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Breast Cancer. What You Need To Know.

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In honor of breast cancer awareness month, I thought it would be a good time to cover the topic on the blog. Most of us know someone who has suffered with breast cancer. Many of us have lost someone to breast cancer. Some of you have even experienced breast cancer or are experiencing it now. To be honest, the thought of breast cancer strikes fear in the heart of many. This is especially true if you happen to have a family member that has had the disease, or if you are a survivor. I hope that you will find comfort in the knowledge in this post. I hope that you will arm yourself with this knowledge and take control of your breast health, and in turn render the fear powerless over you! 

What is Breast Cancer? 

Essentially, breast cancer is a group of abnormal cells that begin to multiply in the body. Eventually these cells become so numerous that they force the normal cells out of place. This grouping of abnormal cells is often referred to as a lump or tumor. Sometimes these lumps can be felt by hand during a manual breast exam, other times they are so small they can only be detected by mammography or similar test. While it is most common for women to experience the diagnosis of breast cancer, it is possible for men to develop the disease as well. These abnormal cells can begin anywhere in the breast, but it is most common for them to begin in the milk ducts. It is possible for these abnormal cells to travel to other parts of the body through the blood or lymph system. This would be known as metastatic breast cancer. 


What are the Symptoms? 

Breast Cancer symptoms can be tricky, because they are often the same symptoms you might experience with other non-cancerous conditions. A breast lump is the most common symptom of breast cancer. The lump can be painless or painful, and is most likely to have irregular borders, but can be round, soft, or hard. While a lump is the most common symptom, there are many other you should be aware of: pain in the breast or nipple, swelling of the breast, dimpling of the breast tissue, development of nipple retraction (nipple is being pulled in towards the breast rather than protruding out), drainage from the nipple when not producing breastmilk, red or flaky skin that may be thickened, and swelling of any of the lymph nodes around the breast or under your arm. If you are currently experiencing any of these symptoms, DO NOT PANIC! As mentioned above, there are many non-cancerous reasons you might develop some of these symptoms. However, it is important that you get an appointment to see your provider of care quickly, so you can have your symptoms evaluated in person. 

What is My Risk? 

Your health care provider will have access to several tools which will help determine your personal risk for breast cancer. It would be impossible to determine your personal risk through a blog post. Breast cancer risk takes into account many factors, and it is highly individualized. However, women are definitely considered high risk if they have a known gene mutation, a first degree relative with a known gene mutation, a history of radiation treatment in the chest area between the ages of 10-30, and anyone who is told they have a 20-25% increased risk based on one of the assessment tools. Simply being a female increases your risk of breast cancer, as well as being over the age of 55. DES exposure also increases your risk. These are all things you have no control over, and simply cannot change. There are many lifestyle factors that may increase your risk of breast cancer, and these are factors you can control, and we will discuss them in detail a little later in the post. It is very important that you talk with your healthcare provider and determine your personal risk level. 

How Should You Screen? 

There is a lot of noise out there about breast cancer screening and what is recommended. It is hard to know what to do. I believe that if women are given all the information, they will make well informed decisions that are best for them and their families. With this in mind, I am going to tell you about all the screening tools, as well as their pros and cons. 

Self Breast Exam:

Even though this is not part of the recommended screening for breast cancer, how will you know if you have breast changes, if you aren't familiar with your breasts? It just makes sense to me that when you are showering or looking at yourself in the mirror that you would feel your breasts and look at them for changes. This would be the time that you would notice any lumps or bumps, dimples, drainage etc. This doesn't mean you have to find a specific time each month to do this, as you are technically doing this every day. Most women who find a palpable lump, do so when going through their regular routine. 

Clinical Breast Exam:

The American Cancer Society no longer recommends annual clinical breast exams at any age for women of average risk for breast cancer. This is the exam your provider normally does during your annual exam visit. Essentially, the evidence just doesn't show clear benefit to these exams. Midwives and doctors have been performing these exams as part of their physical exam in women's health care for a long time, and it is unlikely that your provider will just stop this practice. We feel it is part of performing a thorough physical exam. However, you can decline this portion of the exam if you wish since it is not the way most breast cancers are detected. It is also important to note that the ACS is assuming you are having regular mammograms in the place of clinical exams. 

Screening Mammogram? 

A screening mammogram is performed when you have no signs or symptoms of breast cancer. It is a screening tool that helps detect breast changes before they can be seen or felt. This is different than a diagnostic mammogram which is the same test, but done after a sign or symptom is present. This test uses low dose X-ray to take a 2 dimensional image of the breast tissue. During this test, your breast will be flattened between two plastic plates because the low dose X-ray cannot penetrate the breast tissue very easily. ACS states that a screening mammogram for women with average breast cancer risk is optional between the ages of 40-44. They recommend you have the test annually from the ages of 45-54, and after the age of 55, you can continue annually or reduce to once every 2 years. ACS recommends that women considered at high risk, have a mammogram yearly starting at age 30. They also recommend breast MRI for women in the high risk category. I think it is important for you to know that there is some data available to suggest that mammograms before the age of 50 aren't a good idea. About 10% of women having a mammogram will require additional testing and follow up. What this means is that a certain percentage of women will have an essentially "false positive" mammogram with a follow up biopsy that is not cancer. Some data shows that mammograms before 50 do not reduce mortality (dying) related to breast cancer diagnosis. Every woman will have to weigh her risks, talk to her doctor and make a decision they can live with. This means for some, going all in on any screening or follow up will be their desired route, because they want to take no chances. Others will be comfortable taking a more conservative route, while even others will choose to do absolutely nothing. I say none of these plans are wrong as long as you are making the decision fully informed, you have discussed it with your healthcare provider, and you are comfortable with the plan. 

Digital Breast Tomosynthesis: 

You may have heard this referred to as a 3D mammogram, or a CT Scan for your breasts. This procedure is similar to a traditional mammogram but takes many images creating a 3D image of the breast tissue.This 3D image has the advantage of seeing spots that may have been obscured by other tissues with the 2D mammogram. This screening test, may find more cancers while also reducing false positives. This testing method, can also be especially helpful for women with dense breast tissue, more on that below. It is important to note that this procedure may cost more than a regular mammogram, and may not be covered by your insurance. This procedure also exposes you to higher radiation doses than traditional mammogram.  

Thermogram:

Breast thermography is a procedure that detects heat. Tumors require a blood supply to form and develop. This will likely cause an increase in blood vessel development and activity in the area, which in turn causes more heat generation. In fact, this is often noted in pre-cancerous tissue...you heard that right! The increased vascularity and heat at the site is often seen before the tumor even develops! This means thermography may be the earliest way to detect cancerous changes in the breast tissue. This type of testing is done at specialized centers that offer thermography. Usually, you will be asked to wait in a room for about 15 minutes to allow your body temperature to stabilize. After this waiting period, you will be placed in front of imaging equipment that will use an infrared camera to take images of your breasts. These images are saved for comparison with future images. It is best that this type of imaging begin early, and continue at regular intervals so that changes can be detected at the earliest possible stages. This procedure is the least invasive of all screening procedures, as it is contact and pain free, and uses no radiation. It is important to note that the FDA has only cleared thermography as a supplemental tool in screening for breast cancer, rather than the only tool you use. This procedure may not be covered by your insurance, so if you decide to go this route, make sure to ask about cost and insurance when you are scheduling your procedure. Depending on where you live, it may be difficult to find a location that performs thermography. You can visit thermologyonline.org for a list of ACCT (American College of Clinical Thermology) approved sites in your state.  

Dense Breasts? 

Have you ever been told you had dense breasts? Despite the obvious jokes related to this topic, there are some facts you should know. Esentially, dense breasts contain less fatty tissue and more glandular and fibrous tissue. This is actually quite common among women, especially younger women, and can make it more difficult to detect brreast cancer with a standard mammogram procedure. In fact, having increast breast density alone is associated with an increased risk of breast cancer. This is not a factor you have control over. If you are a woman who has dense breast tissue, it is more common for you to require additional follow up after your mammogram, which could include things like breast ultrasound or more frequent follow up. There are no good guidelines out there to offer a plan for women with dense breasts, but if you are ever told rthis information, it is important to keep the lines of communication open with your provider and make a plan that you are comfortable with for follow up.   

What Can You Do to Help Prevent Breast Cancer? 

Reduce or Eliminate Alcohol Intake: 

Alcohol has been linked to an increase in breast cancer, and seems to be dose dependent, meaning the more you drink, the higher your risk. Women who consume 1 alcoholic drink per day have a 7-10% increased risk of developing breast cancer over non-drinkers. Women who consume 2-3 alcoholic drinks per day, have a 20% increased risk over non-drinkers. Some of you may not be a daily alcohol drinker, but will occasionally drink socially, sometimes just a drink or two, and sometimes to excess. The research on these types of consumers is less specific as to risk, but overall lifetime consumption of alcohol has a clear increased risk. Of course, the safest option here, is to consume no alcohol, but you will have to weigh your own willingness to accept the risk with your desire to enjoy a glass of _______(insert your beverage of choice here)! 

Maintain a Healthy Weight: 

This is a tricky subject all the way around, as there are so many health benefits to maintaining a healthy weight. When related to breast cancer, being overweight for your height after menopause is correlated with an increased risk of breast cancer. This doesn't mean it is safe to be overweight before menopause, so ladies, do yourself a favor and begin working towards reaching your best healthy weight. You will be supporting your overall wellness in many ways! 

Exercise: 

There is no consensus that I could find that dictates how much physician activity is required to reduce your risk of breast cancer. However, the research shows that women living a more sedentary lifestyle, have an increased risk of breast cancer. This is true, especially after menopause. The bottom line here, is get moving! Exercise can help reduce your risk of breast cancer, help you maintain or reach a healthy weight which will further reduce that risk. Not to mention there are countless other benefits to being active. It is important that you talk to your personal healthcare provider about this before beginning a new exercise program. It is important to know that you are healthy enough for exercise before beginning. Once you get the all clear, start slow, and celebrate small successes. I believe that is the key to starting and maintaining any new exercise regimen. 

Have Babies and Breastfeed Them: 

Women who choose to have children, especially before the age of 30 seem to have a slightly lower risk of breast cancer development than women who choose not to have children. It has also been shown that women who breastfeed their babies may further reduce their risk. I want to say here, that I do not mean to be insensitive about childbearing with this paragraph. I know there are many of you who desire to have a baby so badly, and either cannot get pregnant or carry a pregnancy to term. This is an extremely sensitive topic, and I would never want to make a woman in this situation feel badly. My heart breaks for you dear friend. That is why I feel babies and breastfeeding should also be listed in the non-modifiable risk category, since some women do not have any control over this area of their life. 

Hormonal Contraceptives: 

This category includes birth control pills, injectables such as Depo-Provera, and implantables such as Nexplanon. These methods of birth control, all contain hormones, it is how they work. How these hormones contribute to breast cancer is not well understood, but there is some increased risk of breast cancer risk with the use of these methods. It has also been shown that their use can increase the rate of tumor growth in some types of breast cancer. I want you to have all the facts here, but I don't want you to just stop taking your birth control! It is so important that you talk to your provider about the topic of birth control. There are non-hormonal types of pregnancy prevention available, but it is important to talk to your healthcare provider about them and make sure if you are switching to one of these, that it is the right fit for your lifestyle, and has a failure rate you can live with.

Menopausal Hormone Therapy: 

This is another area with so many items to unpack, it would be impossible to do in this post. There can be an increased risk of breast cancer with the use of some types of hormonal therapy for used to treat post menopausal symptoms. Menopausal symptoms can range from barely existent to earth shattering, and each woman's journey through menopause is different. It is so important that you talk to your provider about the risk of breast cancer related to the hormone therapy before you begin a regimen. However, if you are already on a hormone therapy, it isn't too late to make an appointment to discuss it now. This is another area where you will have to way your willingness to accept increased risk versus your life interruption from menopausal symptoms. This will be a very individualized decision for each woman, and is not to be judged by anyone not living in that woman's shoes. 

Bottom Line:

I am sure I have overwhelmed you with way more information about breast cancer than you wanted. However, I think it is important for women to know all the facts about a topic so they can make truly informed decisions about their health and wellness. Breast cancer is a huge topic and while this post covered a lot, it still does't cover everything you may need to know. And, of course, it isn't individualized. This is why I cannot stress enough that you go to your Midwife, Nurse Practitioner, PA, or Physician and discuss this topic with them. This is especially important if you have risk factors that you believe place you in a high risk category. It will be so valuable for you to have this background info when you talk to them, because you don't often have unlimited time with your provider face to face to discuss all these risks in depth. That is the very reason I created this blog! I hope this post has helped you more than overwhelmed you, and feel free to reach out in the comments below if you have questions. 

References: 

American Cancer Society

Westin A. Price Foundation

American College of Clinical Thermology

Barbieri, Robert. (2015) Why is breast density a weighty matter. OBG Management, Vol 27, NO 8, PG 7-11.

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