As scary as breast cancer is, learning about the disease can be empowering.
Chances are you have a friend or family member who’s faced breast cancer. After all, 1 in 8 women will be diagnosed with the disease at some point during their lives, according to the American Cancer Society (ACS).
Sometimes a disease doesn’t seem so scary when you know the basic facts, so we talked with a few breast specialists who have in-depth knowledge about the prevention, diagnosis, and treatment of breast cancer. Read on to find out what you should know.
1. Experts differ on when to start getting regular mammograms.
While the United States Preventive Services Task Force (USPSTF) recommends that women ages 50 to 74 get mammograms every two years, the ACS suggests that women begin getting annual mammograms at age 45. And some experts believe 40 is the right age to start getting mammograms.
“Breast cancer is an age-related disease, so if you look at women under 50, they get far fewer cancers than women over 50; but if you look at women in their forties compared to women in their fifties, there’s not that much of a difference,” says Monica Morrow, MD, chief of breast service in the surgery department at Memorial Sloan Kettering Cancer Center in New York City.
“We think the best thing for women’s overall health is to start at 40, because the best way to pick up small cancers is to have annual mammograms so you can see subtle changes in breasts over time,” Dr. Morrow says.
Finding cancer when the tumor is small has many benefits. “If it’s smaller, you can have less surgery — say, a lumpectomy rather than a mastectomy; it’s less likely to have spread to the lymph nodes; and you’re therefore less likely to have those taken out with surgery,” she says. “You’re also possibly less likely to have chemotherapy.”
Talk to your doctor about when you should start getting mammograms and how often you should get them.
2. Breast self-exams may not save your life.
There’s no evidence that giving yourself a monthly breast self-exam (BSE) reduces the risk of dying from breast cancer, or that BSEs help in finding cancer earlier, according to the National Breast Cancer Coalition. Yet many physicians still recommend doing them.
“They allow you to get comfortable with what your tissue feels like, so that if there’s something new, you’ll notice it,” says Allyson F. Jacobson, MD, medical director of the breast program at Northwest Community Hospital in Arlington Heights, Illinois.
“You have more access to your breasts than anyone else. If you find something like a lump in your breast, sure, it can make you anxious,” says Dr. Jacobson. “But if you’re examining your breasts at regular intervals, you can potentially find something before the next time you see a doctor.” She recommends doing a BSE the week after your period (if you still have menstrual periods), and no more than once a month.
Morrow adds that breasts are lumpy by nature, and for women who have especially lumpy breasts, self-exams may not be effective. “Every time they do an exam, they find a lump, and those women should not drive themselves crazy trying to do self-exams — especially if they’re in the age range to receive mammograms,” she notes.
3. Your breast size doesn’t matter.
Jacobson says the size of your breasts has no bearing on your risk for developing breast cancer. The same is true for detecting cancer with a mammogram.
“As long as the technologist can get the tissue within the plates to compress it and get the image done — which they can almost always do — there shouldn’t be a problem, ” she says. “Even men can have mammograms, and there is very little breast tissue in the typical male.”
Whether or not you or a physician can feel a cancer depends on how close to the surface the cancer is, how different the texture of the cancer is from your breast tissue, and where the cancer is in the breast, says Morrow. “It’s not purely a matter of breast size.”
4. Breast cancer usually shows no signs or symptoms.
The point of mammograms is to detect cancer before symptoms occur, but sometimes cancer is missed on a mammogram.
The most common symptom of breast cancer is a painless lump or mass. But according to the ACS, other symptoms can include swelling; skin irritation; pain in the nipple or breast; an inward turning nipple; redness, scaliness, or thickening of the nipple or breast skin; and nipple discharge that isn’t breast milk.
“Awareness of your breasts is important. If you find something that’s new or different, whether you discover it in the shower or looking in the mirror or another way, bring it to your doctor’s attention,” says Morrow.
5. Most women who get breast cancer don’t have a family history.
More than 85 percent of women who get breast cancer have no family history of the disease, reports the ACS.
“While family history does increase your risk, not having breast cancer in your family does not by any means get you off the hook,” says Jacobson. Even if you have no family history, your risk of getting breast cancer over your lifetime is 12 percent.
“This is very high for a cancer. I see many women who find a lump and don’t think they need to worry, because no one in their family has had breast cancer,” says Jacobson.
6. High risk factors are relative.
When the term “high risk” is used scientifically, Morrow says it means higher risk than someone without any risk factors. “Factors increase the risk of getting breast cancer, but there is no standard definition of what truly constitutes high risk.”
Still, in general Morrow says the biggest risk factors for getting breast cancer are being female and getting older. Some other risk factors, according to the National Cancer Institute, include:
- Being obese
- Having a close relative with breast cancer (specifically your mother, sisters, or daughters)
- Carrying the gene mutations BRCA1 and BRCA2
- Getting your first menstrual period before age 12
- Giving birth for the first time after age 30
- Never being pregnant
- Starting menopause at an older age
- Taking hormone therapy
- Drinking alcohol
Not all of these risk factors are equal; they range from questionable to truly high-risk.
7. Genetic testing is appropriate for some women, but not all.
If you know that a close relative, such as your mother or sister, carries a breast cancer gene mutation (such as BRCA1 or BRCA2), talk with your doctor about genetic testing. If you don’t know whether a family member who had breast cancer was tested for a gene mutation, your doctor can determine if you’d be a good candidate for genetic testing.
“[The number of] women who have this increase in risk is relatively small,” says Morrow. Some other factors that may be markers of a higher risk, and that may merit getting a genetic evaluation, include:
- Having numerous relatives who have had breast cancer
- Having relatives who have had breast cancer at a younger age, before menopause
- Having relatives who have had cancer in both breasts
- Having male relatives who have had breast cancer
- Having relatives with both breast and ovarian cancer
Check with your insurance company about coverage for genetic testing, but note that the Affordable Care Act considers genetic counseling and testing for people at high risk a covered preventive service.
8. Breast cancer treatment is truly individual.
Even though it’s beneficial to find your breast cancer in an earlier stage before it has spread, doing so doesn’t always mean that your treatment will be less aggressive.
“Sometimes we end up doing mastectomies instead of lumpectomies for stage 0 breast cancer, because the biology of cancer the patient has is more likely to be aggressive and shorten their survival,” says Morrow, adding that the same thing goes for chemotherapy.
“Just because a tumor is small versus large doesn’t mean it’s not serious. The biology of the tumor, no matter its size, is what matters,” she says.
By testing tumors, Morrow says it’s possible to determine how the cancer will behave. “Based on those characteristics, even if it’s a small stage I cancer, the potential of what it can do is what drives the treatment,” she says.
9. Mastectomy is not always the best treatment.
While a mastectomy, which is the removal of one or both breasts, is performed to get rid of cancer from the breasts or to prevent cancer from developing in women who are at high risk, Morrow says there is a myth surrounding the surgery.
“It’s often thought that if you have breast cancer in one breast, the safest thing to do is to have both of your breasts removed. For the average woman with breast cancer — meaning those who don’t have a genetic mutation — removing your other breast does nothing to prolong your life,” she says.
Morrow adds that breast cancer does not spread from breast to breast. “The risk of getting a second breast cancer in your other breast has been going down over time, because the drugs used to treat the first breast cancer reduce the risk of making a new cancer. But a lot of people say, ‘I want to see my children grow up. I want to be safe. I hear celebrities say it’s good to remove both.’ It’s just simply not true,” she says.
10. There are some things you can do to reduce your risk.
There is no proven way to prevent breast cancer, yet Jacobson says living a healthy lifestyle is your best defense.
“You can’t beat your DNA or your family history, so whatever you’re predisposed to, you are predisposed to. But there are things you can potentially control and maximize to your benefit,” she says.
Following a healthy diet rich in fruits and vegetables that contain antioxidants and cancer-fighting nutrients, as well as exercising, minimizing alcohol (more than one drink a day on average increases a woman’s risk), and maintaining a healthy weight can all be beneficial, she notes.
“There’s no magic bullet, or pill, or one specific thing, but these are some factors you can control,” she says.