Breast Awareness: What To Look For In Your Self-exam

October is Breast Cancer Awareness Month, and cancer awareness starts with general breast awareness. Dr. Julie Nangia, medical director of breast oncology at the Dan L Duncan Comprehensive Cancer Center, recommends monthly breast self-exams to stay aware of changes in the breast that could be cancer. She explains warning signs women should look for.

"The idea is to get to know your breasts - how they feel and what they look like - so that you notice when something is different," said Nangia, associate professor of medicine - oncology at Baylor College of Medicine. "I tell my patients the best time to do your breast exam is two weeks after your period. I do not recommend examinations more than once a month because you may not notice changes on a day-to-day basis."

To do a self-exam, Nangia advises using the flat of your three middle fingers. Move your fingers in a circular motion, in a spiral around the breast tissue, using caution not to skip any spaces. Extend the examination to the armpit where the hairline ends because breast cancer can present in a lymph node under the armpit. Nangia warns that breasts feel naturally lumpy, so it's important to understand the baseline of what your healthy breasts feel like.

What to look for

During a self-exam, women should first look for a mass. The mass will be hard, but it may not be perfectly round. It can vary in size, from a pea to a walnut or larger. "A mass may not be cancer. It could be a cyst or a benign fibroadenoma, but it's important to get any mass checked out by a doctor and to have a mammogram and/or an ultrasound," Nangia said.

Temporary changes in the breast may occur in the week before and the week after the menstrual cycle. Caffeine can aggravate cysts or cause breast pain as well. "If there's a change lasting more than two weeks, I recommend showing it to a doctor," Nangia said.

Nangia recommends doing a self-exam in front of the mirror as some changes in the breast may be visible. Women should look for changes in the skin. Common things such as eczema may develop on the breast, but any redness that does not improve after two week should be examined by a physician. Nangia says prolonged redness may be a sign of infection or inflammatory breast cancer. Finally, women should note any changes in the nipple, such as inversion or change in direction, and show any major changes to their doctor.

When to get screened

In addition to monthly self-exams, Nangia recommends an annual clinical breast exam with your primary care doctor or gynecologist. Women with average risk for breast cancer should begin annual mammograms at age 40-50 every 1-2 years, and the timing and frequency should be discussed with your doctor. On a mammogram, radiologists will look for masses, abnormal calcium deposits, asymmetry between breasts and changes from year-to-year.

However, some cancers may be missed on a mammogram, Nangia notes, which is why it is so important for women to be aware of changes in their breasts through regular self-exams. Dense breast tissue and certain types of cancer can be harder to detect on a mammogram. For example, infiltrating lobular carcinoma (ILC) presents like cobwebs rather than a lump and can be more difficult to see on a mammogram.

Women with a family history of breast cancer should begin breast cancer screening earlier. Most guidelines recommend beginning screening 10 years earlier than the age a first-degree relative was diagnosed. On the father's side, this can extend to second-degree relatives such as aunts. In families with multiple cancers, a genetic risk assessment may be recommended. It's important to know if there is a genetic risk because it can affect the age at which recommended screenings should begin. For example, patients with a family history of the breast cancer-associated genes BRCA1 and BRCA2 are recommended to start screening at age 25 with breast MRI.

"If you have a family history of breast cancer, especially at age 50 or younger, or if you have had a breast biopsy that shows a precancer change, we recommend a risk assessment at the Duncan Cancer Center's Breast Cancer Prevention Center," Nangia said.

Lower your risk for breast cancer

In addition to breast awareness, it's important to be aware of risk factors for breast cancer. "Studies have shown that 20 to 30% of breast cancers can be prevented by lifestyle changes," Nangia said. She recommends regular exercise - three to five hours of walking per week. The highest risk for breast cancer is after menopause, and obesity is an added risk factor for this age group. Nangia recommends maintaining a normal body mass index. In younger women, breastfeeding has shown to provide benefits to not only the baby but also for the mother.

"There is a process the milk ducts go through when you breastfeed that protects against breast cancer," Nangia said. "No one should feel ashamed or upset if they can't breastfeed. For those who are able to do it, each year of breastfeeding will be protective against cancer."

Reducing alcohol consumption also lowers risk for breast cancer. Nangia recommends three or fewer drinks per week. "There's evidence that suggests folic acid can be protective in women who drink alcohol regularly," Nangia said. "Folic acid is naturally found in leafy green vegetables, or you can take a folic acid supplement."

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