exam every month?

A. Although the American Cancer Society considers self-exams optional, most experts still strongly advise doing them. "It's important to become familiar with the way your breasts look and feel so you can identify any changes," says Larry Norton, MD. "The more effectively a woman examines her breasts, the more likely she is to tell the difference between normal bumpiness and a potentially cancerous lump. I've seen patients who got regular physical examinations and mammograms but still discovered a serious lump themselves." Perform your monthly self-exam during the first few days after your period, when your breasts are less likely to be lumpy and sore from hormonal changes. To do it, lie down with your right arm behind your head and use the pads of your three middle fingers on your left hand to feel for lumps in your right breast. Move in an up-and-down pattern starting from the side of your underarm and work your way across the breast to the middle of the chest bone. Repeat on the other side. If you feel a lump and you're premenopausal, wait a couple of weeks to see if it disappears on its own, advises Dr. Hortobagyi. If it doesn't go away, or you're postmenopausal, make an appointment with your physician right away.

Originally published in FITNESS magazine, October 2006.