Breast cancer: Looking out for yourself, and helping others impacted
With every year, researchers learn more about breast cancer and its prevention and treatment. All of this new information can make it hard to keep up with guidelines and recommendations for this disease.
Yet there’s good reason to learn all you can. Apart from some types of skin cancer, breast cancer is the most common type of cancer in women in the U.S. It’s also the leading cause of death from cancer in Hispanic women, and the second most common cause of death from cancer among white, black, Asian/Pacific Islander and American Indian/Alaska Native women. Though it is rare, men can also get breast cancer. This disease will likely touch all of our lives at some point, personally or through a loved one.
These statistics can be frightening, but the good news is that breast cancer survival rates have increased, and deaths associated with breast cancer continue to decline, mostly because of earlier detection, more advanced treatments, and a better overall understanding of the disease. Learning more can help us all worry less and instead focus on saving lives and helping those around us who are dealing with the disease.
Signs and symptoms of breast cancer
Some people have no symptoms before they are diagnosed with breast cancer, while others may learn they have the disease after seeing a doctor for one or more of the following symptoms:
- Breast pain
- New lumps in the breast
- Thickening or swelling of part of the breast
- Irritation or dimpling of breast skin
- Flaking skin or redness in the area of the nipple or other part of the breast
- Pulling in of the nipple
- Discharge of blood from the nipple
- Change in the size or shape of the breast
It is very important to know that non-cancerous conditions can also cause many of these symptoms, so I don’t want anyone to jump to conclusions if they find one of these signs. Nonetheless, please get the issue checked out by your doctor.
One misconception about breast cancer is that there’s not much you can do to prevent getting it. In fact, while many risk factors are out of our control, some others are not.
Risk factors you can’t control:
- Older age: most breast cancers happen in woman age 55 and older
- Personal history of breast cancer: A woman who has had cancer in one breast has an elevated chance of developing a cancer in the other breast or in another part of the same breast
- Family history of breast cancer: Most women who get breast cancer do not have a family history of the disease, but this factor does raise a woman’s risk.
- Having dense breast tissue
- Race and ethnicity: Under age 45, breast cancer is more common in African American women, but overall white women of all ages are a little more likely to develop breast cancer than African American women.
- Increased exposure to the hormone estrogen: this can be caused by earlier first menstruation, later menopause, or other factors.
- Radiation therapy to the breast or chest for other cancers
Risk factors that can be modified:
- Not being physically active
- Being overweight or obese after menopause
- Taking certain hormones for extended periods such as some hormone replacement therapy for menopause symptoms and some birth control pills
- Drinking alcohol: the more alcohol a woman drinks, the higher her risk of breast cancer
There are several different types of breast cancer. The most common is ductal carcinoma, or cancer of the breast’s milk ducts, and there are also cancers of other parts of the breast. There are breast cancers that grow in response to the body’s natural hormones, such as estrogen, and others that do not respond to hormones. Some breast cancers are defined by the genetic makeup of their cells.
For almost all of these types of cancer, a mammogram (an X-ray of the breast) is the recommended screening tool. Breast self-exams were taught to patients, to search for lumps in breast tissue, but this kind of screening is no longer taught because it has not been shown to lower the risk of dying from breast cancer. Additionally, screening by a doctor or nurse to feel for lumps or other changes has also not been found to lower this risk. You should know your breasts and your familiar lumps and bumps well enough to recognize if something changes but no need to spend specific time doing a breast exam.
Screening exams are for people who have no symptoms. People with any symptoms need to see their doctor right away for further evaluation.
For some people with family or personal history of breast cancer, there are genetic tests that can be used to look for mutations in certain genes that are known to raise the risk of breast and ovarian cancer.
Mammogram recommendations from the U.S. Preventative Services Task Force (USPSTF):
Women, Age 50-74: The USPSTF recommends biennial screening mammography for women 50-74 years.
Women, before the age of 50: The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
Women age 40-49 with average risk who would like a mammogram, may choose to begin screening at this time.
There is no conclusive evidence for giving mammograms to women age 75 or older.
How to protect yourself
We can’t prevent breast cancer, but we can lower our risk by tackling the factors we can control, such as maintaining a healthy weight, or losing weight if overweight or obese, avoiding or limiting alcohol consumption, and avoiding taking supplemental hormones. Breastfeeding your children, if possible, is another way to lower risk. We can also detect cancers early through getting recommended screenings.
Women with particularly high risk for breast cancer due to family history and/or other factors may be candidates for taking medications that can reduce their risk as well as a more robust screening regimen. Discuss with your doctor if this sounds like you.
If you are diagnosed with this disease, know that there are many treatments available, and more on the way. Reach out to others who have been through breast cancer — if you don’t know of anyone, talk to your doctor for connections to other women who can share their stories and support. The American Cancer Society has resources for finding clinical trials for patients who would like to take part in testing new drugs or procedures.
If a friend or relative is diagnosed, they will need their friends more than ever. The American Cancer Society offers many tips for how to help. For example: Send brief, frequent notes or texts, or make short, regular calls. Ask questions. If there is a caregiver, check with them to find out what else your friend might need. Visit and spend time with your friend, but always call first. They recommend making short, regular visits rather than long, infrequent ones. Offer a touch, a hug or a handshake. Be willing to listen, not just talk. Only offer advice when asked. Work hard to understand the cancer. Don’t judge what your friend is doing to treat or not to treat their disease. Think of useful activities you can do for your friend or the caregiver: bringing food, offering to drive them to an appointment, running an errand, or tackling another project, for instance.
There are many different ways that breast cancer will touch each and every one of us. Knowing the ever-changing recommendations, the symptoms to act upon, and avoiding the risks, may give you an advantage against this disease. As for me, I will be getting mammograms starting at age 40, watching for symptoms and making every effort to be a good friend to those who have been impacted by breast cancer.
Mindy Fairbanks, DO, is a board-certified family medicine and obesity medicine physician at Kaiser Permanente Silverdale Medical Center. She grew up in Camas, Washington, and has lived all over the country. She and her husband, a Navy physician, have two kids and two dogs. She loves traveling, reading books, baking cookies, entertaining (so other people eat her cookies), and spending time outdoors.