— Sunshine, Louisiana Urethral polyps can mean different things for different people. In the urinary tract, a fibroepithelial polyp is usually a benign polyp that has no malignant potential — that is, it cannot become cancerous. However, some malignant tumors of the bladder and urethra have a polyp-like appearance; usually a simple biopsy to remove them adequately treats the problem. Women may experience urethral lesions called caruncles, which are also benign lesions of the urethral epithelium. Urologists use an examination method called cystoscopy to evaluate the lining of the urethra and bladder with a flexible tube. This outpatient procedure can usually exclude the possibility of any malignant lesions. Q2. I have been diagnosed with vulvar dysplasia twice. It seems to be confined to the right labia majora. Would it make sense to just remove that entire labia? What are the chances that this will metastasize elsewhere? Vulvar dysplasia is, by definition, not cancer. This precancerous condition is a marker of vulvar tissue that is at risk of developing vulvar cancer. Vulvar dysplasia means that vulvar cells seen under the microscope look abnormal but are not invading surrounding normal tissue. Because the abnormal-appearing cells are not invading normal tissue, they are not capable of metastasizing (leaving the vulva and traveling to other organs). In light of this, it would not generally be recommended to remove the entire labia majora for a diagnosis of vulvar dysplasia. However, you are correct to have some concerns about the risk of developing invasive vulvar cancer. Although this risk is fairly low in patients with vulvar dysplasia, anyone with this condition should still be followed very closely. If vulvar cancer does develop, then surgery to remove the entire tumor, and sometimes some of the lymph nodes in the area, is generally recommended. Q3. My fiancée, age 46, has had breast cancer and a mastectomy. This was two years ago. She has had no recurrence. Is there any restriction on sexual activity after breast cancer treatment? — Brian, Washington If your concern is that frequent sexual activity may increase the risk of recurrence of the breast cancer, then you and your fiancée can be reassured that that is not the case. Frequent sexual activity does not cause breast cancer, and it will not increase the risk of recurrence. Women who are in the midst of being treated for breast cancer are not restricted from having sex, and breast cancer survivors are generally encouraged to try to resume their normal sexual activities. Some breast cancer survivors, however, find that resuming sexual activity is a challenging task. There are many potential reasons for this. A woman may have less confidence in her physical appearance after cancer surgery. Many breast cancer survivors enter premature menopause because of the side effects of chemotherapy; this can lessen libido and cause vaginal dryness. If vaginal dryness makes intercourse painful, it can set up a vicious cycle in which women fear sexual activity, which lowers libido even further. You should try to be sensitive to your fiancée’s physical and emotional concerns. If she has particular questions about sexual activity, she should discuss these with her doctor. Some cancer centers have specialists who help cancer survivors optimize their sexual health after cancer treatments. Q4. Is it true that when you wear a bra to sleep it can increase your chances of getting cancer, because it restricts the breasts? Are there any other potential consequences of doing this? It is a myth that wearing a bra (during sleep or at any time) increases the risk of breast cancer. There are no data from scientifically sound studies that show any increase in the risk of developing breast cancer from wearing a bra. This myth may have started with a general observation that breast cancer is more common in Western, industrialized countries where wearing bras is more common than in the developing world. However, to then draw the conclusion that it is the bra-wearing that causes the breast cancer is completely erroneous. Women in developing countries have shorter life spans during which to develop breast cancer and do not undergo breast-cancer screening. It is probably for these reasons that their chances of being diagnosed with breast cancer are lower, not because they are less likely to wear bras. Bottom line: If wearing a supportive bra to bed allows you to sleep more comfortably, you can do so without worrying about any health risks. Q5. I have fibrocystic breasts. Do I need to take special precautions for preventive care? I used to get yearly mammograms and gyn exams but have not had one in several years due to no health insurance. Fibrocystic breasts are very common, particularly in women who are still in their childbearing years. Women who are past menopause and are taking hormone replacement therapy with estrogen may also have fibrocystic breasts. The lumpy tenderness in the breasts may be worse near the time of the menstrual period. The lumpy changes are typically present in both breasts. Fibrocystic findings in the breasts are not a disease and do not increase the risk of breast cancer. However, women with fibrocystic breast changes should follow the standard recommendations for mammography screening — that is, yearly mammograms starting at age 40. In addition, women with fibrocystic breasts should perform monthly self-examinations in order to be familiar with how their breasts feel, so that if a new lump is found, the lump can be evaluated by a physician. A new lump, particularly if it is distinct (as opposed to a lumpy area) and firm, will most likely need additional testing with a mammogram, sonogram, and/or biopsy. Nipple discharge that is bloody or tinged with blood should also be evaluated by a doctor. Learn more in the Everyday Health Cancer Center.
