When I ask patients if they perform regular breast self-exams I often hear,
"no," and the excuse, "I'm not high-risk."
What they mean is that they don't have a family history of breast cancer
or the BRCA gene mutation associated with a higher risk for breast cancer.
But the absence of family history and the genetic mutation doesn't
mean a woman won't develop the disease. Unfortunately, being "average
risk" is not the same as being no risk.
Just by virtue of their sex, all women are at risk of developing breast
and ovarian cancer. In fact, 1 in 8 women will develop breast cancer in
her lifetime, and at least 85% of breast cancer cases are caused by risk
factors other than a genetic mutation. My concern is that there is so
much emphasis on BRCA recently because Angelina Jolie got a preventive
double mastectomy that we need to further educate women on staying vigilant
against the disease no matter what.
When younger patients walk into Hoag Breast Center for the first time,
too many of them don't know they should be routinely checking their
breasts. They don't know that alcohol consumption can increase a woman's
risk for breast cancer, and they are not always clear on the association
between family history and their own risk of developing the disease.
October is Breast Cancer Awareness month, and I would like to urge women
who don't typically think about their breast cancer risks to start
taking their breast health into their own hands — beginning quite
literally with breast self-awareness.
A great online resource for learning about breast self-awareness is
brightpink.org, which boasts the tagline, "Know Your Body. Know Your Normal."
By knowing your body, you will know what, if any, changes are occurring.
And it's not just lumps you're looking for. Regular self-exams
will help you identify anything that isn't "normal," such
as nipple changes, including discharge, rash, flattening or inversion;
skin changes such as warmth, redness, thickening or dimpling; and pain
in one spot that persists for more than two weeks.
These are red flags that you should bring up to your doctor, regardless
of your age or family history. You might not be "high risk,"
but as a woman, you are still at average risk of breast or ovarian cancer.
I encourage all women to talk with their physicians to find out how best
to address those risks and take charge of their health.
Some women express a reluctance to perform self-exams because they have
"lumpy" breasts. Fibrocystic, or dense, breasts are normal.
What is important is keeping track of where those lumps are, their size
and what they feel like, so that if you notice a change you can check
it out with your doctor.
If you're not sure whether something is new or changing, make a note,
wait two weeks and check again. Waiting two, four or even six weeks to
decide if a finding is concerning is OK, and can help to quell the uncertainty
and anxiety that women with fibrocystic breasts often feel when it comes
to breast self-exams.
Dense breast tissue, which is common in younger women, can make reading
a mammogram difficult. But at Hoag we offer breast tomosynthesis, or 3-D
mammography, breast ultrasound and other leading-edge technology that
can more accurately detect tumors in women with dense breasts.
So the next time your gynecologist asks you if you practice breast self-awareness,
it is my hope that you can say, "Yes. I know that just by being a
woman, I am at risk for breast cancer — and I'm taking control
of my health with my own hands."
JANUARY LOPEZ is the director of breast imaging at Hoag Breast Center in Newport Beach.