Costochondritis

They nurse our children and cradle lovers; they peek out of V-neck tops or hide demurely behind high-collared blouses, From puberty to postmenopause, Irons training bras to nursing bras, our breasts are a source of pride, identity and anxiety. Here, our guide to everything you need to know about your original bosom buddies.

BREAST SCARES (that aren't always scary)

Not all breast ailments are a matter of life and death

By Marcy Lovitch

THE PROBLEM

Breasts that are different sizes

SHOULD I WORRY?

No. Many women have one breast that's slightly bigger than the other, says Susan Love, M.D., a UCLA adjunct professor of surgery and author of Dr. Susan Love's Breast Book (Perseus Publishing). "Having asymmetrical breasts is more of a cosmetic issue than a medical one," she adds.

What should I do?

Some women find lopsided breasts psychologically distressing, especially when the difference is more than a cup size. If your asymmetry makes you feel self-conscious, wearing a silicone bra insert can help, or you may consider having plastic surgery.

THE PROBLEM

Extreme nipple tenderness

SHOULD I WORRY?

Increased breast sensitivity is most often due to hormonal fluctuations associated with your period, says Linda Frame, R.N., senior clinical adviser for the Susan G. Komen Breast Cancer Foundation in Dallas. "Once your period is over, your nipples should feel less sensitive and return to normal," she says. Other possible causes include breast-feeding, perimenopause, pregnancy, eczema of the nipple, an infection or wearing a new bra made of abrasive fabric.

What should I do?

If the discomfort is associated with other symptoms, such as a lump or skin changes, see a doctor as soon as possible. In the absence of other symptoms, wait a month to determine if the tenderness is connected with your menstrual cycle. If so, taking an over-the-counter pain reliever should help. If nipple sensitivity persists for longer than a month, see your doctor.

THE PROBLEM

Change in nipple appearance

SHOULD I WORRY?

It depends. Nipples typically turn dark and become bigger and more erect during the first trimester of pregnancy. They may also darken from taking certain hormonal medications, such as birth-control pills. A rash, redness, scaliness around the nipple or itching that lasts several weeks could also be a sign of eczema or Paget's disease, a rare form of breast cancer.

What should I do?

If you've ruled out pregnancy, see your doctor. Eczema can be treated with topical medications. If your physician suspects Paget's disease, she'll want to take a biopsy.

THE PROBLEM

Nipple discharge

SHOULD I WORRY?

If the discharge isn't bloody or sticky, there's probably no need for alarm. "It can be normal to experience a discharge when you're sexually aroused or when you squeeze or stimulate your breast," says Love. And since the production of prolactin, the hormone that stimulates lactation, continues even after nursing ends, it's also normal to have a watery, slightly milky discharge a couple of years after breast-feeding.

What should I do?

See your doctor if the discharge is bloody or whitish and sticky, or if it comes from one breast, not both. This can signal a precancerous condition or an intraductal papilloma, a benign growth on the lining of the milk duct.

THE PROBLEM

Breast pain

SHOULD I WORRY?

Not necessarily. Many women equate pain with breast cancer, but only about 10 percent of breast-cancer patients actually report pain in the early stages of the disease, says Vivian Lewis, M.D., professor of OB-GYN at the University of Rochester Medical School. In most cases, breast pain is caused by normal hormonal fluctuations. Pain that's accompanied by redness or swelling and skin that's warm to the touch may indicate an infection. Other possible causes are costochondritis (a form of arthritis that occurs where the ribs and breastbone meet), gas, heartburn, an inflamed vein in the breast or a cyst pressing on a nerve.

What should I do?

If the pain is period-related, an over-the-counter pain reliever can help. Some studies have shown that taking 3,000 milligrams of evening primrose oil (found in health-food stores), 400 IU of vitamin E or no more than 100 milligrams per day of vitamin B6 can also ease this pain. If it persists after your period ends, see your doctor.

Marcy Lovitch is a health writer whose work has appeared in Fitness, American Baby and Marie Claim. When Bad Bras Show Up on Good Women

Does your cup runneth over? Is your underwire playing hokeypokey? Maybe it's time to get a bra that fits

By Marcy Lovitch

If you're like most women, your lingerie drawer is hiding a secret even Victoria doesn't know about--bras gone bad. We're talking about the ill-fitting, stretched-out bras you spend all day tugging and wrestling into place. In fact, industry experts say that about 70 percent of us wear the wrong size bra.

To help you find the right one, we asked Linda Emmanuel, a bra specialist at Saks Fifth Avenue in New York City, for some tips:

1. Get measured once a year by a fit specialist at a reputable department or lingerie store.

2. Always try before you buy. Bras come in a variety of styles that often differ in the way they fit.

3. After putting on a bra, use your hands to make sure each nipple is centered in the cup. If breasts bulge out, the cups are too small; if the cups wrinkle or pucker, they're too large.

4. Never buy a bra that you have to fasten on the tightest hook. Instead, make sure you can fasten it on the middle clasp to allow it to give over time through wear and washing.

5. If the shoulder straps dig into your skin, you either need wider straps or a bigger cup. If the straps fall off your shoulders, the band is too big.

6. Check your bra from the back view; it should be level with the front. A rising back usually means the band is too big or the straps are too short.

breast-cancer news update

The latest information on prevention, detection and treatment

By Hilary Beard

PREVENTION

* A study published in the New England Journal of Medicine last June found that taking birth-control pills does not increase a woman's risk of breast cancer. The study of more than 9,200 women ages 35 to 64, conducted by the Centers for Disease Control and Prevention and the National Institutes of Health, found that users of oral contraceptives showed no elevated risk of the disease regardless of race, age, family history of breast cancer or length of time they had been taking the Pill.

* A study released this year by researchers at Georgetown University's Lombardi Cancer Center in Washington, D.C., and in Finland found that women who gain more than 50 pounds during pregnancy and don't lose the weight after childbirth could triple their risk of developing breast cancer following menopause.

DETECTION

* A year ago the medical community was rocked when a study by Danish researchers suggested that mammography does not help prevent breast-cancer deaths. But after reviewing the study, the National Cancer Institute reissued its recommendation that women in their forties and fifties be screened every one to two years. And as African-American women under 45 suffer from breast cancer at higher rates than other women in that age group, Elizabeth A. Patterson, M.D., of the American College of Radiology Imaging Network, recommends that most start getting annual mammograms at age 40. Yearly screenings increase the odds (by as much as 30 percent) of early detection, while the disease is treatable.

* A report in the Journal of the National Cancer Institute suggests that radiologists who analyze more than 3,600 mammogram films per year make far more accurate readings than those who analyze a smaller number of films. Those who make more accurate readings, therefore miss fewer cancers and prescribe fewer unnecessary biopsies. Radiologists who read fewer than 1,200 are the least accurate. The bottom line: When possible, get your mammogram at a large screening facility. And ask how many films the radiologist reads each year.

TREATMENT

* Cancer patients should advise their doctor of any herbs or nutritional supplements they are taking. A study conducted by the Netherlands' Rotterdam Cancer Institute showed that St. John's wort, commonly taken to alleviate depression, reduces the effectiveness of Camptosar, a chemotherapy drug, by about 40 percent. This effect was apparent even when the patient had discontinued St. John's wort three weeks prior to chemotherapy treatment.

* Advances in breast-cancer treatment, such as tumor-shrinking chemotherapy, have lowered the number of mastectomies that are being performed, and new supportive-care therapies have diminished the side effects of treatment. With a wider variety of diagnostic tests and treatments, including novel surgical techniques, lymphnode surgeries are less debilitating,Thanks to this progress, says Edith Mitchell, M.D., an oncologist and professor of medicine at Thomas Jefferson University's Kimmel Cancer Center in Philadelphia, "We are able to provide patients with a good cosmetic outcome."

`I FOUND A LUMP. NOW WHAT?'

By Marcy Lovitch

You're performing your monthly breast self-exam when you detect what feels like a small bump. All you can do is think the worst. But just because you feel something doesn't automatically mean it's cancerous.

"It's normal to get breast lumps right before or during your period," says Leslie Montgomery, M.D., a breast surgeon at the Memorial Sloan-Kettering Cancer Center in New York City. For that reason doctors recommend waiting until a few days after the end of your period to conduct a self-exam. This wait-and-see approach won't increase your risk should the lump prove cancerous. "On average it takes three months for one cancer cell to divide, so waiting a week, or even a month, is not going to put you in any more jeopardy," says Montgomery.

But it's dangerous to ignore a breast lump indefinitely. "Black women over 40 have higher breast-cancer death rates than White and Latina women," notes Harold P. Freeman, M.D., director of the Center to Reduce Cancer Health Disparities at the National Cancer institute in Bethesda, Maryland.

If the lump is still there after your period, your doctor may order a mammogram. If the findings are suspicious, she'll refer you to a surgeon who will then perform one of four types of biopsies--a fine-needle aspiration, in which a slender needle is inserted into the mass and a cell sample is withdrawn; a core biopsy, which uses a larger needle; an incisional biopsy, in which a piece of the mass is surgically removed; or an excisional biopsy, in which the entire lump is cut out. In about 80 percent of biopsies, the tumors are benign. If there is a malignancy, your doctor will then discuss treatment options.

Hilary Beard is a Philadelphia writer.

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