Breast cancer is probably the one disease women worry about the most. While it is the second most common type of cancer among women in the United States, the number of women dying from breast cancer has dropped steadily over the past 20 years. And with screenings and lifestyle changes, you can do a lot to lower your risk and catch the disease in its earliest, most treatable stages.
What is a Healthy Breast?
Your breasts are composed of three main parts: Milk-producing glands, milk-carrying ducts, and connective tissue (the fatty and fibrous tissue that holds everything together). The primary glands are called lobes, which surround the nipple like spokes on a wheel. Inside are smaller lobes called lobules, and at the end of each lobule are tiny bulbs that produce milk. The lobes are all linked together by ducts, or small tubes, which pass the milk through to the nipple. Breasts grow and change over the years depending on shifting levels of the hormones estrogen and progesterone (which are produced in the ovaries), as well as weight gain and even certain medications.
What’s Happening with Your Breasts Now
In Your 20s, 30s and 40s
In your twenties and thirties, your breast tissue is considered fairly dense. Around your period, rising progesterone levels can make your breasts feel tender and swollen. If you’ve gone through pregnancy and breastfeeding, you may notice that your breasts seem smaller and may develop stretch marks afterward. Losing or gaining a significant amount of weight can have a similar effect.
In Your 50s, 60s and Beyond
As you exit your childbearing years, you may develop more cysts or see changes in the shape of your breasts as the number of lobes shrink and the percentage of fatty tissue increases. As you enter perimenopause and menopause, fluctuation in hormones can lead to more changes in the look and feel of your breasts. Once you’re past menopause, your breasts are mostly made up of fatty tissue, so they feel softer and are less dense.
How to Keep Your Breasts Healthy
More than 70,000 breast cancer cases a year in the U.S.—about 40 percent—could be prevented by following healthy lifestyle measures, according to the American Institute for Cancer Research. Here’s how you can reduce your risk:
- Maintain a healthy weight. Numerous research studies have shown that women who are obese (having a Body Mass Index, or BMI, of 30 or more) have a higher risk of developing breast cancer than those who are not obese (having a BMI of 25 or less).
- Be physically active. Doing four hours or more a week of moderate to vigorous activity (such as brisk walking, cycling, swimming or running) has been shown to decrease breast cancer risk. The effect of exercise may be greatest in premenopausal women but can help at any age.
- Avoid or limit alcohol. Research has shown that alcohol increases the risk of breast cancer. Women who have 2 to 5 alcoholic drinks a day have about 1.5 times the cancer risk as the who do not drink any alcohol.
- Follow a healthy diet. A diet that is rich in vegetables, fruits, fish, poultry and low-fat dairy can help you stay at a healthy weight and may help minimize breast cancer risk.
- Get regular screenings. One of the most important things you can do to lower your risk of dying from breast cancer is to get regular screenings that can catch cancer cells before they spread.
- Clinical breast exam. At your annual gynecologist visit, your doctor should perform a clinical breast exam, feeling around your breast tissue and under your arms to look for any abnormal lumps or changes.
- Mammograms. The most common breast-cancer screening test, this X-ray of the breast tissue can find tumors that are too small to feel. New screening guidelines from the U.S. Preventive Services Task Force recommend routine mammograms every two years for women 50 and older, but some groups, such as the American Cancer Society, recommend annual mammography beginning at age 40. Talk to your health-care provider about what’s right for you.
- Digital Breast Tomosynthesis: Also known as 3D mammography, tomosynthesis obtains a series of fifteen low dose, high resolution images in a sweeping arc around the breast. Each image can be displayed and examined either individually or they can be reconstructed together into a 3D rendering of the interior architecture of the entire breast. Digital breast tomosynthesis provides the radiologist with individual images of thin layers of breast tissue, producing a clearer, more complete picture than conventional digital mammography. This separation of normal overlapping tissue also enhances the detection of cancers by better separating the appearance of normal versus abnormal tissue. This enables the radiologist to more accurately interpret breast changes, and as a result helps the radiologist with their primary goal – to find cancers when they are early and small. Although patients are exposed to a small amount of additional radiation during the tomosynthesis exam, the clearer images that are provided help reduce the likelihood of being called back for additional images, thus reducing false alarms and unnecessary stress. The 3D mammogram takes only a few seconds longer than a traditional mammogram, and provides increased clarity and accuracy at no additional discomfort. Overall, the benefits of tomosynthesis far outweigh the potential risks.
- Ultrasounds. Also known as sonography, this screening uses sound waves to create an image of breast tissue. Sonograms are often used in conjunction with mammograms to examine a specific area of concern. Ultrasound exams can help show the difference between a noncancerous cyst and a solid mass that may be cancerous. Sonograms can also be helpful in women with very dense breasts, which can make it difficult to read a mammogram.
- MRI. Short for “magnetic resonance imaging” this procedure uses magnets, radio waves and a computer to create a highly detailed image of the breast. Although MRIs find breast cancer more often than mammograms do, they also have a high rate of false positives, meaning the results appear abnormal even when there is no cancer. Women who are at high risk of breast cancer (having a family history or a genetic condition such as BRCA1 or BRCA2 genes) may opt for frequent MRIs as part of their screening process. Please click here to find an imaging location near you.
Signs and Symptoms
If you notice something unusual or a sudden change in the appearance of your breasts, try not to panic: The vast majority of lumps end up being a fatty cyst or other non-cancerous growth. Often lumps or cysts develop around the time of your monthly cycle, and will go away on their own in a couple of weeks. If not, make an appointment with your health-care provider. You may be advised to get a mammogram and/or ultrasound. Also note that a breast mass must be examined by your doctor, even if your mammogram is normal. About 15% of breast cancers cannot be seen on a mammogram. If a suspicious lump or growth is found, your doctor may order a biopsy. From there, your doctor will be able to provide a definitive diagnosis and course of treatment. Breast issues you may experience include:
- Benign (noncancerous) lumps. Up to half of women in the U.S. experience what’s called fibrocystic breast changes, or an increase in cysts and tenderness which occurs thanks to higher levels of the hormones estrogen and progesterone, particularly around ovulation and menstruation. It’s most common between ages 20 and 45. Cysts, or fluid-filled lumps, can also occur at any point in your monthly cycle, as can fibroadenomas, which are solid, round rubbery lumps that move easily but are not cancerous. They are most common among women under age 30.
- Nipple discharge can be alarming if you are not breastfeeding, but in most cases it’s nothing serious: You may see a fluid discharge during early or late pregnancy, as well as stimulation during sexual activity or vigorous physical exercise. Infection (mastitis), mammary duct ecstasia (an inflammation and possible blockage of the ducts, often around the time of menopause) and a noncancerous growth in the ducts may also cause nipple discharge.
Genetic Counseling and Testing
The majority of breast cancer cases are not hereditary, but a small percentage—about 5-10 percent—can be linked to mutations in specific genes. Most notable are the BRCA1 and BRCA2 gene mutations. Women who have a change in either or both of these genes have a much higher chance of developing breast and/or ovarian cancer. However, not everyone who inherits a BRCA 1 or 2 mutation will develop breast or ovarian cancer, and you can absolutely take steps to lower an increased risk.
Who should consider genetic testing?
Men and women with a personal family history of:
- Breast cancer diagnosed at or before age 50
- Ovarian cancer, regardless of age
- Male breast cancer
- Multiple relatives with breast and/or ovarian cancer
- A relative with a known BRCA mutation
- Ashkenazi-Jewish ancestry with breast or ovarian cancer
If you fall in one of these groups, talk to your doctor about seeing a genetic counselor who will assess your risk, give you information about genetic testing, discuss the implications for you and your relatives and provide psychological support. Contact the Center for Cancer Genetics and Cancer Control at the North Shore-LIJ Cancer Institute for more information.
How North Shore/LIJ Can Help
The North Shore-LIJ Cancer Institute is one of the largest cancer programs in the NY metropolitan area. Comprised of 150 elite physicians in 20 cancer specialties, we offer the most personalized and advanced care available for virtually every type of cancer. Our multidisciplinary teams develop individualized treatment plans that address patients’ physical and emotional needs.
Through our robust clinical trials and research programs, we seek newer, better and more effective ways to treat cancer and our patients benefit from state-of-the-art technologies, highly specialized diagnostic and surgical techniques and the newest, most promising treatments.
Find a cancer specialist at the North Shore-LIJ Cancer Institute.