National Breast Cancer Awareness Month, Self Breast Exams and Reducing Your Risk of Breast Cancer

October is National Breast Cancer Awareness month. The American College of Ob/Gyn is serving again as a national co-sponsor in an effort to raise awareness about early detection and promoting mammography for screening during October and throughout the year.

Women should always be familiar with vigilant about the signs and symptoms which may reveal breast cancer. They should also take advantage of the resources available that can help them assess their personal risk of breast cancer, as well as work with their doctor to reduce their risk factors and increase opportunities for early detection. Since this is National Breast Cancer Awareness Month, this is on opportune time to learn how to perform self breast examination, schedule your yearly clinical breast exam with your health care provider, schedule a mammogram (if necessary or indicated) and make lifestyle changes that can help to prevent breast cancer.

Breast cancer is the second most common type of cancer and the second leading cause of cancer death in American women. A new case is diagnosed approximately every 2 minutes and a woman dies from breast cancer every 13 minutes. These statistics are startling, but there is hope, as the odds of surviving breast cancer improve every year due to advances in early diagnosis and treatment.

The overall risk of an American woman developing breast cancer during her lifetime is 1 in 8 (about 11%), with about 3-4% dying from the disease. Identification of risk factors that may increase your chances of developing breast cancer is important. Risk factors include:

• Personal or family history of breast cancer
• Carrying the BRCA1 or BRCA2 gene ("breast cancer genes")
• History of biopsy proven benign breast disease
• Never having a full term pregnancy
• Having your first full term pregnancy after age 30
• Excess body weight
• Early age at the onset of menses
• Late age at the onset of menopause
• Cigarette smoking
• Alcohol use equal to three or more drinks per day
• Diet high in fat intake
• Oral contraceptive use
• Hormone replacement therapy use

Despite identifying these risk factors, 70% of women who develop breast cancer do not have identifiable risk factors. In other words, do not assume that you won't develop breast cancer if you lack these identified risk factors. Do not develop a false sense of security or complacency when it comes to your breast health.

Performing a self breast exam (SBE) has been widely reported to be one of the best methods for early detection of breast cancer, especially in those who have not yet started routine mammograms for screening purposes. Becoming familiar with how to perform a SBE is important as it can help a woman establish a baseline for what is normal in her breasts. Over time, a woman will normally become much more comfortable and confident performing SBE as she gets accustomed to the normal look and feel of the breast tissues. That way, if a breast mass begins to develop, that woman will be much more likely to appreciate its presence and present more quickly to her doctor for evaluation and management. Such early detection can greatly improve a woman’s chances for surviving breast cancer.

Developing a good SBE technique is important. Try to make the steps you use to perform SBE a routine so it is performed the same way each time. This may also improve your chances of detecting a problem in its early stages. Ideally, plan to do your exam a few days after your period or at the same time each month if you do not have periods.

Always perform SBE in good lighting. Begin in front of a mirror. Place your arms at your sides, look for skin changes such as dimpling, color changes or puckering of the skin, nipple discharge or changes in the shape or contour of the breast. Look for these same changes again with your arms raised over your head, and then one last time with your hands firmly on your hips. Using one hand, keep the fingers flat and together and gently feel your breast without pressing too hard. Examine the entire breast carefully and completely using one of the following techniques:

• Lines: Starting under the arm move your fingers down to the bottom of your breast, then back up to the top of the breast. Repeat this up and down pattern across the breast (toward the breastbone) until the entire breast is checked.
• Circles: Starting at the top of your breast move your fingers slowly around the breast in smaller and smaller circles until you have reach the nipple region.
• Wedges: Starting at the outside edge of the breast slowly work your way inward to the nipple and then back out again. Cover one wedge shaped area of the breast at a time until the entire breast is checked.

With a good self breast exam technique the chance of detecting a problem early is increased. So make this a part of your monthly schedule for minimizing your risk and as a part of your routine care for good health.

Women with first degree relatives with breast cancer (mother, sister, father, brother) have a higher risk of developing breast cancer than those with no family history of breast cancer, especially when the cancer occurred at a young age. Breast cancer risk is increased in families that carry the BRCA1 & BRCA2 genes. These genes are an inherited mutation of the breast cancer susceptibility genes. Carriers have an estimated 50-80% lifetime risk of breast cancer and represent approximately 5-10% of all breast cancer cases. These individuals are also known to be at higher risk of ovarian cancer. Currently genetic counseling is available, and screening blood tests can be performed to determine if one is a carrier of these genes.

Breast cancer risk can be modified. A woman may lower her risk of breast cancer with certain lifestyle modifications, particularly healthy lifestyle habits. Breast cancer has been linked to prolonged exposure to estrogen, and excess fatty tissue promotes the production of excess estrogen. Therefore it is a good idea to control estrogen levels by maintaining a healthy weight. (Longer estrogen exposure is also seen in women with early onset of menstruation or late menopause – but these two factors are not generally modifiable).

Reducing alcohol consumption may also reduce the risk of developing breast cancer. Women who drink two or more alcoholic beverages per day are more than 20% more likely to develop breast cancer than women who drink less.

Hormone replacement therapy and birth control pill use may also be associated with an increased risk of breast cancer. Using such medications for the shortest time necessary is recommended in order to minimize such hormones influencing the development of breast cancer.

Finally, nutrition (as always) plays an important role. Eating a well balanced diet with a good variety of fruits, vegetables, high fiber, low fat and protein rich foods is beneficial to one's overall health and may also influence the development of breast cancer.

With all of the above information at hand I hope you will re-evaluate your approach to breast care and personal risk of breast cancer. Knowing your family history is important, and good nutrition and other lifestyle modifications can help you to decrease your risk. As Breast Cancer Awareness Month is upon us perhaps it is time to resolve to "get at it" and finally start getting used to doing self breast exams monthly if you are not already doing so. Women who perform breast self exams regularly find 90% of all breast lumps – it truly is a useful technique. Proper technique for SBE is very important too. Studies have shown that women who perform BSE correctly are less likely to die of b reast cancer or have metastasis (spreading of cancer) at the time of diagnosis. Women who report performing BSE are 35% less likely to develop advanced breast cancer.

There is no perfect intervention that will absolutely prevent breast cancer. However, monthly self breast exams, mammography, ultrasounds & MRI's is selected cases in conjunction with regular check ups with your doctor can both lower your risk and promote early detection. Combining these measures with healthy lifestyle choices will reduce your risk and provide you with greater peace of mind!

By Dr. Greene, Contemporary OB/GYN
248-656-2022