Identifying potential problems: annual exam called great time to discuss breast-feeding.(Gynecology)

ASHEVILLE, N.C. -- Gynecologists can do much to support and encourage breast-feeding by educating women about their breasts and identifying potential lactational challenges during a regular gynecologic exam, Dr. Edward Newton said at the annual Southern Obstetric and Gynecologic Seminar.

"Your role here is underlined, because 50% of women already have decided how they're going to feed their infant before they even get pregnant," said Dr. Newton of East Carolina University, Greenville, N.C.

Family planning visits and annual gynecologic exams provide great opportunities for gynecologists to identify women who might be at high risk for lactation failure due to breast abnormalities and to counsel them about the effects elective breast surgery might have on lactation.

The breast exam is an ideal time to talk to young women about lactation--an often over-looked aspect of breast health, he said.

"The fear of getting breast cancer has forced us to focus on the breast exam as a cancer identification tool, even in 18-year-old," he said. "But less than 2.5% of breast cancer occurs in women under age 34, when 90% of pregnancies occur, and we know that lactation is associated with a decrease in the risk of later breast cancer. At these visits, we could also be teaching a woman what the breasts were actually put there for and [we could be] building self-confidence about her ability to breast-feed should she decide to become a mother."

Flat or inverted nipples and breast hypoplasia can be easily identified on the breast exam. Each of these conditions is associated with an increased risk of lactational failure.

Inverted nipples occur in about 3.3% of women; they are most often bilateral. This condition is associated with almost a tripling in the odds of lactational insufficiency.