Our Bodies, Ourselves (125 page)

Retirement Security:
After all this time, and in spite of laws and cultural shifts that have opened many occupations to women and enabled many of us to reach higher positions, we still confront ceilings in status and pay. Women still earn on average only 78 cents for every dollar paid to men; the disparity grows with age. That translates to a lifetime of wage discrimination and affects how much we receive in Social Security benefits and pensions. Retirement security can be even more difficult for never-married women with limited incomes, divorced women who were married less than ten years and who therefore can't get Social Security based on their ex-husbands' earnings, and women widowed before age sixty.

Women are more dependent on Social Security because they reach retirement age with fewer resources. It should provide enough to live on
for women who have spent their lives making homes for their families, independent of marital history. Any proposals to address the future solvency of the Social Security Trust Funds must be assessed for their impact on women. Moves to cut benefits, raise the retirement age, or privatize Social Security will undermine women's economic security.

Most women do not receive employer-provided pensions. We need to expand access to employer-based part-time and temporary workers' retirement programs, institute portability of pension plans, and extend spousal rights to everyone. We must call on Congress to close the gender wage gap by passing the Paycheck Fairness Act, which will close the loopholes in and strengthen the Equal Pay Act of 1963.

Though some states recognize the marriage of same-sex couples, the Defense of Marriage Act (1996) still blocks Social Security benefits for same-sex spouses. Many older women would benefit from extending spousal pension rights to all. We need to increase benefits for widows and give Social Security credits for caregivers.

Aging touches everyone's life. Together we need to tell our stories and push our local, state, and national governments to provide a continuum of services for our older years—and to ensure that public and private programs acknowledge the diversity of our lives and economic resources. The steps we take as we age will influence attitudes and policy now and for future generations.

Medical Problems and Navigating the Health Care System

CHAPTER 22
Selected Medical Problems

T
his chapter looks at procedures and problems that are particular to women's organs and the female body. It covers some of the conditions that affect large numbers of women—conditions for which it is sometimes difficult to get reliable women-centered information. Much is still unknown about many of these conditions, though new research findings emerge regularly.

These conditions are organized by anatomy. Some problems, of course, will involve more than one area of the body. The chapter focuses on benign (noncancerous) diseases or problems and on cancer prevention and diagnosis. It deals less with cancer treatments, since they tend to change quickly.

Other chapters in this book cover many topics related to
medical concerns. In particular, see
Chapter 2
, “Intro to Sexual Health” for information on preventive care for sexual and reproductive health and what to expect in a gynecological exam, and
Chapter 23
, “Navigating the Health Care System” for information on how to find good care, how to work collaboratively with a health care provider, and where to find trustworthy and up-to-date health information.

© Christine Bondante

A breast, showing the structure of milk ducts, lymph nodes, and fat cells.

Our breasts are dynamic organs. They change considerably during our lifetime in response to aging and to variations in our body's hormone production. Understanding these changes can help reassure us when we think something is going wrong.

The breasts respond to estrogen and progesterone during each menstrual cycle, with growth and fluid retention that may be barely noticeable for some women but painful for others. The individual differences in breasts, along with the changes caused by age and menstrual cycles, can produce needless anxiety. We may worry that every change or pain is a symptom of cancer, when in fact most conditions causing change, lumps, or pain are benign.

Small cysts (a lobule or duct with fluid inside) may form, but they are usually smaller than a pea. Benign (noncancerous) tumors, such as fibroadenomas, may form during the teens and twenties and grow large enough to feel like smooth, mostly round, rubbery marbles that can be moved back and forth in place.

As we mature, small cysts may fill up further with fluid, sometimes causing tenderness and growing to sizes that can be felt with the fingers. By our fifties, dense glandular tissue and stroma begin to decrease (a process called involution), and fatty tissue increases.
During perimenopause
, hormone levels begin to fluctuate, and our usual cycles may become irregular. Effects of hormone changes on the breasts may include increased pain and lumpiness, which might be worrisome if we are looking for signs of breast cancer. Cancer rarely forms within cysts, but we may feel anxious while awaiting proof that a cyst is not cancer.

Some women's breasts remain lumpy after menopause. Most benign lumps are caused by hormone stimulation, so if you are taking hormones after menopause, the breasts will continue to feel as they used to. Cysts rarely form after menopause, so if a new lump does form, it's a good idea to have your health care provider examine it. Breast pain in the postmenopausal years may be coming from the chest wall, arthritis of the spine, or, only rarely, cancer.

There are several kinds of breast lumps. Cysts are fluid-filled sacs that develop from dilated lobules or ducts, most commonly during our forties or fifties. They can be identified by ultrasound or by removing the fluid and making sure no lump remains. Simple cysts—those that are just fluid, for example—don't have to be removed unless they are causing pain or are so big that you can't feel the surrounding breast tissue. A breast ultrasound is the best way to be sure a cyst is simple.

Treatment involves numbing the skin with a local anesthetic, inserting a thin needle into the cyst, and drawing the fluid into a syringe—a process called aspiration. The fluid may look gray and cloudy, dark and oily, or clear yellow or green. If a lump remains after aspiration, or if the fluid looks dark and bloody, you'll need to have the area biopsied (tissue will be removed and examined under a microscope for further diagnosis). Cysts may refill with fluid after aspiration. If the same cyst continues to refill, removal may be recommended.

Fibroadenomas are benign growths that form mostly during our teens and twenties; some that form early may last throughout life. They may develop in one or both breasts. A fibroadenoma that's getting larger is usually removed surgically. These growths sometimes shrink at menopause, as hormone levels decrease. Fibroadenomas are rarely associated with cancer, although some breast cancers can feel like fibroadenomas. The younger you are, the more likely it is that you have a fibroadenoma and not a cancer. Often a mammogram can confirm that the lump is a fibroadenoma, but the only way to be certain is by doing a biopsy and looking at the tissue under a microscope.

Pseudolumps are areas of dense normal breast tissue. They develop in many women during the premenopausal years. To make sure there is no cancer, these areas should be evaluated with good breast imaging and follow-up breast exams.

Cancer in the breast usually feels firm and hard. It often does not have clear edges but blends into the surrounding breast tissue. Breast cancers are usually about 1 centimeter (half an inch) in size before you can feel them; in women with firmer, lumpier breasts, they must be even larger to be felt.

First of all, don't panic! More than 80 percent of all breast lumps are
not
cancer, especially in women under forty. Lumps in our breasts big enough to feel may be cysts, benign tumors such as fibroadenomas, pseudolumps,
or
cancers. It is impossible to tell the difference with physical examination alone. A lump that gets smaller over time is unlikely to be cancer. A lump that remains the same size or gets bigger could be cancer, so it should be medically evaluated.

Many women feel anxiety and fear upon finding a lump and immediately think it's cancer. Our reactions may vary from wanting to go to the doctor immediately to being immobilized by fear. Finding a lump requires taking some decisive actions for yourself and your health. Tell someone you love about your concerns, so you can get some support and not have to go through the next steps alone. Then, contact your health care provider. Tell the appointment person or nurse that you have found a new breast lump and ask to be seen promptly.

Your clinician will do a physical examination of your breasts and determine whether further evaluation is necessary. She or he may suggest following the lump for one or two months, schedule you for diagnostic breast imaging (mammogram or ultrasound), and/or refer you to a breast specialist (usually a surgeon). If more information is needed, a biopsy may be recommended,
since only a tissue sample determines for sure whether a lump is cancerous or benign.

This can be a very stressful time. Even though it's likely that a breast lump is benign, statistics don't always calm our fears. It helps to speak frankly with your health care provider about your concerns and to have the support of friends and/or family. It is also important to have confidence in your health care provider. If you are not comfortable with his or her recommendations, particularly a “wait and see” approach, be sure to say so. Getting a second opinion may be a good idea in this situation.

Breast discharge, itching on the areola, breast pain, and a breast infection are some of the other benign conditions of the breast that women experience. Nipple discharge, especially if it is bloody or coming from just one breast, should always be evaluated because it can be associated with cancer. Consult your health care provider for any persistent and troubling symptoms.