HCA Midwest Health - September 17, 2018

Aside from skin cancer, breast cancer is the most common form of cancer in the United States. Given that a woman in the U.S. has a one in eight chance of developing the disease, being able to identify changes in your breasts and signs of the disease are key to prevention and early diagnosis.

“Just as we're worried and aware about other aspects of health, like weight, exercise or diet, it’s important to be self-aware of your breast health,” says Kayla Barnard, MD, a Breast Surgeon at Menorah Medical Center in Overland Park, part of HCA Midwest Health network.

Breast self-awareness and unusual changes

In years past, experts suggested women perform breast self-exams once a month. Research, however, has found that these exams don't reliably detect cancer in average-risk women, and leads to a greater number of false positives. Now, many official guidelines recommend breast self-awareness, or knowing what your breasts typically feel like. Having this baseline makes it easier to identify changes that could be signs of breast cancer. Guidelines vary on the value of having regular breast exams done by your healthcare provider, so talk to your doctor to make an informed decision together.

The most common symptom is a new or changing lump, either in the breast or closer to their underarm.

“Notice if you have a lump that's getting bigger, harder or stuck in place,” says Barnard. Lumps can present both with and without pain and can vary in size. While 90 percent of lumps found in women between their 20s and early 50s are benign, it's important to rule out the chance of breast cancer if you discover anything abnormal.

Abnormal skin changes are also important to take note of. These include itchiness, irritation, redness, scaling, swelling on part of the breast, pain or dimpling.

“If you're noticing any skin or tissue distortion where the skin's puckering in or there's any distortion in the natural contours of the breast, those are all abnormal things, and you should be checked out," says Barnard. Be aware of nipple changes that occur as well, like discharge, inversion, pain, crusting or color change. While some of these can be natural changes in certain circumstances, such as pregnancy, it is always better to be evaluated than assume it is normal.

If you do feel or see anything abnormal, or are worried about sudden breast changes, schedule an appointment with your doctor. Your doctor can evaluate changes and suggest a next step, which is typically imaging in the form of a mammogram and a breast ultrasound.

Who is at greater risk for breast cancer?

While all women should be self-aware, there are certain groups at a higher risk for breast cancer than others.

  1. A personal or family history of breast cancer
    “If you have a first-degree relative under age 50 when they were diagnosed, then we tend to do early screening. Women should begin annual mammogram no later than 10 years prior to the earliest age of a diagnosed family member, but not before 25,” notes Barnard. Doctors will recommend early screenings starting at 25 for an MRI and 30 for mammogram for individuals who have a hereditary risk of the disease, such as BRCA1 and BRCA2 gene mutations.
  2. The odds increase with age
    Early menstruation, becoming pregnant at an older age, late menopause, obesity and a history of radiation treatment on your chest are associated with a higher risk. Some studies cite that lifestyle habits, such as heavy drinking and tobacco use, can affect your likelihood of getting the disease, but the evidence is still unclear. However, many women who develop breast cancer may not have any risk factors, so don’t ignore any changes in breast health.
  3. Women with dense breasts
    Barnard notes that due to the density of the tissue, women with dense breasts may also not catch any changes as early as others. “Be conscious of the fact that it can be harder to feel changes within your breast, so you may need to take a little bit more time," she says.

For women of average risk, they should begin getting mammograms at age 40 and get one every year thereafter.

Women with a high lifetime risk of breast cancer are encouraged to get an MRI beginning at age 25, a mammogram at age 30 and or an individualized schedule based on family history and guidance from their doctor.

Breast Cancer Risk Assessment

How can you stay healthy?

Besides knowing what types of changes to look for, there are many other steps you can take to reduce your risk of developing breast cancer.

Keep an open dialogue with your doctors about the frequency of screenings and when to begin getting mammograms. A healthy lifestyle is also a factor in keeping your risk of breast cancer lower. “Eat a healthy diet, maintain a healthy weight, exercise, don't smoke and don't drink alcohol to excess. These are the things that are within our control,” Barnard says. Choosing to breastfeed may also reduce a woman’s risk.

Most of all, if you are concerned that anything is abnormal with your breast health, don’t hesitate to schedule an appointment with your doctor for a consultation.

“Be self-aware and don't ignore changes,” says Barnard. “Make a doctor’s appointment if you notice something. You may have just seen your doctor, but you don't want to assume ‘Oh, it wasn't felt then, so it's fine now.’ If you notice changes, make an appointment.”

tags: breast cancer , t4b