Greetings Ladies and Gentleman (as there are a few of you men out there who may read this and actually have been or are affected by breast cancer). Breast cancer is a HUGE topic and the content of this article only scratches the surface of this subject. My goal is to reach as many women and men as possible and empower them with information that will help take some of the fear and trepidation out of the scary steps ahead. So, since we recently wrapped up Breast Cancer Awareness month, I think I will focus on and summarize the various messages that I have tried to convey recently as well as share insight from sources within our community.
For me, Breast Cancer Awareness month started with an interview inquiring about the need to get a mammogram and what does it feel like to get one? Well, for those of you out there, and this DOES include a few very special and courageous men, getting a mammogram is not unlike those crazy X-rays you get at the dentist’s office. You know the ones where they make you bite down on the little square and it cuts into your gums and you grimace and hope they will hurry up and flip the switch so you can open your mouth again. We’ve all done that at least once (I hope) and the sigh of relief you feel when it’s over. Well, a mammogram is different but the discomfort level is similar just in a different place. Frankly, the concept of breathing isn’t even a priority thought when you’re in compression, though the mamm techs are always telling you to hold still and hold your breath. Like you could even breathe or move if you wanted to! But, seriously, it is NOT a painful test to undergo. Privacy is upheld in a very caring way and some facilities even warm the imaging plate!
As for the question: “Why should I get a mammogram? There is no family history and I’m completely healthy.” Here’s what I tell my patients when they ask this question. First of all only 10-15% of breast cancer patients have a family history of relatives being affected by breast cancer. Ovarian and colon cancer are related cancers as well, so these diagnoses are also important when considering family history. So that leaves 85-90% of the rest of the population with no family history that need to be screened. Mammograms can see things that our physical exam, yes ladies (and gents) our PHYSICAL check of our breasts that you should be doing monthly, cannot find. There are sometimes densities or calcifications that cannot be palpated. Architectural distortion can often be picked up on a mammogram long before any physical finding is apparent. This is a distortion of the normal breast tissue that shows up on a mammogram as a unique opacity that can lead to other tests or possibly to a biopsy and or diagnosis of cancer. Calcifications are usually of the microscopic type that cannot be felt and sometimes barely seen with the naked eye. These are commonly due to normal age-related changes of the breast 70-75% of the time. However, in the remaining 25-30% of cases, these calcifications are pre-invasive changes called DCIS, ductal carcinoma in-situ.
Now, that we have established why you should get a mammogram and what it feels like, I want to return to the concept of the physical exam and tests in general. First, know that no test is perfect. Even the most expensive, sensitive test we have for detection of breast cancer is not always helpful. There is a type of breast cancer (there are many types yet to be discussed at another opportunity) that is often felt and rarely seen, even with breast MRI. So, I want to emphasize the importance, in my experience, of the breast self-exam. This is a quick, easy, inexpensive test available 24/7 in the shower using soap or laying down using lotion, whichever you prefer. The responsibility for doing this exam lies with you, the concerned individual, rather than giving this over to a spousal unit. These are YOUR breasts, take care of them. No one knows them better than you and if you don’t know how, it’s very simple. Here are a few tips:
When in the shower, to check the left breast, extend your left arm up over your head and use your right hand and soapy water, do small circular motions at the nipple and work your way outward in ever larger circles covering the entire breast. Then feel up into the axilla (armpit) to check for any abnormal lumps or bumps that may be present. This same type of exam is then reversed for the opposite side switching hands, i.e. the left hand checks the right breast and the right hand checks the left breast. This exam can also be done laying down using lotion to decrease the surface tension like the soap did in the shower. This just makes it easier to pick up on subtle changes in the texture of the breast. Patients frequently say, “My tissue is so lumpy, I don’t know what I’m feeling for or what is abnormal.” The key is to get to know what your breasts feel like and monitor for any changes. Painful, rubbery, moveable lumps are frequently hormonal in nature and may be cysts or other benign changes. Hard, non-painful lumps that do not move or feel “thick” and “different” than the rest of the breast are often more worrisome. All lumps and palpable changes should be evaluated even if you have been told you have “fibrocystic” breasts because this is very non-specific and one should never assume anything until it has been thoroughly checked.
I am going to leave you with some things to think about concerning risk: Family and personal history alone are not the only risk factors. Dense breasts, late onset of menopause after age 55, having your first child after the age of 35, never having children, having a previous biopsy showing atypical hyperplasia or dysplasia, obesity or BMI between 25-30 and postmenopausal hormone use can all increase the risk of developing breast cancer. Your best defense is a good offense and that means get screened if you are 40 or older and every year thereafter. If there is a strong family history of breast cancer, I frequently start baseline evaluations and mammograms as early as 35 years of age or younger depending on the history. MRIs are often utilized here with strong family history particularly in patients proven to have genetic susceptibility. If you are at least 20 years old you should have a clinical breast exam done by a healthcare professional each year and be instructed in doing your own exam.
Remember, breast cancer presents in many ways and every person is different. If you have a concern, talk to your healthcare provider until you feel confident that your issue has been resolved. DO NOT be afraid to get a second opinion, after all, it is your life and health at stake!
So, until next time, eat right, stay healthy and exercise!
Dr. Laurie
www.washingtonbreastspecialist.com
Dr. Laurie Evans is a board-certified General Surgeon who specializes in problems of the breast. She has developed a keen interest in and done specific training related to diagnosis and treatment of breast cancer. Dr. Evans focuses on comprehensive evaluation and is able to offer a range of diagnostic and surgical techniques. She provides compassionate care and patient education to ensure her patients are fully aware of all available treatment options related to their concern. She participates in a multidisciplinary tumor conference and confers with outside specialists to provide state-of-the-art-inform
Please visit the Tri-Cities Cancer Center Resource Center to pick up a free breast self-exam shower card and/or a breast bar. The breast bar is wonderful organic soap with self-exam instructions.
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