October is breast cancer awareness month, so let’s talk about it.
How big of a deal is breast cancer? The American Cancer Society estimates about 297K new cases of breast cancer and that 43,700 women will die from breast cancer in the U.S. in 2023. Breast cancer is also the 2nd most common cause of death by cancer in women (lung cancer is the 1st).
Whether breast cancer runs in your family or not, please make sure you are checking your breasts regularly at home and scheduling mammograms when it’s time. Screening mammograms start at age 40 for most women with no family history of breast cancer and are repeated every 1-2 years based on your risks of developing breast cancer. Talk with your OBGYN or other medical provider to get to know your breast cancer risks.
Women with breast cancer in their family or genetic markers (e.g. BRCA 1 and BRCA 2 genes, and others) often start screening mammograms sooner than age 40. How soon depends on several factors such as which family members had/have breast cancer and the age in which they were diagnosed. The short explanation is that if your mom, sister, auntie, or grandma were diagnosed with breast cancer, you need to see your regular OBGYN to better understand your risks and when to start your mammograms.
Other risk factors that may be associated with breast cancer are lifestyle driven such as smoking, high alcohol consumption, sedentary lifestyle, early menstruation (before age 12) and later menopause (after age 55) and long term use of hormone therapy (i.e. birth control or to treat menopause).
While some studies have shown a connection between these lifestyle factors and an increased risk of breast cancer, The National Breast Cancer Foundation recognizes that 60-70% of breast cancer cases have no known risk factors. There is still a lot we don’t know about breast cancer, and cancer in general. But, if you have the opportunity to get your breasts checked regularly regardless of your risk factors, why wouldn’t you?
Ok, now that we’ve considered risks for developing breast cancer, let’s address how to actually check for signs of breast cancer.
Some of you out there probably hear the word ‘mammogram’ and think, oh that thing that flattens my breasts like a pancake, you want me to do that? Well, yes, but flatten like a pancake is a bit dramatic.
Mammograms are most accurate when the image is taken as close to the breasts as possible, so yes, some compression is involved.
I'm not going to lie, mammograms may be uncomfortable for some. You might think the bigger the breasts the more uncomfortable the mammogram but actually thick ol’ bitties do really well with mammograms. It’s the slender, barely there breasts that are going to be more uncomfortable because, well, there isn’t as much material to work with.
Most mammograms can be completed in 5-10 minutes, let me say that again, 5-10 minutes! I’m sure most of us have had to endure much worse discomfort for longer than 10 minutes. Menstrual cramps anyone?
Mammograms are no day at the spa but are quick and highly beneficial. No matter your cup size, you should still get your breasts checked. We all have the power to catch breast cancer early and even prevent it from progressing, 5-10 minutes of minor discomfort seems a small price to pay for that.
Would you like an ultrasound to go with that mammogram? Sometimes the mammogram, which is an xray image, cannot see every little speck in the breast. Breasts are made up of tissue, fat, and glands, some are made up of mostly fat which is loose with lots of space between the fibers, kind of like a soft loofah. Others have breasts made up of very compact or dense fibrous tissue kind of like the tightly woven matrix of a Brillo pad. If your breasts fall into the Brillo pad category (aka dense) you will likely be offered an ultrasound with your regular mammogram. An ultrasound offers an additional way to see tissue in the breasts. An MRI is also used to see different parts of the breasts that may not be clear on an x-ray (aka mammogram), though it’s often reserved for those at high risk of developing or have a history of breast cancer.
If I’ve convinced you to get your regular mammograms, GREAT, I’ve done my job.
But it doesn’t stop there. We should all be checking our breasts regularly at home as well.
Let’s talk about self-breast exams. Your OBGYN should be showing you how to do these. If he/she is not, then it might be time to get a new one. But let’s work out what we can right now, together.
When to do it:
Once a week? Once a month? Every other month? Any of these options is acceptable. But really once a month is plenty. It’s best to avoid the week you are on your period because breasts tend to be more tender and dense during this time.
Where to do it:
In the shower or bath is perfect for two reasons. 1. Your’e likely undressed in front of a mirror and can do a visual exam easily and 2. Your’e already scrubbing down the breasts so why not check them too? Lying down before bedtime is also a good time.
How to do it:
First start with the visual exam. While standing in front of a mirror look at your breasts with your hands on your hips and again with them raised above your head. The goal here is to focus more on color and consistency, and less on cup size or sagginess (you mommas who breastfed know what I’m talking about). Outside of previous scars or birthmarks, you shouldn’t see any drastic skin color changes on one breast alone. If you do, it may be the sign of a rash or infection and should be evaluated by a medical professional promptly. The surface of the skin should be seamless with no raised areas, swelling, or dimples. Dimples on your face are super cute, your glutes, not as cute but definitely a reality for most of us. Dimples on your breasts suggests something is under the skin pulling it in and you need to see a medical professional right away. You may also notice stretch marks on your breasts which are perfectly normal.
Now pay attention to your nipples. They shouldn't be leaking fluid unless you’re pregnant or breastfeeding. Nipples also should not change directions.
Did I get your attention with that one?
A nipple that always points slightly up, should not suddenly be pointing down unless there has been major reconstructive surgery to the breast itself. A nipple that has deviated from it’s original orientation will need diagnostic imaging to further investigate.
Time for the hands-on exam. To start, raise your right arm to check your right breast and use the opposite hand to rub circles all around the breast. If you are taking a shower, you are already doing this when you lather soap under your armpit. You want to use the pads of your first 2 or 3 fingers to make the circles. By finger pads, I don’t mean the tips that you drum on the table when you are bored, I’m referring to the part of the finger you use to flip through paper (or count your money-Ayyy!).
Now, imagine the breast is a clock, circle all the areas that fall within 12:00, then 1:00, then 2:00, and so on.
If that’s too many circles for you, try starting at a far end (like under your armpit, and go in a linear pattern (like Pac man, rather, Pac woman).
If that still isn’t enough imagery for your, imagine the breast is a bicycle wheel and you are cleaning the spokes on the wheels going from the outer edge to the center, which in this case is the nipple.
Any and all of these patterns will get the job done.
You will likely feel some lumps from mammary glands and fat pads. Normal lumps should be bouncy and moving in circles with your fingers. Concerning lumps are often fixed in one spot and can feel hard and tiny like a grain of rice or slightly bigger like a frozen pea.
The more often you do this exam the more efficient you’ll get. It takes maybe 5 minutes tops, which is less time than it took me to type all of this out, lol.
And that’s a self-breast exam, ladies! The main purpose of the self-breast exam is to get to know your breasts so well that you will likely be the first to know when something changes. About 90% of breast masses are self-discovered. Not all of those masses are cancerous but it’s still compelling enough to support regular self checks at home.
I hope this information was helpful and has made you more comfortable with mammograms and breast exams. Feel free to contact me with any questions: DM on instagram at @HeatherTheRealNP or send me an email at info@gracehealthct.com.
Healthy breasts are the best!
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