Almost 270,000 new cases of breast cancer were diagnosed in 2018. Aside from skin cancer, it is the most common form of cancer in the United States. Given that a woman in the U.S. has a one in eight chance of developing the disease, being able to identify changes in your breasts and signs of the disease are key to prevention and early diagnosis.
"We should evaluate our breast health as part of our whole health routine and complete screenings as indicated and consider this equally as important as other screening exams such as cholesterol, and heart health," says Jennifer Boyer, a nurse practitioner at Genesis Women's Center in Inverness, Florida.
Breast self-awareness and unusual changes
In years past, experts suggested women perform breast self-exams once a month. Research, however, has found that these exams don't reliably detect cancer in average-risk women, and leads to a greater number of false positives.
Now, many official guidelines recommend breast self-awareness, or knowing what your breasts typically feel like. Having this baseline makes it easier to identify changes that could be signs of breast cancer. Guidelines vary on the value of having regular breast exams done by your healthcare provider, so talk to your doctor to make an informed decision together.
The most common symptom is a new or changing lump, either in the breast or closer to their underarm.
"Take notice of changes, specifically lumps and bumps that feel hard, foreign and not like the surrounding tissue," says Boyer. Lumps can present both with and without pain and can vary in size. While 90 percent of lumps found in women between their 20s and early 50s are benign, it's important to rule out the chance of breast cancer if you discover anything abnormal. "Often we find that a partner may notice a subtle change before we do, speak with your partner about this if you feel comfortable."
Abnormal skin changes are also important to take note of. These include itchiness, irritation, redness, scaling, swelling on part of the breast, pain or dimpling.
“If you're noticing any skin or tissue distortion where the skin's puckering in or there's any distortion in the natural contours of the breast, those are all abnormal things, and you should be checked out," says Boyer. Be aware of nipple skin changes that occur outside of pregnancy or menopause, as well, like discharge, inversion, pain, crusting or color change.
If you do feel or see anything abnormal, or are worried about sudden breast changes, schedule an appointment with your doctor. Your doctor can evaluate changes and suggest a next step, which is typically imaging in the form of a mammogram and a breast ultrasound.
Who is at greater risk for breast cancer?
While all women should be self-aware, there are certain groups at a higher risk for breast cancer than others.
A personal or family history of breast cancer
"Having a first degree relative who was diagnosed under aged 50 may increase your risk and could indicate earlier screenings. It is important to note that men are not exempt from breast cancer and should report symptoms to their provider," notes Boyer.
Doctors will recommend early screenings starting at 30 for individuals who have a hereditary risk of the disease, such as BRCA1 and BRCA2 gene mutations.
The odds increase with age
Early menstruation, becoming pregnant at an older age, late menopause, obesity and a history of radiation treatment on your chest are associated with a higher risk. Some studies cite that lifestyle habits, such as heavy drinking and tobacco use, can affect your likelihood of getting the disease, but the evidence is still unclear. However, many women who develop breast cancer may not have any risk factors, so don’t ignore any changes in breast health.
Women with dense breasts
Boyer notes that due to the density of the tissue, women with dense breasts may also not notice changes as early as others. "Be mindful that most women have some density or fibrous changes chronically of their breast and may need to pay special attention to changes, making notes and routine self- breast exams helps keep track of these changes," she says.
For women of average risk, make an informed decision with your doctor about when to begin breast cancer screenings after age 40. All women should begin receiving mammograms no later than age 50 and continue screenings every one to two years thereafter, depending on guidance from their doctor.
Women with a high lifetime risk of breast cancer are encouraged to get mammograms and MRI’s beginning at age 30, or an individualized schedule based on family history and guidance from their doctor
How can you stay healthy?
Besides knowing what types of changes to look for, there are many other steps you can take to reduce your risk of developing breast cancer.
Keep an open dialogue with your doctors about the frequency of screenings and when to begin getting mammograms. A healthy lifestyle is also a factor in keeping your risk of breast cancer lower. "Eat a healthy diet, maintain a healthy weight, limit caffeine, exercise, don't smoke and don't drink alcohol to excess. These are the things that are within our control," Boyer says. Choosing to breastfeed may also reduce a woman's risk.
Most of all, if you are concerned that anything is abnormal with your breast health, don’t hesitate to schedule an appointment with your doctor for a consultation.
"Be self-aware and don't ignore changes and most importantly don't be afraid or embarrassed to mention these concerns to your provider, even if you recently had a mammogram that was normal. There are other diagnostic tests that may need to be ordered. You know your body best," says Boyer.