Appearances Don't Count
Forget shape or size—keeping your breasts healthy should be your only concern.
By Beverly Burmeier
From the time their breasts start to appear, young girls are concerned about how they look. But the main concern for women of all ages should be maintaining breast health.
There is no such thing as a “normal” breast size or shape. “A normal breast is one capable of producing milk,” says Susan Love, MD, MBA, clinical professor of surgery at UCLA and author of Dr. Susan Love’s Breast Book (Da Capo Press).
Although cancer is the breast disease that worries most women, other conditions can cause discomfort. Very rarely the precursors of malignancy, they do warrant examination.
Checking Breast Changes
“During the past 20 years researchers have begun focusing on benign breast problems, many of which are related to various processes of reproductive life,” Love says. Giving a complete medical history and undergoing a physical exam are the first steps in diagnosing breast changes.
Screening mammography—breast X-rays in women with no signs of disease—can find cancers too small to be felt. This means treatment can be started earlier, although even small tumors may have spread before they’re found. Sometimes cancers are not detected; conversely, benign abnormalities may be mistaken for cancer. Before deciding on a screening schedule, every woman should discuss her own risk factors—such as family history and lifestyle issues—with her practitioner.
In the past, fibrocystic disease has been a catch-all term for variations from the norm that were not deemed cancerous. “Lumpy breasts are caused by the way the breast tissue forms itself, which could be perfectly normal,” Love explains. But she adds that an exam is warranted if a woman notices changes—things don’t feel the same as usual. That’s why it is important to perform self-exams on a regular basis.
Two benign types of lumps are harmless; they may be related to hormonal fluctuations that occur during a woman’s menstruating years. Fibroadenomas, rubbery or marble-like lumps, occur most often during one’s teens or early 20s, while moveable, fluid-filled cysts are more common in women approaching menopause.
“Women should pay attention to any palpable mass and have it checked out, regardless of age,” says Debra Mangino, DO, director of the Special Surveillance Breast Program at Memorial Sloan-Kettering Cancer Center in New York. Still, the chance of a breast lump being cancerous is quite low for premenopausal women.
Breast pain tied to a woman’s menstrual cycle is rarely a cancer symptom. Less common is noncyclical pain, resulting from injury, scar tissue or an abnormality. Pain may also arise elsewhere in the body and be referred to the breasts. Since this type of pain could possibly be a sign of cancer, it’s worth checking out if you can’t pinpoint the cause.
Lactational mastitis, an infection that can affect women who breast-feed, is the most common, although infections can occur in other women as well. There are usually no long-term concerns. “However, inflammatory breast cancer (which causes swelling and redness) can be mistaken for infection, so if it doesn’t get better with a round of antibiotics, a biopsy is in order,” says Love.
Nipple discharge generally isn’t a problem for patients younger than 40, but women over 60 who have a discharge the consistency of egg white should have it examined. “A bloody discharge is almost never a sign of cancer,” Love adds.
Assessing Cancer Risk
While the chances of developing breast cancer vary from person to person, they are never zero for anyone. “People with perfectly normal breasts may still get cancer,” Love says. “Unfortunately, we still don’t have a good way of predicting who is at high risk.”
Some known risk factors simply can’t be changed. Gender is one of them; although men can develop breast cancer, women are 100 times more likely to get the disease. Age also increases risk. One in eight breast cancers are found in women younger than 45, but two out of three invasive breast cancers are found in women 55 or older. Heredity plays a role, too. Having the BRCA1 and 2 genes significantly increases lifetime risk as does having a mother, sister or daughter diagnosed with breast cancer.
According to the American Cancer Society, a woman who started menstruating before age 12 or went through menopause after age 55 has a slightly higher risk, possibly due to a longer lifetime exposure to the hormones estrogen and progesterone. Women with dense breasts (more glandular and fibrous tissue and less fatty tissue as shown on a mammogram) also have a slightly increased risk.
Some hormonal factors involved in cancer risk arise as the result of life choices. Women who have never been pregnant or had their first child after age 30 have a slightly higher risk, probably because pregnancy reduces one’s number of lifetime menstrual cycles. Studies suggest that breastfeeding for an extended period (nine months or more) may reduce breast cancer risk for premenopausal women, probably for the same reason as pregnancy.
Both Love and Mangino say oral contraceptives, at the low doses currently prescribed, do not raise breast cancer risk unless a woman delays pregnancy until after age 30. However, discuss contraceptive use with your practitioner since birth control pills may increase breast density, which makes malignant cells more difficult to spot. So can hormonal therapy for menopause; in fact, Love cautions against taking hormone therapy that combines estrogen and progesterone because it does increase risk (although estrogen alone hasn’t shown that result). She says it doesn’t make any difference if the hormones are natural or bio-identical.
Other lifestyle factors can also affect breast cancer risk. According to Mangino, excess pounds carried by post-menopausal women increase risk because fat cells raise estrogen levels when the ovaries have stopped working. Having more than three alcoholic drinks a week has also been shown to increase risk, but since moderate drinking may decrease heart disease you need to balance the risks and gains for yourself in consultation with your healthcare practitioner.
Recent studies suggest that women who work at night may be at increased risk for breast cancer because exposure to light affects levels of melatonin, a hormone that may inhibit growth of certain breast cancer tumors.
“The three most important ways to protect your breasts are eating a healthy diet, exercising and reducing stress,” Love says.
Research suggests that a tomato-rich diet may help protect those postmenopausal women for whom breast cancer risk is higher than normal. “Eating fruits and vegetables rich in essential nutrients like lycopene (such as tomatoes, watermelons and papaya) had a positive effect on a specific biomarker known to be associated with breast cancer,” says Adana Llanos, PhD, MPH, assistant professor of epidemiology at Rutgers University. Folic acid, found in spinach, broccoli, corn and legumes, appears to mitigate risk posed by alcohol use.
Regular exercise can modify risk. Mangino recommends short intervals of high-intensity exercise, which studies indicate are more beneficial than longer periods of moderate exercise. A study of postmenopausal women published by the American Association for Cancer Research reports that women who engaged in at least an hour of vigorous physical activity every day had a 25% lower risk for breast cancer, and those who walked for at least seven hours a week lowered their risk by 14%. Love makes it simple: “Just get moving. Exercise is an anti-inflammatory that helps keep the immune system strong.”
Prolonged stress weakens immunity. “Our bodies create cancer cells every day, but a strong immune system keeps them at bay,” Mangino says. Getting a good night’s rest is important because fragmented sleep can slow the immune system’s ability to control or eradicate early cancers, thus speeding growth of cancer cells. If you often feel tied in knots, try massage, meditation or mind-body exercises such as yoga or tai chi to reduce stress.
For many women, cancer is—understandably—their single biggest breast health concern. But while nothing can completely eliminate the risk of cancer development for anyone, taking a proactive approach to wellness can help protect your breasts throughout your lifetime.
Be Part of the Solution
“Although we’ve become more successful at treating breast cancer, we really need to focus on finding the cause and preventing it. We need women who are willing to step up and participate in research studies to eradicate breast cancer,” says Susan Love, MD, president of the Dr. Susan Love Research Foundation and a founder of the National Breast Cancer Coalition.
To get emails explaining different studies you might choose to become involved in, check out Army of Women at armyofwomen.org. Or sign up at healthofwomenstudy.org to aid Dr. Love’s foundation in tracking women over a long period of time to uncover clues about breast cancer. You’ll be asked to answer questions online about a variety of topics related to health and lifestyle.