Tuesday, January 16, 2018
Books

Review: In 'Breasts: A Natural and Unnatural History,' Florence Williams covers it all, from milk to cancer to augmentation

On Mother's Day, let's talk about something important that all mothers have in common.

Breasts.

Not what you expected, maybe, but although all women have them, and despite the huge amount of attention paid to them (I'm looking at you, guys), we don't understand them very well at all.

In her smart and surprising book Breasts: A Natural and Unnatural History, Florence Williams quotes one scientist, the "world's foremost expert on lactation," who points out, "The breast is the only organ without a medical specialty." Yet, as Williams explains in vivid detail, it's one of the most extraordinary features of the human body — and I'm not talking about how well it can fill out a Victoria's Secret pushup bra.

Williams, a widely published journalist and a contributing editor at Outside magazine, explains how she came to write the book: "I was happily nursing my second child, blithely backstroking through that magic bubble known as the mother-infant pair-bond, when I stumbled upon a news report that would forever alter my perception of breasts."

It was an article about scientists finding industrial chemicals in human milk. When we see those gauzy photos of a smiling mom with a baby at her breast, we might not think "jet fuel, flame retardant, endocrine disrupters," but, Williams discovers, maybe we should — even though scientists are also finding that breast milk is an almost unimaginably powerful, complex substance that affects a baby's health for the rest of her life, and that formula does not come close to duplicating.

Williams begins with a look at the breast's evolution. Although mammals get their name from their ability to lactate, human beings are the only mammals with permanent breasts, instead of those that swell during breast-feeding and then all but disappear after babies are weaned.

Only female humans begin to sprout breasts at puberty, and these orbs of fat, stroma and glands remain — though constantly changing — throughout life, even in women who never become pregnant.

Why? An earlier generation of anthropologists explained them as sexual signals, akin to the peacock's tail. They evolved, the theory goes, as a way to attract a mate, raising the question of which came first, the breast or the breast man? (Not to mention why, if big breasts are a mating signal, women's breasts are largest when they're already pregnant.)

Noting that most of those theories came from male anthropologists, Williams talks to contemporary researchers who posit a more complex process. As humans began to walk upright, their pelvises changed shape and became narrower. At the same time, human brains were getting bigger. Babies' larger skulls had to fit through a smaller birth canal, so we gradually lost the protuberant snouts most mammals have. "Flat faces and flat chests don't work well together," Williams writes, so voila — the breast.

The old sexual signal theory hasn't gone away, though, judging by what Williams finds out about breast augmentation. In 2009 alone, 289,000 U.S. women had the surgery. She visits a Houston doctor who performs 800 boob jobs each year, and in that city she also delves into the history of the modern breast implant.

In the early 1960s a plastic surgeon named Thomas Cronin held a plastic bag of warm blood and thought, "That feels like a breast." He took his idea to Dow Corning Corp., which made silicone (used for everything from industrial lubricant to Silly Putty), and soon had a prototype.

Cronin's rigorous testing method: He put one implant in "a pound mutt named Esmeralda." The dog promptly chewed it out, but Cronin proceeded immediately to human patients. We all know how that caught on: Even after a 14-year moratorium on silicone implants because of health concerns (and Dow Corning's 1995 bankruptcy in the face of 20,000 lawsuits), when the ban was lifted in 2007 implant surgery soared. Five million to 10 million women are now walking around with fake breasts (which, Williams points out, ironically tend to disrupt or even destroy both breast-feeding and sexual response).

Those women at least made their own choices. Williams writes with urgency about two breast-related health issues that have an even larger impact and that scientists are only beginning to understand: breast cancer and breast-feeding. Both are affected by myriad environmental factors — those flame retardants and endocrine disrupters, among others — over which we have little control.

Even adjusting for an older population, breast cancer has rocketed since 1940, more than doubling to 200,000 cases annually in the United States. More tumors form in the breast than in any other organ, perhaps because breast tissue is exquisitely receptive to its environment — a nursing mother's breast calibrates the fat content of milk depending on a baby's gender.

That receptivity also means breasts are enormously vulnerable to environmental factors. "We're pretty much marinating in hormones and toxins," Williams writes, and that has consequences, like the recent precipitous drop in the average age of puberty. Mean age of breast budding is now 9.8 years for white girls, 8.8 for black girls; menstruation usually begins about two years later. Girls whose first periods occur before age 12 have a 50 percent higher risk of breast cancer.

Nothing is that simple, of course. Early childbirth (before 20) greatly reduces breast cancer risk, while delayed childbirth (after 30) increases it, and never being pregnant increases it even more, as does hormone replacement therapy during and after menopause.

But it's the industrial alphabet soup of BPA, TCE, PBDE and many more untested compounds we swim through each day that's truly scary. They are found everywhere in modern life, and exposure to them may play a part in triggering breast cancer and, even more ominously, they may be passed from mother to child in breast milk. Chillingly, Williams learns, some of these toxins may persist through three generations.

And even as research begins to expose those dangers, it is revealing that breast milk contains more than 800 elements, some of them new to science, and may be nearly miraculous in its power not just to nourish babies but to build their immune systems. On the "raw milk underground" where breast milk is sold online, it goes for $4 an ounce — about 200 times the price of crude oil.

If you've got a pair, or if you love someone who does, Breasts is fascinating and important reading.

Colette Bancroft can be reached at [email protected] or (727) 893-8435.

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