Fear of cancer makes Susan seek help when she discovers a lump in her breast.
Fear is not an unknown emotion to us, says Neil Armstrong, the first man to walk on the moon.
Just as courage imperils life, fear protects it, says Leonardo da Vinci.
It is this protection women look for when they visit their physician with a breast lump.
The scenario of fear and protection leads to frequent office visits, multiple negative needle and surgical biopsies, and sometimes-more anxiety and more fear.
In fact, only 10 to 20 percent of biopsies of breast lumps show cancer. But this is necessary if we are to treat every breast lump as malignant until proven otherwise.
In the last column, we discussed about fibrocystic changes in the breast and the pain associated with this condition. Susan wants to know how this condition is treated.
Painful breasts can be cyclic (associated with menstruation) or non- cyclic. Two thirds of the women have cyclic pain and one- third experience non-cyclic pain.
First step in the management of this problem is to rule out cancer. This is done by history, physical examination, needle biopsy and if indicated, by mammography. If there is a persistent lump after all this then surgical removal becomes necessary. A pathologists report will give a definitive answer.
This process will help reassure 85 percent of the women. Their pain is not significant enough to require more than regular painkillers or anti-inflammatory medications. The remaining 15 percent will continue to have severe pain, which will affect their lifestyle and warrant more than regular painkillers.
This is where we are long on drug choices but short on effective uncomplicated therapy.
Here is a list of substances tried: birth control pills, progesterone, bromocriptine, danazol, thyroid hormones, tamoxifen, vitamins A, B-complex, and E, diuretics (water pills), prostaglandin inhibitors, iodine, primrose oil, restriction of methylxanthine (coffee, chocolate), and the list goes on.
In young women in their 20s, the birth control pill may be helpful as it provides a stable amount of hormones each month.
Bromocriptine (a prolactin hormone antagonist), and danazol (a synthetic anti-estrogen) have been found to be helpful to large number of women but these drugs have significant side effects. Side effects of bromocriptine are nausea, headaches, and dizziness. Side effects of danazol are loss of menstruation, weight gain, acne, hirsutism, and voice change.
Other popular remedies advocated are the use of primrose oil, iodine, and restriction of chocolates, and caffeine containing substances. Whether the benefits obtained are real or psychological is debatable. But the use of or restriction of these substances have no side effects and in fact may be beneficial for other reasons!
There is no effective uncomplicated therapy applicable to all women with painful lumpy breasts. There is lack of research on breast pain. But it is important to remember that pain is usually not an indicator of cancer in the breast. And a breast lump is considered malignant until proven otherwise.
Well, Susan, are you better informed now? She smiles and says: Thank you for now, Dr. B!
This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.
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