Beauty and the Breast Introduction

Beauty

Dr. Alwyn CarstensTHE GOOD NEWS FOR ALL WOMEN.

and theBreast

1Beauty and the B®EAST

Beauty and the B®EAST

Let us discard old dogmas about the female breast and move

forward!

Dr. Alwyn Carstens

Email: [email protected]: www.breastcare.co.za

2 Beauty and the B®EAST

To the Fallen who lead the way and are silent now.

To the Brave, who still inspire, motivate and enrich our lives.

We will uphold your legacy and continue the fight,

To eradicate the Beast, the Fear and Dread.

To educate and Love.A.C.


About the AuthorDr Alwyn Carstens is a physician with special interest in Women’s Health and specifically Breast Health. He practices as a diagnostic Radiologist at The Eastleigh Breast Care Centre in Pretoria. Over 1000 women with breast cancer attend the centre for treatment or follow up.

He started his career as Family Practitioner (GP) in 1975. While in GP practice, he obtained his Masters in Family Medicine (M.Prax.Med) at the University of Pretoria Medical School and the equivalent ( M.F.G.P.) from the College of Medicine of S.A.

From 1986, after qualifying as Diagnostic Radiologist, M.Med.Rad(D) (Pret) he practiced as a General diagnostic Radiologist for the next 10 years. His interest in Breast Radiology and breast disease was ignited while working in New Zealand in a Breast Care Centre. Upon return, he started his own Breast Care Centre in Pretoria, The Eastleigh Breast Care Centre. Together with a specialist team his mission is to provide First World breast cancer treatment and to empower women to take part in decision making. He has now spent 35 years of his

life in the art of Medicine.

After consulting thousands of women regarding breast and general health issues, he is convinced that women find it difficult to make the right decisions due to lack of information. Part of his mission is therefore, to educate and inform women about health issues and the right choices to be made. He does this by giving presentations, talks and writing articles whenever the opportunity arises.

This booklet also intends to do exactly that, especially for the 20,000 patients on his records.


INDEXPREFACE. Page 7

INTRODUCTION. Page 8

CHAPTER 1. Nourishing the Breast. Page 12

CHAPTER 2. Common Breast Diseases and Concerns. Page 19

CHAPTER 3. Stalking The Beast (investigations). Page 24

CHAPTER 4. The Beast (Cancer). Page 31

CHAPTER 5. Modern management of Breast Cancer. Page 35

CHAPTER 6. Breast Cancer Prevention. It is possible! Page 45

CHAPTER 7. Her Breasts, her Bones, her Hormones (Osteoporosis) Page 53

CHAPTER 8. Booboos with your Boobs. Page 58

CHAPTER 9. Exposing Common Myths / Dogmas. Page 61

CHAPTER 10. References. Page 64

REVIEWS. Page 66

This book can be ordered via e-mail at [email protected], or can be purchased as an ebook on the internet at

www.breastcare.co.za/beauty_and_the_breast.html


© Dr. Alwyn CarstensAll rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any informations storage and retrieval system, without permission in writing from the author and publisher.

First Published 2010ISBN 978-0-620-48160-1

Published byOceanic Internet Solutions682 Blouhaak RoadMoreleta Park0184

Layout and Design byMichael Maherry (Oceanic Internet Solutions)Tel: +27 12 993 5156Cell: +27 79 408 6708E-mail: [email protected]: www.oceanicinternetsolutions.co.za

Photographs byMichael Maherry (Oceanic Internet Soltions) - +27 79 408 6708

AcknowledgementsThe author extends his gratitude to Oceanic Internet Solutions for dedicated time spent on script and Design, also to family and friends who contributed to ideas and outlay. A special word of appreciation to Marie Vermeulen Breedt and Jaco van Schalkwyk for their dramatic artwork. Also to Mrs. Joan van Rensburg for many hours of proofreading and the Chapter about Nourishing your Breasts.

Dedication:DEDICATED TO THE THOUSANDS OF WOMEN WITH AND WITHOUT BREAST CANCER, WHO HAVE CROSSED MY PATH AND TOUCHED MY LIFE.


PrefaceCorrect decisions in life can only be made after in depth research of the relevant topic, which is based on information and education.During 35 years in medical practice, I realized that many patients made wrong choices due to lack of knowledge and information.Often the patient finds it difficult, sometimes impossible, to lay hands on the right information to lead the way to the right answers.Medical information is mostly inaccessible to lay people due to medical (often Latin) terminology, exuberant descriptions and long arguments and trial results.Unfortunately information can sometimes be biased towards monetary gain and ignores the patient’s wellbeing and needs. The strength of a medical argument can sometimes be dependent on how much money is put into advertising or how prominent the reporter is in medical society.

These factors make it very difficult for the patient to differentiate money, advertising and personal gain from sound and honest advice for his/her best health decisions.

With this short and practical booklet, I wish to supply women with knowledge and information regarding common breast problems and decision-making.This is not meant to be a detailed scientific explanation of every possible entity or disease.Particularly, it is not meant to treat or take over treatment of any patient with breast disease. Each and every patient’s case must always be managed individually according to many specific factors and circumstances.

Readers will however identify a golden thread that runs through all the chapters of this book: NEVER BE RUSHED INTO MAKING A DECISION. TAKE TIME TO STUDY AND RESEARCH AND ALWAYS CONSIDER ANOTHER OPINION!!

References to Medical Journals and Trials are given whenever a statement or advice could be contrary to what you were told or lead to believe. This will always be a confirmation to my scientific reasoning.

Some of the topics were published in RAY-MAGAZINE (www.ray-magazine.com) under the “Breast Cancer The Good News” series of articles through 2009-2010. Most of the topics are also discussed on www.breastcare.co.za, the website of The Eastleigh Breast Care Centre in Pretoria, South Africa.

Happy reading!! Dr. Alwyn Carstens.


IntroductionThe female breast harbors and expresses awesome charisma. More, I think than the heart. The magic of the breast far outweighs its function, size or beauty. It represents a woman’s image and her womanhood. Her breasts make her a woman and differentiates her from a man. It attracts the eyes and the admiration of all men and makes her desirable.

The rounded form, the movement when she walks, the cleavage when she bends, and the softness on the touch, install the breast with a charisma all men admire.

This is the reason why removing or mutilation of the breast, causes such devastating effects on a woman’s life and relationships.

This is something we, as medical profession, should take into account and show more empathy and understanding towards our female patients.

A patient of mine once told me a story illustrating this: She visited a male surgeon after she detected a breast lump. He explained that she has to be operated to remove the lump. She must however sign a consent form to remove her breast, if the lump is found to be cancer. She then asked him if there might be another option besides the


mastectomy. He answered her: “ Alida, you are sixty. What do you want your breast for?”

It was our privilege to offer her hope and an opportunity to save her breast.

Studies have found that the psycho-logical impact of mastectomy is often devastating on the life and relationships of a woman and her spouse and even the whole family. Divorce is common after mastectomy. In many races, divorce is almost inevitable.

This is not because love is lost, but because the partners find it difficult to handle. Men particularly, do not know how to show empathy, and do not know how to handle and treat their wives after mastectomy. It is either a false scorn or false empathy or “it doesn’t matter my love”.

When working with traumatized women in a Breast Care Centre, we are very well aware of this and are more careful with what decisions we make or advice we give. “Save her breast to save her woman-hood” is an important principle in our Breast Centre, more so when there is worldwide data to show that there is no survival benefit when the breast is removed.

Of further importance is to have the spouse involved in the discussions and treatment plan. The partners are both important members of our team of experts, when deciding the way forward and choosing treatment options. This approach also means that we will

take time and allow time before making treatment decisions. The suggestion by many doctors that there is urgency “because the cancer will spread” is loathsome and has more to do with money or convenience than with real treatment outcomes.

We know that breast cancers are present for years before they are detected. Why would it then be important to operate in a hurry… or next week? There is no proof or even a thought that delaying treatment for 2 weeks would influence survival of a woman with breast cancer.

The one golden rule I want to stress to all women with a breast lump is:

NEVER BE RUSHED INTO A DECISION. TAKE 2 WEEKS TO RESEARCH AND ASK MORE OPINIONS!! INTERNATIONAL OPINIONS. THE INTERNET IS AT YOUR FINGERTIPS.

The female breast is often regarded as not important because it is not necessary for sustaining life. It is not an organ that breathes, pumps blood or digests food they say. This leads to a very nonchalant or casual attitude by many doctors when dealing with breast issues.

We thus found that unnecessary operations and aggressive surgical treatments for innocent symptoms are often done and advised.

The women and her doctor should know that 95% of breast lumps are not cancer and that lumps should always first be

Your Breast and the Doctor.


investigated (mammogram, ultrasound and needle biopsy) before embarking on surgery. These investigations are usually available within 3 hours drive in South Africa. There is no need to act as if special investigations like these are only available in another continent.

Unnecessary interventions, without careful pre-operative investigations, commonly lead to the wrong treatment which often means that the breast cannot be saved. This wrong approach causes cancers to be incompletely removed. Then the breast is often lost with second and third operations to follow.

It is not always the doctor who is to blame. When a doctor experiences a woman to be unwilling to go to a specialized centre, perhaps in another town, he will be forced to do operations that he is not comfortable with. When the wrong information is supplied by the radiologist, this also leads to wrong operations.

Outcomes of breast surgery and treatment depend strongly on whether the right treatment approach is maintained from the start or whether a booboo is made and the breast then cannot be preserved.

Breast cancer management is evolving at a very fast tempo. It is dangerous to treat it outside of a specialist team at a modern Cancer Centre. The role of the breast in a woman’s existence is too important to risk it in the hands of a one man show.

The effects many prescription drugs might have on your breasts are very important. Remember that your doctor has your other complaints in mind when prescribing drugs and not necessarily the effects on your breasts. The effects on the breast might be regarded as not important, but in a Breast Care Centre we often encounter the serious side effects prescription medicine might have. A few most commonly prescribed drugs are mentioned below.

1) The contraceptive Pill. Side effects: breast enlargement, tenderness, pain. Lumpiness and discrete lumps causing a lot of anxiety. Nipple discharge. Enlargement of lumps and tumors. Breast cancer. [1,2] Yes, it is a fact that The Pill increases your chances of getting breast cancer, especially in the women under 45 years. If it is denied by anybody, read the references and consider the following question: Why must you stop taking The Pill when having breast, cervix and uterine cancer or have a history of blood clots, when it is claimed that it is not causing these deadly diseases. Makes you think, doesn’t it?

Current Pill users can be at risk of Breast Cancer. Lancet 1996;347:1713 “All hormonal components of oral contraceptives have been found to be carcinogenic in animal models” Acta Oncologica 28:857 2) Any hormone replacement pills (HRT) Also estrogen alone.

Prescriptions and your Breasts.


Side effects: Breast enlargement, increase in weight, loss of libido, breast pain, lumps, nipple discharge, blood clots, breast cancer. Read the pamphlet and you will find breast cancer in all of them, often disguised as “breast tumors.” The foreign xeno-estrogens and progestin in the Pill and HRT are the same and all are carcinogenic. [3](cause cancer). HRT for 5 years or longer significantly increases women’s risk.V. Beral et, al. The Lancet, August 8/03

Breast density increases the longer HRT is used which makes mammograms more difficult to read and to detect smaller cancers .[4]

3) Many antidepressants and mood stabilizers.Many cause increase in prolactin secretion from the brain, which we find can cause breast tenderness, widening of milk ducts and often nipple discharge.

4) Infertility Treatment.Side effects. Breast enlargement, pain, ovarian cancers.

I am not even mentioning the many other detrimental side effects on the rest of your body. Stroke, heart attack, hypertension, blood sugar and blood triglyceride problems are only a few.

Remember that Medical Care is the third leading cause of death in the United States, only after heart and cancer deaths. The main contributor to these deaths is adverse drug effects. [5]

Please, stress the importance of your breasts to your doctor when dealing with treatment options.


Nourishing the BreastThe American Cancer Society states that about 1/3 of the ½ a million cancer deaths in the US each year, can be at-tributed to dietary factors. Their two top recommendations are:

1) Choose most of the foods you eat from plant sources.2) Limit your intake of animal protein.

Recent identified risk factors for Breast Cancer are:

1) Limit or avoid alcohol.

Studies in France show that regular intake of alcohol amongst women (4 litres or more of red wine in 1 month)

or ½ a glass per day is associated with a substantial increase in the risk of Breast Cancer amongst premenopausal women.European Journal of Epidemiology-Sept.1997

A pooled analysis of studies (USA, Canada, Sweden, Netherlands) involving 32 2647 women over 11 years supports the hypothesis that alcohol intake is associated with an increased risk of Breast Cancer. JAMA Feb 18.1998

2) Cut out smoking.

There is a three-fold increase in Breast Cancer risk amongst women who engage


Common Breast Diseases and ConcernsThe most common complaint I hear from women every day is breast pain. It is so prevalent that I am sometimes convinced that the female breast is destined to pain. Caucasian women complain more of breast pain than other races. Most probably, this has to do with different lifestyles, diet and what they take as medicines.

We know that caffeine, chocolate and beverages containing caffeine and certain types of cheese, can cause mastalgia (breast pain.) We advise that these foodstuffs should be reduced, usually with good results.

The main cause of mastalgia however, can be found in the drugs women often use.Estrogen is a growth hormone on breast tissue. Its function is cell proliferation in order to enlarge the milk factory to supply milk for the offspring. In reproductive women, this cyclic estrogen production by the ovaries, causes cyclic breast enlargement, pain, swelling and water retention. This is normal.

Each month when conception does not take place, the pain and swelling disappear and the breast reverts to normal. This is also the function of progesterone, secreted by the ovary, when ovulation takes place each month. Progesterone is thus an opposing hormone to estrogen and causes apoptosis (cell death) so that the excess breast cells (proliferation of cells) die off and breast pain disappears.

Normal Asymmetric breast size in young girl.


Stalking the BeastIn this chapter, we will be discussing issues regarding the early detection of Breast Cancer using Mammography, ultrasound and how we make the diagnosis before we embark on treat-ment.

Breast Self Examination.In the past, before mammography and ultrasound were invented to examine the breast, the only way to examine was with the hand (palpation).We then made a lot of fuss about how the woman should examine her breast. This caused a lot of anxiety as most women do not know which is the best way to examine her breasts.

As mammography became readily available with reasonable cost, we

realized with shock that cancers are present in the breast long before it becomes palpable by hand.

We found that the average doubling time (one cell divides to two cells) of most breast cancer types is about 120-180 days. To reach a detectable size of about 1.5-2cm, the time span could be 5-7 years!! This means that a cancer can be in the breast for that long before it becomes palpable by the hand of the examiner (doctor or woman herself). That is not good enough.

With mammography and ultrasound combined, we are able to shorten this pre-clinical phase by 2-3 years. Even though the cancer is already in the breast for a few years when detected by mammography plus ultrasound, the gain


The Beast (Cancer)This Beast is feared by all women. To know the Beast better is the way to attack and kill the Beast. We will be the supporting army around you to help you overcome the fear and overcome The Beast. Knowledge and information will be your strength.

Invasive Breast Cancer Types:1. Infiltrating Ductal carcinoma (invasive Ductal carcinoma.) Characterized by stony hardness on palpation.

Gritty resistance encountered upon transection; used to be called “scirrous” carcinoma.

Typically metastasizes to bone, lung and liver. 2. Tubular carcinoma. It is a variant of infiltrating Ductal carcinoma.Often detected by mammography. -5% of all breast cancers.Better prognosis than infiltrating Ductal carcinoma. Can be difficult to distinguish from radial scar (benign proliferative lesion). Typically ER (+) and progesterone receptor (PR) (+).

3. Medullary carcinoma. - 5-7% of all breast cancers. Females tend to be younger at diagnosis (< 50 years old).


Modern Management of Breast Cancer

In this chapter, we will be discussing the exiting modern management of breast cancer, which is not really new, and already more than a decade old. For many doctors and patients, it might be new however, because old dogmas still prevail.

Typically in western medical practice it takes 50-100 years to admit that we were wrong, before we accept new concepts and embrace them in our day-to-day practice.

It is often, (like in breast cancer management,) the patient’s pressure that moulds her doctor into new ways of treating and forces him/her to study and adapt his/her practice to new concepts in treatment. Breast cancer management is

such an example.

In the, past surgery was the only treatment available for breast cancer. This meant mastectomy and the complete removal of the glands in the armpit. Unfortunately many doctors still offer this as first option to a woman with breast cancer.

Today we have better ways to manage breast cancer and surgery is not the only treatment. We do not have to mutilate a woman to treat her cancer. This is treatment of the Middle Ages like demonstrated on a picture from the Dark Ages of breast surgery above.

This has changed and it is GOOD NEWS for women.


Breast Cancer PreventionOnly about 4% of breast cancers are of the genetic type, associated with higher family risk. Even these genetic types can be suppressed by down regulation of gene expression.

That means the majority (96 %) are caused by other risk factors.

Many women ask me: “What on earth is causing the increase in breast cancer?”

To answer this question, one must look at the greater picture.

Breast Cancer is a hormone driven disease. That means, it is driven by estrogens, whether it is the women’s own hormones or those she ingests with medication, her water, her food or Endocrine disruptors in the environment... (Environmental pollution)It is the time span in years that the breast is exposed to estrogens that is causing the risk.

That is why early start of menstruation, late onset of menopause (stopping menstruation) low number of pregnancies, and short duration of breast feeding (lactation), are all increasing the risk of breast cancer. As a group, nuns have the highest incidence of Breast Cancer.

The Udder side of the Breast.The main function of the breast is to produce milk for the newborn. The purpose of the breast is not predominantly for beauty and body image. The best inheritance one can give your child is ‘Breast milk’. It contains all the nourishment needed as well as the transfer of immunity from mother to child.

Mothers’ milk promotes facial and jaw development, protects from obesity, allergies, infections and enhances the babies’ brain and vital nervous system development. Higher IQ’s are associated with components in human milk.


Her Breasts, Her Bones, Her Hormones (Osteoporosis) New Trends

What we have known and advocated as prophesy about Osteoporosis and the treatment thereof until now has changed. The results of recent trials (Like the Women’s Health Initiative [WHI]) forced us to have a new look at the management and New Trends in the Diagnosis and Treatment of Osteoporosis. Doctors and particularly GP’s and gynecologists as well as patients, should be aware of this, and adapt their treatments and advice to patients accordingly. [19,23]

Old Myths to Discard:• Osteoporosis is a disease of women in the menopause, due to declining estrogen levels. • Thus, men do not get osteoporosis as there are no declining estrogen levels to blame. • As the menopause is often considered as a curse for women, causing

a disease like Osteoporosis, we must prevent it by upping her estrogen levels from an early age and she needs to take estrogen for her entire life. (“Mrs. X you must continue your HRT for ever, lest your bones will break”). • Many doctors still treat Osteoporosis with hormones.

Why This Argument??When BMD (Bone Mineral Density) machines became available, we started to test menopausal women’s bone Calcium content and found the bones tend to break easily when her BMD is lower than 2.5 deviations from the norm. (T= -2.5) This is the norm for the diagnosis of Osteoporosis. This set of statistics was derived from many normal Caucasian (white) American women between 20 and 40 years who were tested.

There is thus a flaw and inaccuracy in that it is not applicable to men and women of


Booboos with your BoobsCosmetic surgery of the breast.

Any woman has the right to decide on issues regarding her own breasts.Many women have a bad body image about the size; shape etc. of her breasts and it could influence her life and sexual image.

Having accepted that as a given, there are certain facts about cosmetic surgery that she should keep in mind. Often only the desired results are explained and not the possible complications. Some facts are as follows:

• Surgery can enlarge (augment) make smaller (reduction) or lift (pexion) the breasts.• The breast is not a piece of wood that can be carved, chiseled, or sandpapered to perfection.• The body’s healing processes

are different and cannot be anticipated.• The women lies on her back during surgery and the position of breast and nipple is difficult to judge in this position (although we plan carefully before the operation)• Complications often follow. Bleeding, fat necroses, fibrosis, scarring, uneven size and height can cause good intentions to be nullified, and results could often not be what the women desired.• She should always be aware of this and should question the surgeon about complications that are common or might be expected.

Breast Augmentation.Prosthetic implants are used. The prostheses can be implanted in the breast or behind the pectoralis muscle.


Exposing common Myths/DogmasNow that you have read this far, you will have noticed that many myths and dogmas about your breast and cancer have been exposed and discarded. Here follows a summary of the wrong arguments to refresh your memory:

• The mammogram is painful and gives dangerous cancer forming radiation. [15] “There is little evidence of any increased risk to women exposed after age 40.”• Breast Cancer is one disease and there is one treatment. • “MRS. X you have a breast lump. We must remove it as soon as possible. It could be cancer!!” • “If during the operation we find cancer, your whole breast will be removed. So sign the consent form now.” • “You have Breast Cancer. Your breast must be removed as soon as possible as it can spread.” • Mastectomy is the only safe treatment . If you were my wife, I would have it done immediately.” • “MRS. X you are sixty. What do you want your breast for?” • “You need a bilateral mastectomy to be safe and prevent spread and recurrence.” • “Your glands in the armpit must be removed to prevent the cancer from spreading.” • If you have a mastectomy you do not need further treatment. • Radiation after lumpectomy is causing cancer. Therefore rather go for mastectomy. • Hormone replacement therapy is good for you. Continue forever. • Mrs. X, do not read the HRT pamphlet. The side effects are not really of concern and are only mentioned to protect the drug company. • HRT is good for your heart and prevents a heart attack. • God, our Creator made a mistake with all women to let her estrogen levels decline in the menopause. We know better and must push up your estrogen levels!


AS A LAST THOUGHT..I hope you found this booklet informative and of help whenever you or your friends need answers to life changing questions.

My passion for the health and preservation of your breasts might have filtered through. It might even have sounded as if I am a little critical of the profession.

This is because the thousand women with Breast Cancer in my practice are dear to me.

They have enriched my life and made it worthwhile. I cannot be silent when harm or unnecessary mutilation is forced upon anyone of them. May we continue to be committed to excellence, to meet our patients at their point of need, to show them empathy and understanding, and to help them preserve their breasts.

I trust that this book will have been a source of inspiration to all who read it.Together, joining hands, we can make a difference.

Voula Diagnosed at age 45 in 2007.Another Breast Saved!

15 August 2007 - Lumpectomy


References1. Miller DR, Rosenberg L, Kaufman DW and 3 others (1989). Breast Cancer before age 45 and oral contraceptive use: New findings.Am J Epidemiol 129 (2), 269 -2802. Oral contraceptive use and breast cancer in young women. Lancet 2 (8508),650-653.27.Rushton L, Jones D (1992)3. Hormones and Breast Cancer: Evidence and Implications of Risks and Benefits of Hormone Replacement Therapy. Colditz Graham A. Journal Of Women’s Health Vol. 8 Number 3,1999 4. The effect of Hormone Replacement Therapy on the sensitivity of screening mammogram. J.C.Litherland. S.Stallard. D.Hole. C. Cordiner. Clinical Radiology (1999)54,285-288 5. Starfield Barbara M.D. “Is U.S health really the best in the world?” Journal of the American Medical Association (JAMA) 284 (2000) 483-4856. The effects of omega-3 EFAs on tumor angiogenesis and their therapeutic potential. European Journal of Cancer 45(2009) 2077-20867. Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1696-708. Specialty supplements and breast cancer risk in the Vitamin And Lifestyle (VITAL) Cohort8. Endocrine disruptive activity and potential health risks in an Urban Nature Reserve. Report by Water research Commission South Africa.9. Study on role of antioxidants in reducing Chemotherapy Toxicity. Presented at the 43rd Annual Meeting of the American Society of Clinical Oncology ( ASCO) 3 Jun 2007. Keith I. Block MD. Robert Newman. PhD. Prof. of Cancer Medicine at M.D.Anderson Cancer Centre.10. Journal Clinical Oncology.2005; 23: 6631 – 663811. Br J Cancer. 1996. June; 73(12): 1552 – 512. Ghent WR, et al. Iodine replacement in fibrocystic disease of the breast. Can J Surg 1993; 36:453-460)13. Tabar. Lancet 2003 361: 1405-1410 40% reduction in breast cancer deaths with screening mammography14. Garne JP,Aspergen K, Balldin G, Randstam J. Increasing incidence of and declining mortality from breast carcinoma: trends in Malmo, Sweden. 1961-1992. Cancer 1997; 79:69-7415. Health effects of exposure to low levels of Ionizing Radiation: BEIR V. Washington DC: National Academy Press 199016. Lancet 2003; 361:1411-1417 20% death reduction in Netherland screening mammography.17. Shimkin MB, Grady H. Carcinogenic potency of stilbestrol and estrone on strain C3H mice. J Natl Cancer Inst 1940; 1: 119-12818. Hully,S, Grady, D, Bush, T, Furberg,C Herrington, D,Riggs, B and Fittinghoff, E (1998) HERS Research Group. JAMA 280,605-613


19. Writing Group for the Women’s Health Initiative Investigators. Risk and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 88: 321-33320. Ravdin PM, Cronin KA, Howlander N, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 2007; 356(16): 1670-167421. Robbins AS, Clarke CA. Regional changes in hormone therapy use and breast cancer incidence in California from 2001 to 2004. J Clin Oncol 2007; 25(23): 3437-343922. Clarke,CA and Glaser SL (2007) Declines in breast cancer after the WHI;apparent impact on hormone therapy. Cancer Causes Control 18,847-85223. Emerging trends in the Diagnosis and Treatment of Osteoporosis. Medicographia, Vol 28, No. 1, 2006 23


ReviewsAt last! A wonderful book about breast cancer, in understandable language, for the average woman. This book will help to avoid the misperception that women have about breast cancer and the treatment. It can be cured! It is imperative that women become aware of any changes in their breasts and to feel comfortable to seek help if they think there might be something wrong. I think this is a great gift to all my fellow humans in order to make them aware of breast cancer. This beast can be prevented and cured.

Stienie NaudéBreast cancer patient 2004 – 2010.

I was privileged to receive World Class treatment for my large breast cancer in 2007 at the Eastleigh Centre. This book will empower women to make the right decisions. My husband and I are tackling the peak of Mount Kilimanjaro in Sept 2010. This personal challenge will also col-lect funds for The Eastleigh Breast Care Fund.

Patricia Robbertse 40 yrs. My breast was saved!!

“The Good news about Breast Cancer” is what this book is all about. Thank you dr. Carstens for the sharing of your experience, that allow us to better understand Breast Cancer, for the patient and her family.

Hetta van Niekerk.Diagnosed 2007Aged 62My breast was saved.


Affiliated Charitable Organisations1. Eastleigh Breast Care Fund A Non-Profit section 21 Company Registration No: 2006/010405/08 Banking Details: Nedbank, Woodlands, Branch Code: 149745, account number:14971831622. Eastleigh ‘Breast Friends’ Support Group For more information on the above please contact: Joan van Rensburg - Tel: +27 72 267 8160


Let us discard old dogmas about the female breast and

move forward!68 Beauty and the B®EAST

Documents

Beauty and the Breast Introduction