A lump which develops in a young woman is less likely to be cancerous than one in an older, particularly post-menopausal woman. However, there are many causes of breast lumps at any age.
Unless a lump can be confirmed as being clearly benign by clinical diagnosis, mammography and fine needle aspiration, most surgeons will opt to remove it. Some women also prefer to have obviously benign lumps removed, and most surgeons will comply with this wish. The operation can normally be performed as minor day-case surgery under a local or general anesthetic.
Dysplasia
Dysplasia simply means the changed structure of tissue. It is a benign condition which becomes apparent as hardening around the edges of the breast, often occurring in both breasts simultaneously. It is normally associated with age-related changes in the tissue rather than with any serious disease, although it can cause concern to a woman who suddenly discovers it. More localized lumps may be cysts.
Fibroadenosis
Also known as chronic mastitis (a poorly descriptive term that is sometimes used), hyperplastic cystic disease, or benign mammary dysplasia, fibroadenosis is a general benign condition which usually occurs in women between the ages of 30 and 50. It can also develop around the time of the menopause, when it is due to hormone imbalance or to the start of hormone replacement therapy (HRT). Although its cause in younger women is unknown, the fact that its signs and symptoms are related to the menstrual cycle, and that it can be induced in men and animals given the female hormone oestrogen, has led to the suggestion that it may be related to hormone imbalance in this age group as well. It may be less common in women who have breast-fed their babies.
Fibroadenosis involves the presence of lumps, cysts and irregular breast tissue. Some degree of lumpiness of the breasts is normal in pre-menopausal women, especially during the last half of each menstrual cycle. However, one or several persistent lumps appearing before a period, and painful, tender breasts could indicate fibroadenosis. Occasionally there may be an associated clear or brownish discharge from the nipple, and the lymph nodes in the armpits may swell and become tender, although this is more common in duct ectasia.
Diagnosis and treatment
Diagnosis is usually straightforward, but investigations may be necessary to confirm that there is no malignancy. These include fine needle aspiration biopsy, mammography or ultrasonography. Fibroadenosis is not associated with breast cancer, and surgery to remove part or all of the tissue from a lump should only be necessary if the results of the investigations are inconclusive. A biopsy may also be done for women approaching the menopause, for which the chance of having a cancer is greater.
Although the lumpiness itself requires no special treatment, the breasts should be re-examined by a specialist after 2 or 3 months. This examination should be done during the first half of the menstrual cycle, when there is less normal irregularity of the breast.
If necessary, the associated symptoms of fibroadenosis, particularly cyclical breast pain, may be relieved by various hormones and ‘anti’-hormones such as the drug danazol or tamoxifen, by evening primrose oil, and possibly, although there is no evidence to substantiate this claim, by a low-fat diet.
Fibroadenosis-like symptoms can also occur in women having HRT. If so, a lower dose of hormone preparation may be needed or the HRT may have to be stopped altogether.
*12/39/5*
Some research shows that women having abortions are psychologically just like other women but have simply taken more risks or have used inefficient contraceptive methods. Other research suggests that this is too simple a view and that most of the women got pregnant to prove their love for their man, to add satisfaction to a relationship, or to secure a failing one. Some women were found to have got pregnant to punish themselves for sexual misdemeanors or for a previous abortion. Sometimes it was to replace a dead child or a lost boyfriend. On investigation most of the ‘bad luck’ category can be reallocated to other causes. These include:
Depression
This can lead to carelessness over contraception and a hope that a baby will improve things.
Uncertainty over sexual identity
A few women have to prove that they are really female by having a baby.
To punish parents
A teenage girl often wants to punish her repressive parents, especially if they have implied that she is promiscuous when she is not. Some of the girls also see having a baby as a way of getting away from home.
Trying to trap an unwilling or hostile partner
This is much less common than it was.
A final ‘fling’ before ‘settling down to middle age’ is not an uncommon story in older women who have an extra-marital pregnancy.
Deliberate non-contraception
A conscious failure to practice effective contraception is remarkably common. Many women either don’t like the method of contraception they are using, or really want to get pregnant, however unconsciously, or follow a moral or religious code that bans contraception.
Personality problems.
Women who seek abortions are found to have different views on sex compared with those who go through with their pregnancies. Abortion-seekers often don’t see themselves as instrumental in their unplanned pregnancy.
Changes in circumstances after conception
An example of this would be the collapse of a relationship.
Partner factors
These are not all that common but must be considered. Some men deliberately get their partner pregnant to test their own fertility; to try to secure the relationship; to give themselves added personal status; to give the woman something to worry about; because of an inability to keep away from intercourse during unsafe periods; because of a weak personality; or because of a refusal to let the woman use oral contraception (a virtually 100 per cent safe method), supposedly on religious or medical grounds but sometimes really because they fear her fidelity or the demands for sex she might make on them, and so on.
*25/72/5*
When it comes to cleaning her plate, Barbara Vaughan knows where to draw the line, quite literally. She has been doing it for 30 years.
Like most of us, Barbara learned at an early age not to waste food. “In my family, it was a sin to not finish everything on your plate,” recalls the 51-year-old Boston businesswoman. “I’d sit at the table for hours because my parents wouldn’t allow me to leave until I’d eaten my peas. When you’re raised like that, you get conditioned to clean your plate. It’s a habit that’s really hard to break.”
Barbara’s clean-plate habit stayed with her when she went to college, where the cafeteria served jumbo-size portions of practi-
cally everything, from mashed potatoes with gravy to burgers to ice cream. True to form, she ate every last bite. Her weight climbed to 140, then to 145, during her freshman year alone.
As the pounds piled on, Barbara grew more and more dissatisfied with her appearance. She knew that she was eating a lot more than she should and that the extra calories were contributing to her weight gain. So she set out to break herself of her clean-plate habit once and for all. And she used a knife to do it.
Whenever Barbara sat down to a meal in the campus cafeteria, she’d take her knife and draw a line right down the middle of her plate, bisecting the meat, the mashed potatoes, or whatever else she was served. Then she ate only the food to one side of the line, leaving the rest behind. This simple trick cut Barbara’s portions in half. It also enabled her to change her clean-plate mindset. “That line showed me when I had eaten enough,” she explains. “I could let the rest of my food lie without guilt.”
Her strategy worked. By the time Barbara graduated from college, she had taken off 25 pounds. She has maintained her weight at a healthy 120 pounds ever since.
WINNING ACTION
Draw the line on eating.
One way to teach yourself portion control is to use Barbara’s technique. Use your knife to draw a line right down the middle of your plate. Eat only the food to one side of the line, and leave the rest. You can save it for another meal!
*19\89\8*
The level of pollutants in drinking water has been steadily rising in recent years. Pollutants run off the land into rivers or seep down through the soil into groundwater. Various purification measures are taken before the water reaches our taps, but these are never 100 per cent effective.
Agriculture makes the major contribution to water pollution. Nitrates, used as fertilizers, run off from the fields, and in several parts of Britain, tap-water regularly exceeds the EEC limit on nitrates. Although nitrates have received a lot of publicity, they are not as worrying as some of the other water pollutants. There are no clear signs that the nitrate levels found in drinking water are
damaging to health, except in newborn babies. As far as chemical-sensitive patients are concerned, nitrates are unlikely to be a problem.
Small amounts of pesticides also get into the water supply from farm use. In addition, there have been accidents in which large amounts of highly toxic pesticides such as dieldrin (now banned for agricultural use) have been emptied into drains or soakaways close to boreholes, causing major pollution of the groundwater below. Most water authorities do not systematically monitor drinking water for pesticides.
Oil from spillages may find its way into drinking water, but usually this is only in minute amounts. Organic solvents (see p164) also turn up in water supplies – a study by Imperial College, London, found the solvent trichloroethylene in 36 per cent of the 168 groundwater samples they tested. The level was higher than the limit set by the World Health Organization in 10 percent of the samples, and in one it was seven times the WHO limit. Other solvents are also found in groundwaters, usually as a result of factories discharging their waste solvents into drains or ditches. Very few of the water authorities systematically check their supplies for solvents or other industrial pollutants, and serious incidents of pollution may easily go undetected. Some of the chemicals used for purification also leave a residue in the water, but this is unlikely to be harmful as long as the correct amounts are being used.
Chlorine is added to water to kill bacteria and viruses that might otherwise cause disease. Unfortunately, chlorine readily reacts with certain organic molecules to produce chlorinated hydrocarbons. (The organic molecules may themselves be pollutants, or they may be produced by large amounts of waterweed, growing and then rotting down in reservoirs.) Some of these chlorinated hydrocarbons are carcinogenic, and they have occasionally turned up in drinking water.
*414\180\8*
If something goes wrong during the food testing – you might get influenza for example, or some other infection – then you will have to stop testing foods. All is not lost, but there is no point in trying to test foods beyond three months. If vou are unable to test all the excluded foods, then you should go back to the healthy-eating diet for about a month. Eat whatever you like, but if there are anv foods which gave a positive reaction when tested, then you should continue to avoid these.
Keep a record of your symptoms, and see how you feel at the end of the month. If you are reasonably well, then continue with the healthy-eating diet, avoiding the incriminated foods, and see how you get on. As long as you keep your diet varied, so as not to acquire new sensitivities, you can always go through Stage 2 again later.
If, after a month on the healthy eating’ diet, some or all of your symptoms have returned, then you should start the exclusion phase of Stage 2 again. Any foods that you previously tested and found safe can be eaten as well, but if your symptoms have not cleared after a week, then you should exclude these foods as well.
Assuming your symptoms clear up, then you can test the excluded foods as described above. If they do not, then you should go on to Stage 3.
*367\180\8*
The mother who wishes to ensure that her baby is solely breast-fed needs to be prepared in advance. Because breast-feeding is thought of as ‘natural’ it is often assumed that it ‘comes naturally’. Unfortunately this is not true, and many mothers give up because they have not been shown how to breast-feed properly, or because they have sore nipples, or other problems. Advice and help with breast-feeding can be obtained from several organizations.
Before going into hospital, enquire about their policy on night feeds and supplementary feeds. Make it very clear to the midwife that you do not wish your baby to have anything but breast milk. Ask whether you will be able to have your baby with you and feed it on demand – this is far more conducive to successful breast-feeding than a system that is ruled by the clock. Another factor in establishing a good working relationship with your baby is starting breast-feeding within four hours of birth. Where a baby or mother is very ill, this may not always be possible, but you should ask that the baby be put to the breast as soon as possible.
If breast-feeding is not possible, for whatever reason, then the mother should not feel guilty about the situation. There are alternatives that carry less risk of allergy than standard infant formulas. These are feed mixtures known as hydrolysates which are available on prescription.
Formula feeds based on soya are sometimes used with children who are known to be sensitive to cow’s milk. These tend to be prescribed because they are a great deal cheaper than hydrolysates, and they may be very effective in clearing up symptoms that are due to cow’s milk sensitivity. However, there is always the risk that a child will develop allergic reactions.to soya proteins, which are themselves noted allergens. This is especially likely if the mother has eaten soya, which she may well have done, since soya flour is increasingly common as a hidden’ ingredient in many foods. As part of a prevention programme, soya-based formulas are not necessarily that much better than standard milk-based formulas – hydrolysates are definitely preferable.
There is little doubt that prolonged breast-feeding and careful weaning are the most important factors in diminishing the risk of allergy in newborn babies. There are also good reasons for believing that breast-feeding reduces the likelihood of food intolerance, as well as having more general benefits, such as-protecting babies from infection. Trying to breast-feed for as long as possible is something that would benefit any child. As a matter of national health-care policy, the many obstacles and discouragements to breast-feeding should be removed, and the promotion of formula feeds in maternity wards should stop, as the World Health Organization has recommended.
*320\180\8*
The first and most important step is to get the baby examined by a doctor, who should check for serious problems such as gastro-oesophageal reflux – acid passing from the stomach up into the gullet (oesophagus), and thus causing pain – or intestinal obstruction. Assuming that there are no such problems, and that your doctor can suggest no other likely causes for the excessive-crying, then it is worth investigating the possible role of food.
Bottle-fed babies
Try giving smaller, more frequent feeds as an initial step – if the baby has slight difficulties with lactose then this may be the answer. Should this produce no improvement.
There are two main possibilities to be considered here: temporary lactose intolerance or other forms of food sensitivity.
If your baby only has colic in the evening, then a temporary deficit in lactase, due to the morning feed being larger than usual, is a possibility. There are various ways of reducing the amount of milk in the morning feed, and these are worth trying. The simplest approach is to let the baby feed first from one breast only and then from the other – rather than keep switching breasts. This reduces the amount of milk produced overall. If this has no effect, try expressing some milk before the morning feed; refrigerate or freeze it for use later. Another method is to give the baby a small amount of boiled water from a bottle before the morning feed, so that it feels full more quickly, or to feed from one breast only – this will tend to reduce your supply of milk overall, so you should only do this if you know your milk is plentiful.
For the baby who does not respond to this, or who has colic at any time of day, food intolerance should be investigated.
*269\180\8*
Being an omnivore – an animal who eats adaptably, taking whatever is available – is a high-risk, high-return strategy in the natural world. It opens up a huge range of foods, but it makes it impossible for the omnivore to adapt to the specific chemical toxins of a single food source. Rats are omnivores, which is why they are so remarkably successful and so very difficult to poison. When a rat encounters a new food it nibbles at it very cautiously, taking a tiny amount. Then it waits for a day or so. As long as it is not ill, it returns to eat some more.
At one time, the human approach to eating out would have been very similar. Until about 10,000 years ago our ancestors were hunter-gatherers whose food consisted of wild plants and animals. Like the rat, they would generally have approached new foods with extreme caution. They would also have been endowed, as we are today, with the best type of equipment for breaking down food toxins. That equipment resides in the liver, in the form of chemical compounds called enzymes that can break down foreign molecules. A powerful set of detoxification enzymes is something every good omnivore needs.
We are still omnivores today, although we do not rely much on wild foods. Farming changed our way of eating fundamentally, but it was not a change that happened overnight. The process took thousands of years, beginning with the collecting of wild grasses where these were growing abundantly. The wealth of food available from this harvest allowed people to settle down in one place, whereas before they had always been nomadic. The grass seeds could be stored and eaten for a large part of the year, but other wild plants and animals were still a major element in the diet.
The transition to farming took place once people realized that they could plant some of the stored seed and thus grow more grasses and increase their food supply. In time, they would have started to select the seeds used for planting, choosing those from the best types of grass. The process of domestication and plant improvement had begun.
*21\180\8*
Do brassieres cause breast cancer? Will switching to undershirts decrease your risk? Probably not. Although Sydney Ross Singer and Soma Grismaijer, the husband and wife coauthors of Dressed to Kill: The Link Between Breast Cancer and Bras (ISCD Press), maintain that the bra/breast cancer link is supported by scientific evidence, their “study” of this evidence is full of holes.
The bra/breast cancer theory was born several years ago in Fiji, when Grismaijer found a lump in her breast. Around the same time, her husband noticed the red marks on her body from her bra…and became convinced that the bra was to blame for her lump.
Grismaijer did not have the lump biopsied. Instead, she began a regimen of exercise, organic vegetarian food, purified water, herbs and vitamin supplements—and complete bralessness.
Guess what? The lump disappeared. But to attribute its disappearance to not wearing a bra—as Grismaijer does—is ridiculous.
*5/47/1*
Another objection by this same patient was, “What if my wife isn’t playing a game? What if she really gets headaches? Isn’t it cruel to imitate her?” Generally when a symptom (headache) happens repeatedly and directly in response to the same situation (sex), it is psychosomatic. This is not to say that the headaches are not real. They are real—but they also are somatic representations of unconscious feelings. So to cure the headache entails resolving the feelings underneath. It is no crueler to mirror her headaches than it would be to apply an ice bag to her temple.
The other reason why my patient was skeptical was that he didn’t want to give up the game he had been unconsciously playing until then—the passive game of “Oh, what I have to endure because of you.” He would rather have continued that game and derive its secondary benefits of feeling morally superior to his “rejecting” wife than take an action designed to end their ritualistic conundrum. All too often we would rather cling to an old way, even if it is not working, than venture to a new one.
*101/196/1*