Best For The Breast

A few days ago I was listening to a news report and was surprised to hear the reporter mention that women with dense breasts are more likely to get breast cancer.  I knew that women with dense breasts were more likely to have a lump missed by mammogram technology (dense tissue shows up as white, as does a tumour, making it difficult to see), but I had not learned about an increase in actual cancer risk. Off I went in search of the study.

According to a Norweigian study published this year, women with dense breasts have a slightly increased risk of being diagnosed with breast cancer. The increased risk was not substantial, but was statistically significant. It’s an interesting study that also reviews the rate of recall and biopsy, sensitivity of mammographic testing and size of tumours identified in dense vs fatty tissue. The study also reminded me that dense tissue is not something that you feel, but that is identified by mammogram technology (you can’t know if you have dense tissues unless you’ve had a mammogram).

However, one line in particular caught my eye: “The odds of interval breast cancer were substantially higher for women with mammographically dense versus fatty breasts…” This meant that between regularly scheduled mammograms, lumps were being identified by the patients and followed up by their doctors. This got me thinking about self-breast exams and the mixed messages that women get about doing them.

I am a big proponent of doing self-breast exams and often review the practice with my patients. Being familiar with your breasts will mean that if there is a change to them, you’ll know relatively quickly. Some women avoid doing breast exams because they are afraid of finding a lump; some don’t know what to do so they don’t bother. Here are the instructions/advice that I give them.

How to do a proper self breast exam

1. Be consistent. Breast tissue changes throughout the month, especially if you are still menstruating. Doing the breast exam on the same day of each cycle will mean that you are comparing apples with apples. I usually recommend day 7 (one week after the first day of your period), which is when the tissue is least affected by hormones. Some women have breast tenderness or cysts that enlarge closer to their periods. These are normal changes that in no way suggest breast cancer.
2. Star the exam by looking at your breasts in the mirror. Are there any areas that bulge, pucker, or have a different skin texture?
3. Do the rest of the exam in the shower. Wet soapy skin provides less drag and makes your fingers more sensitive. However, if you’ve been in the shower or bath a long time and your fingers get wrinkly, the opposite may be true.
4. Put your hand behind your head with your elbow out to extend and smooth the area.
5. Be systematic. Using the pads of your three middle fingers, use a pattern that brings you into contact with the entire breast. I prefer a spiral – starting in the armpit and moving in a circular pattern finishing with the nipple. Some people prefer a pizza pie pattern, moving from the outer ring of the circle toward the nipple in “wedges”. As long as you are covering the entire breast, there is no right or wrong. I do remind women that the tail of the breast extends into the armpit and that breast tissue can actually cross midline, so err on the side of checking more area than less.
6. See your doctor if you find a lump. How many boobs have you touched? Trust me, your doctor has touched more. Getting a second opinion will put your mind to rest if it turns out to be nothing, and get the ball rolling if it is something. I don’t give patients too much information about what exactly to look for – smooth edges/irregular borders, moveable/attached to the tissue underneath can be tricky to differentiate.

When I started reviewing the research on breast cancer, I was reminded that there is a lot that we can do to keep our breasts healthy.

• Eat your fruits and veggies. A study that followed a group of nurses for 30 years, found that greater intake of total fruits and vegetables, but especially yellow/orange and cruciferous (cauliflower, broccoli, cabbage, kale, etc…) may reduce the risk of breast cancer, especially agressive tumours.
• Eat soy. Especially when you are young. Soy still gets a bad rap, even though tons of research (like here and here) shows that eating soy regularly reduces the risk of breast cancer, and reduced the risk of recurrence in women who have already had breast cancer.
• Reduce stress. In some studies, women who report higher levels of psychological stress had higher incidence of breast cancer. Certainly not definitive, but we can all use the reminder to keep our stressors down.
• Get enough sleep – in the dark. Increased exposure to artificial light at night was associated with an increased risk for breast cancer.
• Sweat! Exercise, saunas and steam all increase the body’s elimination and contribute to breast health.
• No plastic in the kitchen. Chemicals found in both hard and soft plastics have been shown to have hormone like effects on breast tissue. Keep household plastic to a minimum and keep it out of your food and water as much as possible.

For patients with a strong family history of breast cancer we may also choose to do additional testing of hormones and metabolites.