Breast Cancer Screening: How to reduce your chances of missing the diagnosis
Monthly self-breast exams are still my recommendation. The literature and guidelines vary on this issue, but I seek to highlight risks and benefits of self-examination as well as discuss some lifestyle practices that can minimize disease occurrence. In this post you will read about the following topics:
- What does the evidence say about self-breast exams and what are cancer detection rates using this practice?
- How to perform self-exams and what are common pitfalls?
- What the heck is a frozen pea?
- What to do if you find something.
- What lifestyle practices can prevent or reduce your risk of developing breast cancer?
- Bonus Feature: My song about self-exams and prevention. No, I am not a singer, but I’ll sure pretend to be.
What Does The Evidence Say About Self-Breast Exams and What Are Cancer Detection Rates
Monthly self-breast exams are no longer recommended across the board based on the evidence, and some research discourages them because of the likelihood of a woman finding a mass or lump that is benign but that leads to a lot of follow up testing, biopsies and mental anguish. My, non-evidence based take on that is that you should make the choice. Only about 20% of lumps detected on self exam will be cancer. The other 80% can cause anxiety if you let them, but just don’t freak out. If you don’t check, you have to be okay with not finding anything, even if there is a small cancer. By that logic, not checking at all is better than possibly finding a cancer. But what about the stats that say anywhere between 20-40% of breast cancers are detected by self-exam? I don’t know about you but I don’t like my head in the sand, and not just because of my hair.
Mammograms are recommended yearly starting at age 50, but from 40-50 or 45-50, depending on which guidelines you check, they depend on the family history and are up to the discretion of the patient and doctor. Together we can go through pros and cons and decide which seems more reasonable. The cons are similar to those for self-breast exams- a disproportionate number of findings will be benign, but also, cancers that develop later in age are more likely to be aggressive, so early detection may not decrease mortality. Ultimately, then, you could say it is up to how much information you want to know. Would you feel better knowing your breasts are cancer free, even if it means going back for more testing, or would you rather assume they are cancer free and not get checked, even if there is a small chance that something abnormal is there. As for me, I want to know.
ACOG is where much of the evidence and recommendations come from that guide our practice of medicine. Let’s stop for a second and examine this term “evidence” as in “evidence based medicine”. The NIH defines this term as the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. Evidence based medicine integrates clinical experience and patient values with the best available research information. I wanted to highlight that definition because, with the help of Google and Facebook Mom’s groups (no one specific #nooffense), a single post or article can feel like it represents everyone. Keep in mind, people post or write about experiences when they are different or unique. The other 99% of people who had normal or typical or average experiences, don’t blog or take an hour or more out of their lives to write about them. I digress.
How To Check Your Breasts And Common Pitfalls
Monthly self-breast exams help women to find breast changes or abnormalities sooner than they would normally be found by a yearly gynecologic exam. I see you once a year. You see yourself every day. To try to justify not doing exams, women often tell me one of two things: Either they don’t know how to do these exams, or they don’t know what is normal or abnormal. What I tell those women is “Friend, get up in there! They’re yours right?”
The how-to is simply to firmly but comfortably press through the entire breast in a systematic way to be sure to feel all breast tissue. Don’t leave out the area under the nipple or under the arm pit because breast tissue extends into those areas. The question of how one knows what is abnormal can be answered by knowing what is normal. You don’t have to be a breast expert, but you should be your own breast expert. Do these exams after your period or, if you don’t have monthly periods because of your birth control type, do them at the same time every month. If you know your breasts well- the densities, the texture, etc- then you will be the first to know if something changes or a new nodule or frozen pea pops up.
A Frozen Pea? What’s That
The term “frozen pea” is used commonly in the medical community to refer to a breast lump that doesn’t move when you push on it. It is the size of a pea and it feels frozen and hard in the breast. That type of lump is more concerning than the mobile lump that is easily pushed around. A patient recently told me that her breast doctor referred to these as “breast mice” because they move around freely in the breast. Breast Mice? That is a TERRIBLE name for anything within a woman’s body. Maybe I take this one so personally because I have lived in a domicile (a few domiciles) with mice before. The last thing I want is to think about one within the breast. Consider this my own attempt to change that term to one more pleasing to my ear: “benign breast nodules commonly feel like fruit in breast Jello.” No? Well, as I am typing this I immediately thought of Bill Cosby. So much for that attempt. I’ll think of something…
What If You Find Something?
What if you find something? Rruht rroh (insert Scooby-Doo voice). What if you have a breast pain, a lump or a bump, or discharge from the nipple. There are many breast changes that can occur and some are scarier than others. Thickened areas that arise just before the period and go away shortly thereafter are far less concerning than a new firm lump that is painless and doesn’t move well. The term “frozen pea” is used to refer to a small, pea-sized rock-like structure in the breast that is not freely mobile because the tissue around it is scarred. Any area that is new warrants some attention. That attention could be your own mental note to check on it daily or every other day until your period comes and see if it goes away. Or, that attention could mean that you call your gynecologist and schedule an appointment to have it checked out.
When I evaluate someone for breast concerns, I will typically listen to the history of its onset, do a physical examination, and give my best opinion and recommendations about their signs and symptoms. Those recommendations may be to do nothing at this exact moment, or they may be to get at a mammogram or ultrasound. For my ladies who want further imaging when I don’t recommend it, I tell them that I will order the evaluation if their piece of mind is at stake. Some doctors may take issue with that approach. They may think that since we go to school for half of our lives, we should be trusted to make the right decisions for diagnosis and treatment of our patients. We should. I too believe that. The flaw in adhering to that philosophy without exception, is that we are all adults and can make our own decisions in life. This is the entire concept of informed consent. I present you with your options, and the pros and cons to each and my recommendations. You can make your own decision. If you won’t be able to sleep at night until that breast ultrasound report says benign, who am I to deny that piece of mind even if I think it is unnecessary. At the end of the day it is your body and I am here to help you safe both mentally and physically.
If you suspect a new breast lump, as with any health concern, don’t ignore it. Ignoring the symptoms won’t make them go away. Either time will pass and it will get better, or time will pass and the symptoms will get worse. You would hate to know that if you have acted sooner, you may have improved your health or even saved your own life.
How Can You Prevent Or Minimize YOUR Risk Of Developing Breast Cancer?
Here is what the American Cancer Society has to say about prevention of breast cancer.
- Because obesity and excess weight increase the risk of developing breast cancer, the American Cancer Society recommends that women maintain a healthy weight throughout their life. Losing even a small amount of weight has health benefits and is a good place to start.
- Growing evidence suggests that women who get regular physical activity have a 10%-25% lower risk of breast cancer compared to women who get no exercise. Doing even a little physical activity beyond your regular daily routine can have many health benefits.
- Many studies have confirmed that drinking alcohol increases the risk of breast cancer in women by about 7% to 10% for each drink per day. For women who drink alcohol, the American Cancer Society recommends they limit themselves to no more than 1 drink per day.
- There is some scientific evidence that smoking increases the risk of breast cancer slightly, especially among heavy, long-term smokers and women who begin smoking before their first pregnancy. A recent study by American Cancer Society researchers found that women who begin smoking before they give birth to their first child had a 21% higher risk of breast cancer than did women who never smoked. Quitting has numerous health benefits.
- To find breast cancer early, when treatments are more likely to be successful, the American Cancer Society recommends women should begin having yearly mammograms by age 45, and can change to having mammograms every other year beginning at age 55. Women should have the choice to start screening with yearly mammograms as early as age 40 if they want to.
For all my sisters in the struggle, you think I’ve forgotten about you (yes, I’m quoting/stealing from Kirk Franklin- I’ve been looking for you.) I haven’t. The only thing I will add that is specific to us, is that breast cancer occurs in African American women at a slightly lower rate that Caucasian women, but we are significantly more likely to die from the disease than Caucasian women- 42% more likely to be exact. This is partly because the disease onset is earlier and thus not detected as soon, and it is often more aggressive. This is even more of a reason to do self exams, to see your doctor yearly, and to be aware of your family history to discuss with your doctor.
Enjoy your breasts, but if they misbehave, be ready to replace them. You, however, are Irreplaceable!