Health care professionals get lots of questions. People are curious about their health and understandably concerned when things go not according to plan. That’s particularly true with cancer, which is a difficult topic for most to discuss.
During Breast Cancer Awareness Month, we’re giving particular focus to the topic of breast cancer. While we’re sharing a great deal of information about the disease, there are always some questions that are a little too specific to address. Thankfully, Mount Carmel Breast Surgical Oncologist, Dr. Padia, is here to answer some of those questions.
Q: How often should I do a breast self exam?
A: We have gotten away from recommending "self-breast exams" as this can be intimidating to women because it is sometimes difficult to know what is considered concerning and not. Instead, women should have "self-breast awareness." This does includes giving yourself a breast self-exam once a month. Look for any changes in breast tissue, such as changes in size, feeling a palpable lump, dimpling or puckering of the breast, inversion of the nipple, redness or scaliness of the breast skin, redness or scaliness of the nipple/areola area or discharge of secretions from the nipple.
If you discover a persistent lump in your breast or any changes, it’s very important that you see a physician immediately. Though 8 out of 10 lumps are benign, all require evaluation to confirm that they are not cancerous.
You should perform your breast self exam 7-10 days after your menstrual period starts, which is also when your breasts are the least tender and lumpy. If you’re no longer menstruating, then you should select the same day of the month (first of the month for example) and mark it on the calendar to remind you when to perform the self exam. What you should look for is a change from last month’s exam to this month’s exam.
All women should know the geography of their own breasts. It’s not unusual to have lumpy or bumpy breasts. If you’re having trouble remembering, draw a diagram of where the lumps, bumps, grooves and other findings are felt so you can use it as a reminder from month to month. It is important to remember that our breasts are truly separate organs. The right may never look like the left and vis versa. Make sure that each breast looks the same as it did the month before, knowing that each breast will look different from each other. There is no added value in doing breast self exams more often than monthly. Also your findings may be different in relationship to where you are in your menstrual cycle.
Q: How often should I go to my doctor for a check-up?
A: You should have a physical every year, which should include a clinical breast exam and pelvic exam. If any unusual symptoms or changes in your breasts occur before your scheduled visit, do not hesitate to see your doctor immediately.
Q: Does a family history of breast cancer put someone at a higher risk?
A: Although women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history. Statistically only 5-10% of individuals diagnosed with breast cancer have a family history of this disease. If your family history causes you some concern, contact your physician to discuss any next steps.
Q: What kind of impact does stress have on breast cancer?
A: Some research studies have shown that factors such as traumatic events and losses can alter immune system functions, and when immune functions are altered cancer cells may have an opportunity to get themselves established within the body. What also has been shown is that it’s not the fact that a major life crisis has occurred but how the individual reacts to and copes (or doesn’t cope) with it that matters. Therefore, identifying ways to keep your stress level in check is wise.
Q: Can physical activity reduce the risk of breast cancer?
A: Exercise boosts the immune system and helps you to keep your weight in check. With as little as three hours of exercise per week, or about 30 minutes a day, you can begin to lower your risk of breast cancer. That doesn’t mean going to a gym either. Power walking is more than sufficient.
Q: Can a healthy diet help to prevent breast cancer?
A: A nutritious, low-fat diet (30 grams or less) with plenty of fruits and green and orange vegetables can help reduce the risk of developing breast cancer. A high-fat diet increases the risk because fat triggers estrogen production that can fuel tumor growth.
Q: Does smoking cause breast cancer?
A: Smoking is a confirmed risk factor for many types of cancer, including breast cancer. Additionally, second-hand smoke is also a risk factor. So if you’re a smoker, help yourself in a significant way and join a smoking cessation program to help you stop. The day you stop smoking the healing can begin and each week in which you’re smoke-free, you give yourself increasing advantages for a healthier life.
Q: Can drinking alcohol increase the risk of breast cancer?
A: Moderation is key. One drink per day has been shown to slightly increase the risk of breast cancer. Having more than one drink per day has shown to be a more significant risk factor, and the alcohol content doesn’t matter: wine, beer or a mixed drink. Alcohol also increases estrogen in your bloodstream.
Although we know that more than one drink per day increases risks, to date there are no studies that demonstrate directly that the more a person drinks, the greater their risk for cancer. And in some cases, drinking one glass of wine a day can offer heart-health benefit. If you drink alcohol, discuss it with your doctor so that you’ll know what limits are best to observe.
Q: Is there a link between oral contraceptives and breast cancer?
A: There’s an increased risk of breast cancer for women who’ve been using birth control pills for more than five years. However, due to the low amount of hormones in birth control pills today, the risk is relatively small. But if you’re a young woman with a significant family history of breast cancer, your gynecologist may recommend taking a break for a year from the pill at the 5-year time frame then resuming again for another 5 years. Although evidence-based research data does not offer strong support for this standard of care, it has nevertheless become an increasingly common practice.
Q: Is there a link between hormone replacement therapy (HRT) and breast cancer?
A: Yes, there is. HRT was added to the carcinogenic list by the American Cancer Society in the early 2000s. It’s recommended that women with known risks not be placed on HRT to control of menopausal symptoms. You should instead seek other safer alternatives.
Q: How does menstrual and reproductive history affect breast cancer risks?
A: Research has proven that the number of menstrual cycles a woman has over time does influence risk. That means women who began their menstrual cycles before age 12, have no biological children, or had their first child at 30 or older or began menopause after 55 are at a higher risk.
Q: Can breastfeeding reduce the risk of breast cancer?
A: Yes, breastfeeding is known to reduce the risk of developing breast cancer.
Q: Are mammograms painful?
A: Mammography does compress the breasts and can sometimes cause slight discomfort for a very brief period of time. Patients who are sensitive should schedule their mammograms a week after their menstrual cycle so that the breasts are less tender. Your doctor may also suggest taking acetaminophen an hour before the x-ray is performed to prevent discomfort. Another tip would be to stop any caffeine consumption at least two weeks ahead of time to limit breast tissue sensitivity.