Keeping Abreast Of It

By Linda Jane

There is no human organ that attracts more overt attention than the female breast. It is subjected to criticism and adoration (it often being difficult to distinguish between the two), misinformation and fear. While society tells us the breast is essential to our womanhood, the medical profession persists in the surgical barbarism of cutting it off. In all the clamor, it's easy to forget just why our breasts are there.

What Is It?

The breast is a complex organ whose major function, aside from its sexual one, is producing milk. It is made up of several types of tissue. Glandular tissue removes products from the blood and converts them into milk. The glands empty into the milk ducts, which empty into larger and larger ducts, which eventually empty into the nipple. Fibrous connective tissue, very similar to the muscle tissue in the wall of the uterus, attaches the breast to the chest wall, holds the breast together, and supports the duct system. Fat tissue is interspersed throughout the breast to cushion it. Lymph vessels carry away dead cells and fight bacteria which enter the breast through the ducts or the bloodstream (the lymph cells collect outside the breast in the lymph nodes of the armpit and elsewhere, which filter out the garbage). This entire structure is enclosed is an envelope which is an extension of the pectoral muscles (the chest muscles extending from the chest wall to the shoulder and collarbone).

The breast is considered a satellite organ because its function is dependent on hormones produced by the pituitary and adrenal glands, and the ovaries. As such, it is affected by any upsets in these glands, as well as the repeated fluctuations associated with the menstrual cycle. The breast develops very quickly and late in life compared to our other organs and is in a very exposed position. It is believed that all these factors help account for the high incidence of breast disorders.

Normal Breasts

To recognize what is abnormal for a breast, it is important to understand what is considered normal. Breasts come in about as many shapes, sizes and colors as any other part of our bodies. In most women, one breast is larger than the other, just as one foot or hand is often larger. Some women have hairy breasts, while others do not. Some nipples are dark and some are light, depending on a woman's general complexion. If a woman has a child, her nipples tend to turn darker and stay that way.

Most breasts are slightly lumpy, especially during a woman's period when there is an increase in blood and other fluids in the breasts. And all breasts at some time have at least a slight milky or clear discharge, called sebum, which is secreted by the sebaceous glands to keep the milk ducts open. This discharge may be more noticeable during a woman's period or if she takes birth control pills. Generally, this discharge stops after menopause.

As a woman gets older, the amount of gland tissue in her breasts begins to decrease and the amount of fibrous connective tissue to increase. These bands of fibrous tissue weaken and stretch, causing the breasts to sag-whether or not she wears a bra.

Breast Disorders

Estimates of the risk of breast cancer among women in the U.S. range from about one in twelve to one in fifteen, but as many as one-fourth to one-half of U.S. women will at some time undergo surgery for a breast condition. Whether or not all of this surgery is warranted is another question altogether, but the fact is that many of us will at some time experience what is considered a breast disorder.

Because of their vulnerable location, injuries to the breasts are fairly common. A blow can damage fat

tissue and blood vessels, resulting in a hard, irregular lump. The injured area can also collect fluid and feel like a cyst. Most injuries should disappear within a few weeks. Current statistics do not link breast injuries to cancer.

The breasts can also become infected. Breast infections are usually accompanied by tenderness and a pussy discharge. Infections, however, are rare and are usually associated with nursing (mastitis).

The most common breast disorder among women 35 to 50 is fibrocystic disease. Estimates of its incidence range from 15 percent to 50 percent, depending on the source. This condition is described as a hyperplasia, or an overgrowth of normal cells, and is characterized by a general lumpiness throughout both breasts. It appears to be an exaggeration of normal breast changes. The breasts are unable to dispose of the normal cells that accumulate each month, causing a thickening of the fibrous tissue, ducts, glands, or all three.

Fibrocystic lumps usually are fairly easy to distinguish from tumors. Unlike tumors, they generally wax and wane with the menstrual cycle. Also, they usually affect both breasts and are numerous (a tumor generally starts out as a single lump in one breast). And, finally, they tend to be triangular and flat and firmly attached to the breast, whereas tumors are usually round and loosely attached.

Because the function of the fibrous tissue of the breast is so similar to that of the muscle tissue in the uterus, fibrocystic lumps often appear in conjunction with fibroids of the uterus. Both generally disappear after menopause. Studies suggest that women with fibrocystic disease run a greater risk of developing breast cancer.

Lumpiness can be caused by a buildup of fluids (usually colostrum and dead cells) as well as by a buildup of cells. This accumulation leads to cysts. Like fibrocystic lumps, cysts are more common in women 35 to 50 and may wax and wane with the menstrual cycle. They too tend to disappear with menopause.

A far more serious condition is breast tumors. Tumors are called neoplasms, since they result from localized new cell growth rather than the buildup of cells as part of a normal process. If the growth is restrained-in other words, the tumor is surrounded by a fibrous capsule-it is considered benign. If the growth is unrestrained, it is considered malignant. Fortunately, the majority of tumors (80 to 90 percent) are benign.

Benign tumors are often classified according to the type of tissue involved. If a tumor consists of fibrous cells, it is called a fibroma; gland cells, an adenoma; both fibrous and gland cells, a fibroadenoma; fat cells, a lipoma. If the tumor involves the duct system, it is called a papilloma.

Benign tumors tend to be firm and round and, unlike fibrocystic lumps, move fairly freely. In addition, papillomas are often accompanied by a heavier, and sometimes bloody, nipple discharge. There are varying opinions as to whether any of these types of tumors are precancerous. However, doctors usually recommend their removal if they grow large enough to cause pain or if there is any question of malignancy.

Malignant tumors of the breast fall into two categories. Tumors that start in the fibrous tissues are labelled sarcomas. Fortunately, this type is rare, as it grows rapidly and quickly invades other parts of the body through the bloodstream. Tumors that originate in other breast tissues, such as the ducts and glands, are labelled carcinomas. Aside from skin cancer, carcinoma of the breast is the most common form of cancer in women in the U.S., its overall incidence ranging from 5 to 7 percent and increasing with age. Carcinomas spread throughout the body in a more irregular path than sarcomas. Some forins of

this tumor grow quickly and others so slowly that they can almost be considered benign.

Detecting Lumps

The outlook is, not as bleak as it may seem. Remember, as many as 90 percent of breast tumors are found to be benign, and statistics suggest that over 90 percent of malignant tumors can be cured if discovered early. Methods of detection include mammography (X-rays) which, although considered highly effective in detecting lumps, may have disastrous effects when used on a routine basis. Evidence supported by the National Cancer Institute now suggests that routine mammography may create an epidemic of iatrogenic (doctor-caused) breast cancer. Another method, thermography, does not have any ill effects but is considered less reliable. It measures changes in the blood flow. Areas of irregular growth show up as "hot spots" due to the increased flow of blood to the area. An older method, transillumination, involves passing a light through the breast. Lumps show up as shadows. Transillumination is effective in distinguishing between a cyst and a solid tumor, since light passes more easily through a cyst. It cannot, however, determine whether a tumor is malignant or benign, nor can it detect very small lumps.

If any of these methods do detect a lump, a doctor usually follows one of several courses. If a cyst is suspected, a doctor usually will aspirate it (draw the fluid out with a needle) and a pathologist will examine the fluid for malignant cells. If it is a solid lump, a doctor may recommend a needle biopsy (cutting out a small core of the tumor for examination). If the lump is still questionable, most doctors will recommend surgical biopsy, or removing the entire lump for examination.

Self Breast Exam

None of the preceding methods are done before a manual breast exam. Even most doctors agree that the manual breast exam is probably the best method of detecting lumps initially. And the best person to do the exam is the woman herself, as she knows better than anyone what her breasts feel like on a regular basis. As many as 80 to 90 percent of all breast tumors are detected by the woman.

To be effective, however, self breast exams must be done thoroughly and regularly. It's best to do a

Vernon C. Kimmel self exam only once a month. If you do it more often, it will be harder to detect subtle changes, since your breasts change so much normally. The best time to do a self exam is shortly after your period ends, when your breasts are least lumpy and tender. If you are postmenopausal, choose a day, such as the first of (continued on page 10)

September, 1979/What She Wants/Page 5