Understanding breast health

Discovering a change in your breasts can be an unsettling experience, and one which should prompt you to see your doctor as soon as practical. Often, the change is benign and there are lots of explanations for what may be happening.

To better understand what to expect when meeting with your GP, Oxford Women’s Health consultant oncoplastic breast surgeon Josie Todd has shared some useful information.

“Breast lumps or changes can be caused by many things. For example, if you are taking contraceptives or antidepressants, you may experience breast and nipple changes. Most lumps and changes turn out to be fine, but it’s important that you see your doctor to address the issue and rule out the possibility of something more serious.”

Your doctor will ask about your family history of breast health. The criteria for what constitutes a ‘strong’ family history of breast cancer has become very precise in recent years, so even if you have relatives who have had the disease, it doesn’t necessarily mean you are at a higher risk of cancer.

If needed, your doctor may perform a breast examination to better understand what the changes might be.

“These examinations will help to determine the lump’s size, shape, mobility and any tenderness. If you haven’t experienced menopause yet, you may be asked to come back for an exam after your next period, as menstrual cycles can affect lumps,” Josie says. After seeing your doctor, you may be referred for diagnostic breast
 

Josie Todd

imaging or a biopsy. Diagnostic results can indicate a range of things. They may strongly show that the tissue is completely normal, or it may be less clear what the lump is.

If it is recommended that the lump be removed, you’ll have the option of having this done in the public or private system. Josie adds that you always have the option of seeking a second opinion, and you should follow this up if you’d like more certainty about your breast health.

If you notice an abnormal change in your breasts, such as a new lump, discharge, eczema, thickened tissue, unusual pain that won’t go away, or a change in nipple or breast shape or size, book an appointment with your GP.

If your lump requires further investigation, you can ask to be referred to see Josie in our team.

Polycystic ovary syndrome and eating well

For women with polycystic ovary syndrome (PCOS), the importance of a good diet is central to managing some of the common symptoms, as well as reducing long-term health risks.

Nutrition consultant and dietitian Sara Widdowson works with a number of PCOS clients at Oxford Women’s Health, helping them to reach their goals and providing a wealth of advice for improving their nutrition.

She says the first thing to remember is that PCOS can vary considerably between people, with some women struggling to manage their weight, while others navigate fertility difficulties, irregular periods, unwanted hair growth, or acne. 

“PCOS affects people differently, but overall the condition increases the risk of developing diseases like type 2 diabetes, cardiovascular disease, and some cancers. The good news is that much of this risk can be significantly reduced by good nutrition that’s tailored especially to someone with PCOS.”

PCOS, which affects roughly 20 per cent of women and people with ovaries, is a condition where small cysts containing follicles develop along the edge of ovaries. It isn’t clear what exactly causes the condition but it is important to be diagnosed and work with your GP to address the symptoms.

One common symptom – and driver – of PCOS is insulin resistance, and Sara says having good dietary habits is key to helping manage it.

“Insulin is the hormone your body releases when you eat carbohydrates and we need it to process sugars, either to use as energy or store as fat.”

“For PCOS, there is a complex relationship between insulin and sex hormones. What often happens is the body’s cells stop responding the right way to insulin and they can’t use the food’s energy properly.
 

Sara Widdowson

This leads to high blood sugar levels, which if not addressed, can result in type 2 diabetes.”

Understanding what and when to eat can have a big impact on insulin. That means paying attention to the macronutrients, ie. protein, fat and carbohydrates, in your diet.

Good sources of protein like chicken, red meat and eggs help keep people fuller for longer which can reduce the feeling of needing to reach for carb-heavy, sugary snacks through the day.

“When I first start working with clients, something they often tell me is that they are starting the day with some toast or a muesli bar, and then skipping lunch – usually because they don’t have a lot of time at work. Having a good source of protein in your meals instead of having a muesli bar, for example, is key to keeping full and it’s something I recommend for many of my patients.”

Carbohydrate awareness is also important. If you’re eating a lot of carbs through the day, it’s usually beneficial to reduce this by swapping these foods out for less carbohydrate-dense foods like cauliflower rice or lettuce leaves as wraps.

Dressing or pairing the carbs in your meal with good sources of fat like seeds or avocado, fibre-rich vegetables, acidic dressings, and protein-rich condiments or supplements can also improve your overall diet and reduce bad cholesterol.

Research into impact of inflammation on endo symptoms

A recent study measuring inflammation markers in the peritoneal fluid and blood from endometriosis patients could help pave the way for the development of non-invasive diagnosis and treatment of the disease.

The study has been undertaken by Oxford Women’s Health gynaecologist Michael East, in collaboration with Teagan Edwards at the University of Otago, and David Sharkey and Louise Hull from the Robinson Research Institute at the University of Adelaide. 

The preliminary results, which Mr East shared at the World Congress on Endometriosis in May 2023, showed that levels of key inflammatory cytokines may be lower in peritoneal fluid following endometriosis surgery. If confirmed, this shift in inflammatory status may underpin the improvement in conception and pain reported by women with endometriosis after surgery.

Affecting an estimated one in nine women, endometriosis can cause painful periods and infertility as tissue grows outside the uterus. Previous studies have identified elevated inflammatory mediators in the peritoneal fluid of women living with the disease. With this information in mind, the collaborative study between Oxford Women’s Health, and the Otago
 

Michael East

and Adelaide Universities, was launched in 2018.

Comparative measurements, before and after surgery, were possible thanks to ‘re-look’ laparoscopies, which offered Mr East an opportunity to test for changes in the inflammatory markers.

In about 51 per cent of endometriosis surgeries, ‘re-look’ laparoscopies are performed if the ovaries have been lifted during the initial surgery to help reduce scarring between the ovaries and pelvic sidewall.

Mr East performs the ‘re-look’ laparoscopy three months after the initial operation to confirm that the ovary has returned to its normal position. Fifty-six women, aged between 17 and 38 years, who required routine laparoscopy for surgical removal of endometriosis and a 're-look' procedure agreed to take part in the study.

Bryony Simcock joins Oxford Women's team

A big welcome to Bryony Simcock who joined the Oxford Women’s Health team in October.

Bryony is one of only seven gynae-oncologists in New Zealand and we are absolutely delighted to have her with us. She is an expert in the treatment of all gynaecological cancers and pre-cancers, including cancers of the ovaries, uterus, cervix, vulva and vagina. Bryony is also a highly experienced colposcopist with a special interest in complex colposcopy.

Aside from working with her patients, Bryony is passionate about clinical research and was a founding member of the Graci Foundation gynaecological cancer research trust. She is also involved in many research programmes through the Australia New Zealand Gynaecological Oncology Group (ANZGOG).

One of her most exciting projects at the moment is being part of an international research programme looking at how the amount of radiation women receive during cancer treatment can be reduced, depending on their molecular profile. She says, “Radiation can be very unpleasant for some people and I am hoping this work will be a gamechanger for them.”
 

Bryony Simcock

Bryony says she chose to come to Oxford Women’s Health because of the supportive environment and the organisation’s strong multidisciplinary team approach to caring for patients. 

She will continue to also work at Christchurch Hospital where she is a member of the gynaecologic cancer team. She says she is very proud of the work she has done in gynae-oncology in the public system but decided she also wanted to work in the private system to help give people more choice about where they receive their care.

If you need to see a gynae-oncologist, you can be referred to see Bryony through your GP.

Welcome to Rachael Kerr

We are delighted to have nutrition consultant and registered dietitian, Rachael Kerr, join our team.

Rachael says she loves working alongside people to help them make informed choices that support their overall wellbeing and are tailored to their individual lifestyles.

After graduating with a Masters of Dietetics in 2017, Rachael completed her clinical placement and thesis in Christchurch, before going on to work in different areas of the health sector. She returned to nutrition by registering as a dietitian in early 2023.

Since then, Rachael has been gaining clinical experience at Christchurch Hospital, primarily working with adult patients in the orthopaedics department, and in older persons’ health services.
 

Rachael Kerr

In her spare time, Rachael enjoys horse riding, sharing stories over food with friends and family, and finding new books to read. She is available for appointments at Oxford Women’s Health on Wednesdays, Thursdays and Fridays.

News in brief

Jim Edwards consulting from Queenstown 
Dr Jim Edwards, medical oncologist and clinical director at St George's Cancer Care Centre is now holding monthly clinics at our Queenstown rooms in the Centre of Medical Excellence. Dr Edwards specialises in gastrointestinal and urological cancers, and lymphoma.
St George’s Cancer Care Centre works in partnership with Dunstan Hospital for the provision of chemotherapy and immunotherapy treatments, ensuring treatment options are available locally for patients. 

Greymouth clinic in demand
Our clinic in Greymouth has been a great success. We have heard from many people on the West Coast who are appreciating the opportunity to travel to Greymouth rather than Christchurch.
Gynaecologist Simon Jones has been providing monthly clinics at the Coastal Health GP practice in Greymouth since October. 

Jim Edwards

Simon Jones