DEAR DR. DONOHUE: I am a 45-year-old woman, and I have what my doctor calls “lumpy breasts.” I feel the lumps, and they hurt somewhat when I am menstruating. My great fear is cancer. I have had mammograms and even a biopsy, and they are normal. How can I tell if the lumps are cancerous? – J.A.

ANSWER: Breast cancer is on the mind of every woman, especially those with breast lumps. Breast cancer usually begins as a single, hard, painless lump in one breast. The lump is fixed to the underlying breast tissue. You can’t push it around.

Lumpy breasts have multiple fluid-filled sacs that enlarge and are painful during menstrual periods. Estimates say that half of all women have such cysts, so the condition is now referred to as “fibrocystic changes,” not “fibrocystic breast disease.” It doesn’t make a lot of sense to call something a disease when half of the population has it.

Your doctor has examined your breasts and did not find any signs of cancer. You have had mammograms, which did not show cancerous changes. You even had a breast biopsy, the ultimate test in detecting cancer, and it was negative.

If neither your mother nor your sisters nor your daughters have had breast cancer, that’s another point in your favor. If you did not begin to menstruate at an early age – say, 12 – that’s another favorable factor. Having had children affords women some protection against breast cancer. Early menopause is another element that prevents breast cancer.

You are ruining your life by dwelling on this topic. All you need to do is follow your doctor’s suggestions.

DEAR DR. DONOHUE: What would be a good daily calorie intake for a woman who weighs 110 pounds and is 5 feet 4 inches tall? I think I should start watching my calories more closely. – F.G.

ANSWER: You are worried about calories? Why?

I calculated your body mass index, and it’s 18.9 – that indicates you are on the slim side. A body mass index between 18.5 to 24.9 is normal. You don’t need to do anything more than you are already doing. (Body mass index is obtained by dividing weight in pounds by height in inches and dividing that result again by height in inches. Multiply that number by 703 to obtain BMI. If you use metrics, divide weight in kilograms by height in meters squared.)

If you want a rough estimate of what calorie intake should be, I can give you one way of figuring it. Multiply your present body weight by 10. That gives you the number of calories that keep all your body functions going. Then take half that number and add it to the first number. For you, it’s 1,100 plus 550 to yield 1,650 calories a day to keep body weight at its present level.

DEAR DR. DONOHUE: I have very large breasts. I think they’re the reason why I have such pain in my upper back. What kind of doctor do I see about this? Do insurance companies consider this cosmetic surgery? My insurance doesn’t cover cosmetic procedures. – D.H.

ANSWER: Large breasts can cause upper-back and neck pain. Reducing their size for pain relief doesn’t constitute cosmetic surgery. You should check with your insurance company to see if you are eligible for breast-reduction surgery.

The doctor to see is a plastic surgeon, a general surgeon or a surgeon your family doctor recommends. If the insurer balks at the procedure, ask the doctor to intercede for you.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com


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