BREAST DISORDERS: CYSTS, FIBROADENOMA

Cysts

A lump in the breast is most likely to be a fluid-filled cyst or one of a variety of benign tumours which can be treated effectively (e.g. a duct papilloma or fibroadenoma).

Cysts are most common in women between the ages of 40 and 50, particularly in those who have not had children. Although the majority of cysts are solitary, some women may have between two and five in one or both breasts.

It is thought that cysts form as an aberration of the normal process of shrinking of the breast which occurs as women get older. Their development appears to be hormone related – possibly associated with the balance between different hormones. Cysts are commonly part of fibroadenosis.

Symptoms

Cysts normally become apparent as smooth lumps in the breast which may be painful. They are usually quite hard, but can be squeezed between the fingertips. A painless cyst may only be discovered during routine screening by mammography.

Diagnosis and treatment

When a cyst is suspected, and ideally its presence has been confirmed by an ultrasound scan, a needle aspiration may be undertaken. The fluid is withdrawn through a needle -the cyst often collapsing like a pricked balloon – and is sent for examination. The remains of the cyst will need to be examined again after about 3 weeks.

Rarely, cancers can form as cysts, and for this reason any aspirated bloodstained fluid needs to be examined under a microscope, and a biopsy may be necessary. Non-cancerous cysts rarely yield bloody fluid.

Cysts are easily identified by ultrasound or a mammogram, and these investigations may be done when a cyst is suspected in a woman over the age of 35. If a cyst is revealed which cannot be felt, a guided needle aspiration may be undertaken.

Although cysts will sometimes refill with fluid after aspiration, further treatment is not normally required. However, surgical removal of a cyst which refills after two or more aspirations is probably advisable as a cyst of this type may be associated with breast cancer. For the same reason, cysts in post-menopausal women (which are uncommon) may need to be surgically removed. There is, however, little evidence to suggest that other types of cyst are linked with breast cancer.

For women with multiple cysts, although drug treatment will not affect those already present, it may help to prevent more developing.

Fibroadenoma

This is the most common type of solid benign breast lump, and is usually found in women between the ages of 15 and 25, although it can occur at any age. A fibroadenoma is a fibrous lump of glandular tissue surrounded by a capsule which can grow to as much as 3 to 4 cm (1 to 1.5 inches) across. Fibroadenomas which develop deep within the breast tissue may remain undetected.

Although fibroadenomas are uncommon after the menopause, they do occur in women in this age group. It may be that as the breast tissue is replaced by fat, a previously hidden lump is revealed. Some post-menopausal women choose to have a fibroadenoma removed to be absolutely sure of its innocence.

Symptoms

A fibroadenoma may appear as a firm, often hard, painless lump. It is likely to be very mobile, and will slip easily out of the fingers when held – hence the name ‘breast mouse’. In younger women the tumours rarely grow very large.

Diagnosis and treatment

The results of fine needle aspiration, mammography or ultrasonography may have to be confirmed by excision biopsy. Surgical removal of fibroadenomas is not usually necessary for medical reasons in younger women, but they can be the cause of some anxiety and many women, both young and old, prefer to have them removed. However, very occasionally, a cancer can mimic a fibroadenoma, and for this reason it is probably advisable to remove any persistent lump of this type in older women, particularly if any doubt remains.

Fibroadenomas rarely recur once excised, although others can sometimes form elsewhere in the breast.

*13/39/5*

PREVENTIVE MEDECINE: IMPORTANT QUESTIONS ASKED ABOUT SCREENING

Are screening procedures likely to pick up the diseases that really matter?

This is difficult to answer but an examination of the results of ten major industrial health examination programmes in the US found that less than half of the people who subsequently died from cancer had the condition diagnosed at a screening examination, and slightly fewer than two-thirds of those who died from heart disease were identified prior to developing symptoms of lethal heart disease. Even if we do agree that picking up some people who are at risk from such serious disorders, and treating them ahead of time is valuable, regular screening appears to be a rather insensitive tool for the early detection of serious diseases.

Will the treatment of a risk factor really have an impact on the development of the disease?

It is all very well knowing that someone has an increased likelihood of, say, having a heart attack or stroke if he or she has high blood pressure but prevention is more complicated. Reducing blood pressure brings a marked reduction in the risk of having a stroke but, it seems, a much smaller reduction in the risk of having a heart attack.

Will people act on the results of screening?

Results from screening procedures are of no value in themselves-they have to be acted upon by someone. Any smoker knows how difficult it is to stop and every fatty how difficult it is to slim.

The results of the many studies that have examined how reliably patients take medication are sobering. Studies in Canada, for example, have found that ‘ambulatory patients are unlikely to take more than 50 per cent of the prescribed medications they receive from clinicians and the amount of knowledge which a patient possesses about his or her illness has almost no relation to that patient’s degree of compliance with therapeutic instructions’. So if people won’t or don’t take their medication or the advice the doctor gives, why bother to tell them what’s wrong in the first place? A study of high-blood-pressure patients found that those who were told they had the condition, following screening, had more sickness absence from work than those who weren’t told.

Do screening programmes really alter the outcome of disease?

Interesting research has come from the Kaiser-Permanante Group in California who randomly divided several thousand patients into two groups. The first group was encouraged to have regular health screening whilst the other used the medical services as and when they needed them. After seven years of study the results showed no advantage to those who were screened regularly-or rather no advantage for women and only a small one for men. Only men aged between 45 and 54 when they entered the trial showed differences in illness and absenteeism from work.

Perhaps of most significance is that of the 400 deaths occurring in the control group (those not given regular screening) during the experimental period only 15 per cent were judged to have been ‘potentially postponable’ with the best possible application of preventive medical treatment!

Are we evaluating screening tests properly?

Every disease has a natural clinical course and to a great extent the success doctors have with treatment depends on where in this process they catch the disease. Early diagnosis through screening will always appear to improve survival because screening will tend to detect patients in whom the disease has a long hidden (pre-clinical) stage. As a result conditions picked up during screening can expect to have a better outcome even if the treatment they receive has no effect at all.

Could screening actually be harmful in any way?

In our understandable desire to detect everything as early as possible it is easy to forget that screening has a potential for harm too. First, it costs an enormous amount in terms of both money and other resources to screen thousands or even millions of people, and the ratio of positive discoveries to cost can be very low indeed. This is closely linked to the fact that in a free society we cannot force people to be screened for most things. So it is that in certain conditions (notably cervical cancer) the people who come forward to be screened are the least likely to be at risk, while those who stay at home would be the most cost-effective group to be screened. In a society with finite resources for medical care-which is now the case in almost every country-such a ‘waste’ of money and resources must be a serious cause for concern.

*29/72/5*

FEED YOUR BODY RIGHT: THE FINE PRINT PARED HER FIGURE

When you want to lose weight, how much you eat is just as important as what you eat. Phyllis Barbour found that out the hard way.

In 1993, Phyllis went on a special low-fat, low-salt diet after undergoing cardiac bypass surgery. She followed the diet to the letter. To her pleasant surprise, her weight dropped from 130 pounds to 114 pounds in about 3 months and stayed there for several years.

So the Morristown, New Jersey, woman was understandably puzzled when, in 1997, her clothes started feeling a little snug. She was cooking and eating all the right foods, and she worked out three or four times a week at a local health club. Plus, her job as a department store saleswoman kept her on her feet constantly.

“I was doing all the right things, yet I was still gaining weight,” she says. “I couldn’t figure out why.”

Then one day, while eating a bagel, Phyllis picked up the package and read the nutrition label. She discovered that one of those big, doughy delectables equaled four servings of bread. “I was shocked,” she says. “I had always counted it as just one serving.”

That incident prompted Phyllis to check out the labels of some other foods that she ate regularly. She found more of the same: What she considered one serving was actually two or three—some- | ^ times more.

“It became clear why I was gaining weight,” Phyllis says. “I started paying closer attention to my serving sizes, even measuring portions when I needed to. It made a big difference almost immediately. My weight dropped back down to where it belonged.”

Now age 70, Phyllis remains vigilant about her serving sizes. And it shows: Her weight is once again holding steady at 114 pounds. “I’m glad that I figured out why I was gaining,” she says. “I worked hard to slim down, and I wasn’t about to let all that effort go to waste.”

WINNING ACTION

Read those labels! Even low-fat and fat-free foods can cause you to gain weight if you eat too much of them. What they lack in fat they more than make up for in calories. So pay attention to the labels on packaged and processed foods.

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WATER POLLUTION: FEW QUESTION ABOUT FILTERS

Needless to say, the better filters are more expensive, but a high price is not an unfailing guide to quality, so you need to ask some searching questions:

Does it contain silver? (If not, then it is probably dangerous.)

Is the filter registered with the EPA? What is the registration number? If not EPA registered, then you should ask what quantity of silver leaches into the filtered water. (Ask to see test figures. They should be less than .05 parts per million, which might be expressed as 50 parts per billion, 50 micrograms per litre or 50u,g per litre.)

What percentage removal of chlorine, chlorinated organic chemicals, pesticides and organic solvents does it give? Ask to see test results. (Should be more than 95 per cent for each of these groups. The tests should have been carried out by an independent laboratory.)

How many gallons will the filter process?

What percentage removal can be expected when it is nearing the end of its life? (This is a crucial question – the manufacturer may say the filter is good for 5,000 gallons, but if it is only removing 30 per cent of contaminants after 4,000 gallons you may as well drink tap water. Good filters should still be removing 90 per cent or more at the end of their useful life.)

How much does a replacement filter cost?

Given these figures, you can work out the cost per gallon. Ask whether they are working in British gallons or US gallons, as this will make a difference. (1 British gallon = 1.2 US gallons, so 5,000 US gallons is only 4,160 British gallons.) Bear in mind that the cheapest price per gallon may not be the best in terms of water quality.

The same sort of questions should be asked if you are choosing a filter that combines activated carbon with reverse osmosis (see p311). If they do not include silver, ask about bacteriological control. Filters that work by reverse osmosis alone are not recommended.

None of the above systems remove harmful bacteria, and they are only suitable for use with tap water that has already been chlorinated or otherwise treated by the water authority. All water used for baby feeds should be boiled before use, including bottled or filtered water.

For people who can obtain water directly, from a borehole or spring, there are large-scale devices that kill bacteria as well as removing pollutants and sediment. These are known as water purification systems and are much more expensive, but the water obtained should be of very high quality.

*418\180\8*

THE EXCLUSION PHASE OF THE ELIMINATION DIET

This is meant to be a very simple, basic diet, in which you consume nothing but your allowed foods. No herbs, no spices, no flavourings, nothing tinned and no packaged foods of any sort. It is not going to be a gastronomic delight, but the diet does not last long and it may make you well again.

Eat only your allowed foods, remembering to vary your diet, not to eat any one food every day, and not to eat too much of any one food. Drink only bottled or filtered water. As before, you can drink herb teas, but avoid any that you have consumed regularly before. You should also vary them and not drink more than two or three cups a day – you can become sensitive to anything you eat or drink, and herb teas are no exception. Look at the label on herb-tea mixtures: some contain orange, lemon or apple extracts and these should be avoided.

If, after reading Chapter Nine, you think you may have chemical sensitivity, then you should try to eat only unsprayed food during this diet (as well as following the avoidance measures for synthetic chemicals. Unfortunately, eating ‘organic’ foods only may be very difficult, since your choice of foods is limited anyway, but it is worth choosing organic produce for some of the foods, even if you cannot manage it for all of them. Check a variety of sources to see what sort of organic produce is available – the range is widening all the time. Remember that friends’ gardens are often the best source of unsprayed fruit and vegetables – ask around to see if you can buy surplus produce. During the testing procedure, you can test for sensitivity to pesticide residues by comparing your reactions to the same food, sprayed and unsprayed.

Continue the exclusion phase for at least three weeks. If you are not substantially better by then, it is highly unlikely that you have food sensitivity. Keep a record of everything you eat and all your symptoms.

You should also weigh yourself regularly during this diet, especially if you are not overweight at the outset. Anyone who is underweight should not embark on the diet without medical advice. If you find you are losing weight rapidly, then you should discuss the matter with your doctor. Elemental diets can sometimes be useful in these circumstances, as a nutritional supplement.

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PREVENTING FOOD SENSITIVITY: KEEPING THINGS IN PERSPECTIVE

None of these preventive measures is foolproof, unfortunately. Some children go on to develop allergies, come what may. So a philosophical outlook is essential – do what you can to protect the child from allergens and irritants but accept that it may sometimes be impossible. Above all, try not to get too anxious. A child needs to see the world as a safe and welcoming place, not one that is fraught with dangers. If your anxiety is obvious it may do a great deal of psychological harm.

Once the child is a year old, the risk of sensitization is far less, and you should be able to sit back and reap the benefits – an allergy-free child. There is no need to continue these stringent preventive measures unless there is a clear need for them – if the child obviously reacts to house dust for example, then you will have to continue being ultra-clean, but if there are no problems then you can allow your standards to slip a little.

If your child develops allergies anyway, then try not to blame yourself or other people – you can never know for sure what went wrong and it is pointless trying. Take comfort from the thought that your child’s allergies might have been much worse if you had not gone to so much trouble – in the Swedish study, described above, it was notable that the different risk factors added up to give an even greater risk. Your preventive measures must have subtracted some aggravating factors and made your child’s illness less severe than it might otherwise have been.

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FOOD PROBLEMS IN CHILDREN: HYPERKINETIC SYNDROME: DAVID’S STORY

David was very restless as a baby and slept little. By the time he could toddle he was a constant worry to his mother, because he was ‘into everything’ and could not be left alone for a minute. Getting him to bed in the evening was almost impossible, and when he was forced to do something he did not want to do he could throw violent tantrums. Like many children, David was fond of sugary foods and liked ice-cream; orange squash, chocolate and crisps. Since he was still only three it was relatively easy to exclude all these items and other common foods, such as milk and eggs, from his diet. On this diet he showed a

dramatic improvement. He began to sleep through the night, and became much less active – for the first time he could sit down and watch a television programme through to the end. When he had been on this diet for ten days he was tested with various foods. After eating a small square of chocolate he became very aggressive and rushed around the house frantically banging doors and kicking furniture. Then he became dopey and fell into a deep sleep that lasted for several hours. A similar reaction occurred when he was given sugar, milk and oranges. Avoiding these foods has produced a great improvement in his behaviour.

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MYTHS ABOUT FOOD INTOLERANCE: DIGESTING THE FACTS

To add to the myths about food, there are some long-standing misconceptions about human digestion that fuel the arguments over food sensitivity. The most important one is that food is broken down into very small molecules before any of it is absorbed. Every school biology student is taught this: that the enzymes in the mouth, stomach and small intestine break down food into its basic constituents. Starches (complex carbohydrates) are broken down into sugars, and proteins are broken down into amino acids. These very small molecules are then absorbed and enter the bloodstream, but larger molecules are excluded by the gut wall – or so the story goes. If this were true, food could not cause allergic reactions in the skin or airways: the molecules that got through the gut wall would be too small to provoke any reaction by

immune cells in the blood, which only respond to fairly large molecules, not to simple sugars or amino acids.

Research carried out in the last 10-20 years has shown that this picture of digestion is very simplistic and misleading, but the news has been a long time getting through. In one study, healthy adults were given potato starch dispersed in water to drink. After 15-30 minutes, blood samples contained up to 300 starch grains per millilitre of blood.

After a meal, a small number of undigested or partially digested food molecules are found in the bloodstream, so it is clear that the gut wall is not as impregnable as was once thought. In fact, specialized areas of the gut wall actually ’sample’ the gut contents, actively taking up droplets of liquid that contain intact food molecules. The cells that do this are called Peyer’s patches and they form part of the immune system. By sampling the gut contents they are able to prepare the body for the arrival of food molecules in the bloodstream. They ensure that the body makes a distinction between these food molecules and any disease organisms that may enter the blood. Under normal circumstances, this prevents the body from mounting unnecessary and damaging attacks against the food molecules.

*25\180\8*

ALPINE PLANTS AND LOWLAND PLANTS – ALPINE PLANTS 2

To obtain scientifically acceptable evidence in this matter would involve costly experiments. In any case, what really matters are the results of our practical experience with herbs and herb extracts. For instance, we know it to be true that St John’s wort grown at alpine altitudes is richer in active substances and more efficacious than the same plant grown in the lowlands or at an intermediate elevation. The tincture obtained from the former is a much darker shade of red than that prepared from the lowland plant. Hence we must conclude that the medicinal dye content is greater. The plant itself looks different from the ordinary lowland Hypericum perforatum; it is shorter and more compact. And since it is indigenous to the alpine regions it is distinguished by the name Hypericum alpinum. You will see, then, that it is the alpine plant which is richer in medicinal value and content; the variety of plant is the clue to the mystery’s solution.

What is true about St John’s wort also applies to goldenrod. The alpine variety is small and bushy and instead of one flower stem, like the lowland kind, it has 12-15 arising from its small rootstock. The alpine variety of Solidago is more aromatic and stronger, contains more essential oil, and its diuretic effect is far stronger than that of its lowland cousin.

*685/28/1*

THE SKIN – IMPETIGO (BIOLOGICAL TREATMENT)

This unpleasant condition can also be treated with biological remedies, an excellent one being Molkosan. Used externally, this natural, concentrated, whey product, containing 15 per cent lactic acid, will give good results. Soak a cotton pad with it and dab the affected areas. Repeat the application after about five minutes, this time using Echinaforce instead. Molkosan kills the bacteria and Echinaforce prevents infection. When a pustule comes to a head and you feel like squeezing it open, do so only with sterilised cotton wool. Immediately afterwards, apply Molkosan and Echinaforce as indicated above. Do not use soap for washing, but cleanse the skin with 45 per cent alcohol to which a few drops of arnicatincture have been added. When you suffer from pustules your skin is rarely dry, but if it should be, apply Bioforce Cream once a week.

*641/28/1*