About Breast Disease

Most women experience breast changes at some point in their life time.

Age, hormone levels, and medicines you take may cause lumps, bumps, and discharges (fluids that are not breast milk).

If you have a breast lump, pain, discharge or skin irritation, you should see a breast specialist. Although many women fear cancer, most breast problems are not cancer.

Factors that appear to decrease the risk of, early diagnosis of, or recurrence of breast cancer are regular breast examinations by health care professionals, regular mammograms, self-examination of breasts, healthy diet, and exercise to decrease excess body fat.

Breast pain

Pain is one of the most common breast symptoms experienced by women and management requires careful assessment and diagnosis. There is often understandable anxiety associated with the symptom, particularly about breast cancer. This concern is the primary reason most women seek medical evaluation. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low and suitable reassurance can usually be given.

Breast pain is uncommon in men. Pain and tenderness may occur in men who develop gynecomastia secondary to medication, hormonal factors, cirrhosis and other conditions. Cyclical breast pain is clearly only confined to women but both non-cyclical breast pain and extramammary pain can occur in men. The assessment of these types of pain is similar for men and women.

Classification

Breast pain is typically approached according to its classification as:

  • Cyclical breast pain - breast pain that has a clear relationship to the menstrual cycle and the most common type of breast pain.
  • Non-cyclical breast pain - may be constant or intermittent but is not associated with the menstrual cycle.
  • Extramammary (non-breast) pain - is interpreted as having a cause within the breast but arises from elsewhere (chest wall or other sources).

The classification is important because the assessment and response to treatment is different for the different types of breast pain.

Epidemiology

  • Only about half of patients with breast pain seek medical advice.
  • This is a common presentation in general practice, usually in women aged 30-50 years.
  • In patients attending specialist clinics and general practice for breast problems, breast pain is given as the reason for attendance in about half of patients.
  • In a series presenting to a breast pain clinic, most patients were found to have cyclical breast pain (54%). Other presentations were trigger zone pain (localized single tender area in the breast (14%) or continuous pain (8%). Tietze’s syndrome (5%), spinal root pain (4%), duct ectasia (4%) and psychological depression (2%) account for most others). Approximately 10% were undiagnosed.

Presentation

Symptoms

The history should be directed toward identifying and characterizing breast-related symptoms. Establish:

  • Quality and severity of pain (ranges from mild discomfort to severe tenderness and pain).
  • Site of pain.
  • Any relationship to activity.
  • Presence of other breast symptoms (lumps, discharge).
  • Relationship to menstrual cycle. Establish whether the pain is cyclical, ie worse in the luteal phase, but may persist throughout, or whether it has no relationship to menstrual cycle.
  • Medication history.
  • Reproductive, medical and family history.

Normal or physiological breast pain

  • Mild premenstrual breast discomfort lasting for 1 to 4 days can be considered "normal".
  • In order of decreasing frequency, premenstrual breast symptoms are tenderness, swelling, pain and lumpiness.

Cyclical breast pain

  • Women who experience more severe and prolonged pain are considered to have cyclic mastalgia.
  • Research studies use methods to measure the severity and duration of pain. Cyclic mastalgia is taken to be more severe pain lasting for more than 7 days per month.
  • About 10 to 20% of women will meet the criteria for cyclic mastalgia.
  • Pain may be present to a lesser degree during the entire cycle (with premenstrual intensification).
  • The pain is typically in the upper outer breast area. It often radiates to the upper arm and axilla.
  • Most cyclic mastalgia is diffuse and bilateral (may be more severe in one breast).
  • Pain is described as "dull", "heavy" or "aching".
  • It is important to ask about medical history and any associated problems. Such problems are common and disruptive. Likely findings include:
  • Sleep problems.
  • Work, school and social disruption.
  • Previous investigations (including mammography and breast biopsy) are more likely and often under age 35.

Non-cyclical breast pain

  • It is less common and typically accounts for approximately 31% of women seen in breast pain clinics.
  • It tends to be unilateral and localized within a quadrant of the breast.
  • Non-cyclic breast pain presents later (fourth or fifth decade). Many women are postmenopausal at onset of symptoms.
  • Most non-cyclic breast pain arises for unknown reasons.
  • It is more likely to have an anatomical rather than hormonal cause (with the exception of breast pain associated with medication).
  • A minority of non-cyclical breast pain is explained by pregnancy, mastitis, trauma, thrombophlebitis, breast cysts, benign tumors or cancer.
  • A wide range of drugs have been associated with breast pain. Between 16% and 32% of women report breast pain with estrogen and combined hormonal therapies. Other drugs associated with breast pain include antidepressants (including venlafaxine and mirtazapine), cardiovascular drugs (including digoxin and spironolactone) and other drugs including metronidazole and cimetidine.

Extra mammary pain

Extra mammary pain due to various conditions may present as breast pain. There are many such conditions but most common are costochrondritis and other chest wall syndromes.

Signs

  • Clinical breast examination requires careful inspection and palpation of each breast (including nipple and areola), together with examination of the regional lymph nodes.
  • Palpation may demonstrate an abnormality. Commonly it reveals coarse nodular areas resembling bundles of string in the breast, but check carefully for any discrete lump.
  • It may be appropriate to examine other potential causes of the pain. Examination of the cervical and thoracic spine, chest wall, shoulders, upper extremities, heart, lungs and abdomen may help further diagnostic evaluation.

Associated diseases and risk factors

Chronic pelvic pain, premenstrual syndrome, fibrocystic disease and caffeine intake.

Differential diagnosis

Breast-related:

  • Cyclical breast pain
  • Non-cyclical breast pain
  • Mastitis
  • Breast trauma
  • Thrombophlebitis/Mondor's syndrome
  • Breast cysts
  • Benign breast tumors
  • Breast cancer

Musculoskeletal

  • Chest wall pain
  • Costochondritis/Tietze's syndrome
  • Chest wall trauma and/or rib fracture
  • Fibromyalgia
  • Cervical and thoracic spondylosis/radiculopathy
  • Shoulder pain
  • Herpes zoster
  • Thoracic outlet syndrome
  • Bornholm disease

Miscellaneous causes

  • Coronary artery disease/angina
  • Pericarditis
  • Pulmonary embolus
  • Pleurisy
  • Gastroesophageal reflux
  • Peptic ulcer disease
  • Cholelithiasis/cholecystitis
  • Sickle cell anemia
  • Psychological
  • Pregnancy
  • Medication, i.e. contraceptive pill

Investigations

Ultrasound of the breast and mammography in patients with breast pain is often used to investigate and rule out a physical cause for the pain, i.e. cysts, nodules, and/or cancer.

Management

Management will depend on the cause but a variety of measures which have been routinely recommended by some in the past should no longer be so recommended.

Measures not routinely recommended include:

  • Diets low in fat and high in carbohydrate, or low in caffeine
  • Stopping or changing other medication, including combined oral contraceptives
  • Evening primrose oil
  • Progestogen-only contraceptives
  • Antibiotics
  • Diuretics
  • Pyridoxine
  • Tibolone
  • Vitamin E

Cyclical breast pain

First-line management

  • Reassurance that the pain is not due to breast cancer and an explanation as to its hormonal nature may be all the management that some women require.
  • A better-fitting bra and simple analgesia is the first line of treatment. Simple non-opioid analgesia can be helpful for mild discomfort.
  • Topical diclofenac may be helpful. There is some consensus that topical NSAIDS are effective and well tolerated.
  • Changing from the contraceptive pill to a mechanical method is sometimes helpful if symptoms are severe.
  • Although there is little evidence to support its use, some women find a soft support sleep bra helpful at night.
  • Continue treatment for 6 months before considering second-line treatment.

Second-line management

A diary of pain and symptoms for 2 months may help in assessment. Further treatment may include:

  • Danazol (an anti-gonadotrophin) is licensed for severe pain and tenderness in benign fibrocystic breast disease which has not responded to other treatment. GPs inexperienced in its use may wish to refer to a consultant before prescribing. Adverse effects (commonly nausea, dizziness, rash, and backache) can be minimized by reducing the dose of danazol to 100 mg from initial starting dose of 300 mg daily, and restricting treatment to 2 weeks preceding menstruation. Non-hormonal contraception is essential as danazol has androgenic effects in the fetus.
  • Tamoxifen (an estrogen-receptor antagonist) is effective and one trial suggested its benefits lasted longer than that of danazol. However, it is not licensed for mastalgia in the UK. There is a consensus to limit its use to no more than 6 months under expert supervision due to high incidence of adverse effects (commonly hot flushes, vaginal discharge, gastrointestinal symptoms). Non-hormonal contraception is required during use because of potential teratogenicity. There is a risk of thromboembolism but there is no long-term evidence to suggest this is a significant adverse effect at a dose of 10 mg given from days 10 to 25, which is the standard dose for mastalgia and lower than the dose used for breast cancer.
  • Goserelin injections (a gonadorelin analogue inhibiting gonadotrophin release) are occasionally used for severe refractory mastalgia. The incidence of side-effects (mainly vaginal dryness, hot flushes, decreased libido, oily skin or hair, decreased breast size, irritability) can be reduced by using tibolone or hormone replacement therapy.
  • Bromocriptine is now rarely used because of frequent and intolerable adverse effects (mainly nausea, dizziness, postural hypotension, constipation). In one large trial, the overall withdrawal rate was 29%.
  • Toremifine (a selective estrogen-receptor modulator).

Non-cyclical breast pain

  • Chest wall pain often responds to NSAIDs, i.e. ibuprofen, alleve, motrin.
  • Trigger spots sometimes respond to infiltration with local anaesthetic and steroid injection.
  • For true diffuse breast pain a support bra, oral or topical NSAIDS may be helpful.
What is Breast Cancer?

The first step in understanding breast cancer is learning about cancer in general and what causes it. Put simply, there is no single specific cause for any type of cancer, as many different factors from lifestyle to genetics have been known to play a part in causing cancer. Cancer is a disease in which a cell loses some of its basic functions and becomes unhealthy to the body and other cells around it. These functions vary depending on the type of cell and cancer, but usually these changes result in rapid, unchecked, reproduction of these cancerous cells. As time passes these cells accumulate in a mass known as a tumor, which appears as a hard bump to the touch. In cases of breast cancer, the lumps felt under the skin of the breast are such a tumor. Luckily, advances in modern medicine mean that having cancer is not the end of the world, and there are many ways in which oncologists and surgeons can fight cancer and often times remove it from the body entirely. You can learn more about some of the ways this is accomplished in the Treatments section of this website, found here. Breast cancer is just another type of cancer that starts in the same fashion, but within the tissue layers of the breast. Usually, the origins of such cancerous tumors are found along the milk ducts or lobules, which produce milk within the breasts. As such, cancer found in the milk ducts is called ductal carcinoma whereas cancer in the lobules is known as lobule carcinoma.

What are the risk factors of Breast Cancer?

While there is no specific known cause for breast cancer, research has revealed a number of risk factors that may promote the development of cancerous tumors. In no particular order, they are as follows:

  • Gender: Breast cancer has been found to almost exclusively affect women, making gender the biggest risk factor for developing the disease.
  • Age: As a woman gets older, the fatty tissue in her breasts begins to form lumps naturally, although there is no way of telling if these lumps are cancerous without further testing.
  • Genetics: Studies have found that two genes, BRCA1 and BRCA2, that are key in repairing damaged cell DNA and stopping abnormal cell growth. If these are mutated, however, then a woman’s chances of breast cancer increase significantly.
  • Family history: A woman’s risk of developing breast cancer at some point in her life nearly doubles if a close relative (mother, sister, or daughter) has had or develops breast cancer as well.
  • Menstrual Periods: If a woman began menstruating before the age of 12 or did not enter menopause until after age 55, then she is at an increased risk of breast cancer due to increased exposure to estrogen. Estrogen is a naturally occurring female hormone that develops feminine body characteristics, such as the breasts. Studies have shown that, in excess, estrogen has been linked to the development of breast cancer.
  • Not having children or having them later in life.
  • The use of combination hormone replacement therapy.
  • Not breast feeding.
Are there different kinds of Breast Cancer?

There are also two kinds of pre-cancerous lesions that can be detected and alert cancer specialists to the increased potential of cancer developing later in life. The first is lobular carcinoma in situ (LCIS), which is found in the lobules, or milk producing glands, but not penetrating the lobular wall into the rest of the breast tissue. This condition is not a true cancer, but there is a 7 to 11 times greater risk of developing breast cancer after having this condition, and so LCIS is considered a signal to begin a more frequent screening plan for breast lumps than other patients. The second pre-cancerous lesion is known as atypia. This condition is found as atypical ductal hyperplasia and atypical lobular hyperplasia. Put simply, these conditions are lesions that are easily detected and signal future cancerous potential, similar to LCIS.

There are four different types of breast cancer, each of which necessitates a different treatment strategy. The first, Ductal carcinoma in situ (DCIS), is found in the breast duct and is non-invasive, meaning that the cancer has not yet spread from the ducts to other parts of the breast. The second, and most common, type is known as invasive ductal carcinoma (IDC). This cancer accounts for about 8 out of every 10 cases of breast cancer, and has spread from its origin in the breast ducts. This cancer has the ability to metastasize, or spread to other parts of the body, if not treated promptly. The third type of cancer is known as invasive lobular carcinoma (ILC), and is very similar to IDC except that it only accounts for about one out of every 10 incidents of cancer and it originates in the lobules, or milk producing glands. The final type of cancer is known as inflammatory breast cancer (IBC), and is generally uncommon. It is not easily diagnosed, such as through the detection of a lump, and instead is detected through irritation of the breast skin. Patients with IBC may note that their breasts feel bigger, firmer, and itchier.

What are the stages and grades of Breast Cancer?

Stages

Often times when a patient is diagnosed with cancer their specialist will discuss in what stage the cancer is found. Stages of cancer, specifically breast cancer, refer to general sizes and characteristics of tumors that affect how a breast specialist may choose to treat them. It is important for patients to understand as much as possible about their stage of breast cancer so that they are as informed as possible about their treatment plan and can decide if there is any way to better maintain their health through treatment (i.e. diet, massage.) Tumor stage follows a TNM system, which stands for Tumor, Node, and Metastasis. Combining the size of the tumor, any nearby affected lymph nodes, and spreading to other parts of the body, the stage of each patient’s cancer can be determined. The stages of breast cancer are listed below:

Stage 0

DCIS, LCIS or pure carcinoma in situ, no spreading to nearby lymph nodes, no metastasis to other body parts

Stage IA

A tumor 2 cm or less at greatest dimension, no spreading to nearby lymph nodes, no metastasis to other body parts

Stage IB

Tumor is 1 mm at greatest dimension, micrometastases have formed in lymph nodes, no metastasis to other body parts

Stage IIA

Tumor is 1 mm at greatest dimension and has spread to 1-3 axillary lymph nodes, but has not metastasized to other body parts OR tumor is greater than 2 cm but less than 5 cm at greatest dimension but has not spread to lymph nodes or metastasized to other body parts

Stage IIB

Tumor is greater than 2 cm but less than 5 cm at greatest dimension, has spread to 1-3 axillary lymph nodes, and has not metastasized to other body parts OR tumor is more than 5 cm at greatest dimension but has not spread to lymph nodes or metastasized

Stage IIIA

Tumor ranges in size from 1 mm to 5 cm at greatest dimension, has spread to 4-9 axillary lymph nodes, and has not metastasized OR tumor is greater than 5 cm at greatest dimension, has spread to 1-9 axillary lymph nodes, and has not metastasized

Stage IIIB

Tumor is of any size and is growing into chest wall or skin, has spread to up to 9 axillary lymph nodes, and has not metastasized to other body parts

Stage IIIC

Tumor is of any size noted in previous stages, has spread to 10 or more lymph nodes under the arm or other locations near the breast, and has not metastasized to other body parts

Stage IV

Tumor may be any size noted in previous stages, any number of lymph nodes may be affect, and cancer has metastasized to other body parts

Grades

Although cancer may be found at any of these stages listed above, this information does not reveal how likely the cancer will remain in that stage. Cancer cells are mutated normal cells, but without conducting tests on them there is no way to determine the degree of mutation. Depending on test results, cancer cells are assigned a grade that reflects the observed differences between the two cell types.

Grade I

Grade I cells have minor differences from normal breast cells and tend to be slow growing

Grade II

Grade II cells have visible differences from normal cells and grow at a moderately increased rate

Grade III

Grade III cells have significant differences from normal cells and are growing at a very accelerated rate

Male Breast Disease

The male breasts are susceptible to many of the same pathologic processes as the female breasts and are diagnosed with the same imaging modalities (Mammography, Ultrasound - US and Magnetic Resonance Imaging –MRI).

Mammography is the initial imaging modality for a clinically suspicious mass. A palpable mass that is occult or incompletely imaged at mammography mandates targeted US. Suspicious or indeterminate masses require biopsy, which can usually be performed with US guidance.

An ultrasound-guided breast biopsy uses sound waves to help locate a lump or abnormality and remove a tissue sample for examination under a microscope. It is less invasive than surgical biopsy, leaves little to no scarring and does not involve exposure to ionizing radiation.

Gynecomastia (swelling of the breast tissue in boys or men, as a result of normal changes in hormone levels, though other causes also exist) is the most common abnormality of the male breast. Gynecomastia can affect one or both breasts, sometimes unevenly, and can produce pain. Gynecomastia may go away on its own. If it persists, medication or surgery may help.

Benign (noncancerous) breast neoplasms that may occur in men include angiolipoma, schwannoma, intraductal papilloma, and lipoma.

Other benign neoplasms that may occur in the male breast include intramammary lymph node, sebaceous cyst, diabetic mastopathy, hematoma, fat necrosis, subareolar abscess, breast augmentation, venous malformation, secondary syphilis, and nodular fasciitis.

Male breast cancer is very rare. Less than one percent of all breast cancer cases develop in men, and only one in a thousand men will ever be diagnosed with breast cancer.

Following are breast cancers found in men:

Treatment is determined by the stage of the tumor, cancer cells hormone receptors, amount of HER2 protein, your overall health and personal preferences, and how fast the cancer is growing. Surgery, hormone therapychemotherapy (chemo) and/or targeted radiation therapy are options to be considered.

The following factors can raise a man’s risk of breast cancer:

  • Family history of breast disease or presence of a genetic mutation.
  • Age. The average age for men to be diagnosed with breast cancer is 65.
  • Elevated estrogen levels.
  • Klinefelter’s Syndrome.
  • Liver Disease.
  • Low doses of estrogen-related drugs that are given for the treatment of prostate cancer may slightly increase the risk of breast cancer.
  • Lifestyle factors.
  • Being obese or even overweight increases the risk of breast cancer.
  • Lack of exercise may increase the risk of breast cancer because exercise lowers hormone levels, alters metabolism, and boosts the immune system. Increased physical activity is associated with a decreased risk of developing breast cancer.
  • Drinking 2 or more alcoholic drinks per day may raise the risk of breast cancer. However, this risk factor has not been studied in men.

Be aware!

Men should know their family history and be familiar with the feel of their breast and chest wall tissue, so they can talk with their primary care doctor if they notice any lump or change and subsequently make an appointment with a specialist.

How can I check for Breast Cancer?

There are a number of ways to check for breast lumps in order to facilitate better prognoses if a cancerous lump is found. The first line of defense in protecting your breasts’ health is a monthly self examination. This process should begin in a woman’s mid-20’s and occur at the same time every month. Beginning self-examination early in life gives a woman a good idea of how her breasts feel, and so any unusual change can be detected right away. In addition to self-examination, every woman in her 20’s and 30’s should have a clinical breast exam once every three years, and every year in her 40’s and older. Finally, upon reaching 40 years of age, it is recommended that a woman should have a yearly screening mammogram to promote detecting any changes in her breasts at the earliest stage possible. Employing all of these measures will not prevent breast cancer, but it will give women the best chance of detecting possible breast cancer early in development, when it is at the most treatable stage.

What happens if I find a lump?

If any screening test does detect a lump, the most important thing to do is to remain calm. There are benign breast lumps, and often they require no medical attention other than careful observation to ensure that they do not become larger or begin to cause discomfort for the patient. As discussed in the section about risk factors, a woman’s fatty breast tissue begins to form lumps naturally as she ages, and so it is not unexpected that a mammogram or clinical examination would detect something that may not necessarily be cancer.

Benign Cyst

A good example of such a benign lump is a breast cyst, which may also be referred to as fibrocystic disease. A cyst is a fluid-filled sac that may develop in a woman’s breast. They are not cancerous in any way, but may signal a patient’s pre-disposition to developing cancer, so a breast specialist should be notified as with any other lump. Cysts are most common in pre-menopausal women and are known to resolve themselves after menopause, but they can develop at any age. Generally, women who are still menstruating may experience pain during the second half of the menstrual cycle. Additionally, this pain may be exaggerated by childbirth, stress and caffeine. A cyst may feel like a grape or firm lump during a self examination, but an ultrasound or aspiration can easily determine the nature of the lump and whether or not it is fluid-filled. If the cyst is painful to the patient, it may be removed as would any other breast lump or be aspirated, in which a needle is used to drain the sac of the fluid within it. There is a very low chance that a benign cyst will turn into a malignant lump, but cysts do indicate the potential for cancer to develop in the breast. This makes self-examination and regular mammograms especially important for these women.

Fibroadenoma

Another similar benign breast lump is known as a fibroadenoma. This lump tends to be smaller and firmer than a cyst, and is slow growing. Women usually develop fibroadenomas during childbearing years, and they can also resolve themselves following menopause. Like breast cysts, they must also be analyzed further with techniques such as ultrasound or biopsy in order to confirm that they are not cancerous lumps. Like benign cysts, fibroadenomas may also be left in the breast and observed so long as they do not become too large in size or cause discomfort for the patient.

Phyllodes Tumor

Phyllodes tumors are a rarer form of benign breast lump than cysts or fibroadenomas, and they develop in the connective tissue of the breasts rather than the lobules or ducts. In very rare cases, this lump may prove to be malignant, but in either scenario the best option for treatment is removal of the tumor. Depending on whether or not the tumor is malignant and the overall size of the tumor, a lumpectomy may be conducted with smaller margins removed in benign cases and larger margins for malignant tumors. If the tumor is too large, a mastectomy may be opted for instead. If a malignant phyllodes tumor has been found to metastasize, then a chemotherapy plan for soft tissue sarcomas may be used to combat this problem or to shrink tumor size before removal.

Breast Pain (Mastodynia)

There are a few other problems that women may encounter with their breasts that share some symptoms with cancer but are not malignant. The first of these problems is simply breast pain, or mastodynia. While this may seem to signal a serious problem with a woman’s breasts, this pain may also be cyclical in nature along with the menstrual cycle. This cyclical pain may be most intense before the start of a woman’s period due to fluid filling the breasts, and subside after the period begins. If the fluid does not completely drain, a compounding effect may occur over multiple periods, making the pain seem more constant.

Nipple Discharge

Another commonly observed breast problem is nipple discharge. It is generally not serious, but should be discussed with a physician if it occurs in only one breast, or is a color other than white, such as yellow or green. Spontaneous discharge, called galactorrhea, is not cancerous and is usually colored milky white. Bloody discharge is usually related to infection or an overgrowth of ductal cells known as intraductal papillomas. In rare cases, bloody discharge can be caused by cancer, meaning that if it does occur it should still be reported to a physician.

Is Breast Cancer preventable?

Exercise

While there is no direct way of preventing breast cancer, there are a number of factors that studies show can reduce the chances that breast cancer will occur if controlled appropriately. Two such factors are weight and diet. Research has shown that exercise and avoiding high cholesterol diets can help to prevent the occurrence of breast cancer. This is because of fatty tissue’s ability to produce estrogen, which increases the risk of breast cancer development. Regular exercise in addition to healthy eating goes a long way in maintaining energy levels for patients that are either preparing for or have undergone surgery, radiation therapy, or chemotherapy. While this may seem like quite an intimidating task due to the fatigue that treatment for breast cancer may cause, studies have shown that even periods of exercise as short as 15 minutes a day are a great start to improving one’s health and speeding up recovery.

Hormone Therapy

Hormone therapy shares its method of preventing breast cancer with exercise in that both types of treatment work to reduce the overall level of estrogen in the body, and limit the activity of potentially cancerous breast cells. If a patient has suffered from breast cancer that was proven to be hormone receptor positive, then a specific therapy plan may be devised to block these receptors from future stimulation by estrogen in the body, known as a SERM therapy. SERM (Selective Estrogen Receptor Modulator) therapy is useful in not only blocking known cancerous receptors within a patient’s body, but preventing other breast cell receptors from being used by cancerous cells in the same fashion.

Avoiding estrogen products

To further insure that breast cancer does not develop in patients that are determined to be at an increased risk for the disease or have suffered from previous episodes of cancer, it is generally agreed upon that hormone supplements should be avoided. Primarily, this concerns hormone replacement therapy that may be pursued following menopause. Although there is no significant statistical work available to validate avoiding treatments such as this, specialists agree that the risks of prolonged increased exposure to estrogen and progesterone are too great compared to any benefits obtained from the therapy. It is important to note that these conclusions were determined for orally administered hormone therapy, and that vaginal and other more localized hormone treatments have not been studied as intensely and may not have the same potential risks.

Myths About Breast Cancer

Antiperspirants do not cause breast cancer

Recent claims have asserted that breast cancer can be caused through the use of antiperspirants because the lymph nodes are unable to drain toxins found within the lymph fluid. As a result, these toxins pool in the breasts and can lead to mutations that cause cancer. There are a number of reasons that these claims do not make sense, starting with the fact that there are many other places on the body that can perspire besides the underarms. Additionally, it follows that if antiperspirants were to trap toxins in the lymph nodes, there would be a much larger rate of cancerous lymph nodes compared to breast cancer, as those areas would be exposed to toxins first. This is not the case, meaning that it is unlikely any toxins are being trapped. Finally, in the lymph system, lymph nodes under the arm would drain fluid away from the breasts to other parts of the body, meaning that these alleged cancer causing toxins would not even enter the breasts.

Birth control pills do not cause breast cancer

Logic would show that breast cancer can be caused by birth control pills, given that they contain estrogen and progesterone. However, numerous studies have shown that there is no correlation between breast cancer and birth control pills. Although one study did combine the data taken from numerous previous studies and did find a correlation, the increase in breast cancer risk was minimal and decreased over exposed birth control usage. On the contrary, studies have proven that birth control pills actually have benefits that include decreasing ovarian and endometrial cancer risk, relieving menstrual disorders, and improving bone mineral density.

Eating high fat foods does not cause breast cancer

While it has been proven that excess fat tissue increases estrogen levels inside the body, there has been no study showing that a high fat diet directly increases the risk of developing breast cancer. High fat diets may include high density lipoproteins (HDLs), which are needed by the body and actually help to reduce other low density bad cholesterol.

Self-examination alone is not the best way to check for breast cancer

In the past, some publications have asserted that breast self examination is the best way for aging women to detect breast cancer. This is a dangerous and false assertion, as studies have shown that a breast lump is much more likely to be detected by mammogram alone than self examination, and if the woman elects to perform both self examination and receive regular mammograms, then that likelihood rises even further. Therefore, it makes sense that in order to ensure one’s breast health, they should not simply rely on self-examination to diagnosis potential problems.

Other common misconceptions

There is also no increased risk of developing breast cancer from the following things:

  • Wearing a bra
  • A blow or injury to either breast
  • Drinking milk
  • Having breast implants
Breast Health Quick Age Guide

For women younger than 40

Women younger than 40 tend to have denser breast tissue and are at a lower risk of developing breast cancer. As such, regular mammograms are not required at this point in their lives and may be substituted for regular monthly self-examinations starting in the mid-20’s. These examinations should be conducted at approximately the same time every month. They may involve either visually examining the breasts in a mirror to look for any changes between months, or feeling the breasts, collarbone, and underarm regions for any lumps or lumpiness in either breast. Although there is no specific guideline that dictates a regular breast examination by a practicing physician, there are certainly no drawbacks to having this performed regularly. As such, if women are unsure of what is considered normal when feeling their breasts, it may be beneficial to have a physician regularly examine a woman’s breasts as well, but no more often than once every three years.

For women ages 40-49

Maintaining breast health in this age range is very similar to maintaining breast health before 40 years of age. The only differences between these two age groups are the increase in clinical examinations to once every year, and the recommendation to begin an annual mammogram to provide a more in depth diagnostic examination of the breasts.

For women ages 50-69

In addition to continuing self examination, studies have shown that this age group receives the most benefit from receiving regular mammograms and examinations by a breast health specialist. This is due to the fact that most women enter menopause at this time, at which point their risk of developing breast disease increases and their breast tissue becomes less dense, allowing for easier screening through mammography.

For women of any age at higher risk of breast cancer

Any woman that has suffered from, or who has an immediate relative that has suffered from, prior cases of DCIS, LCIS, or invasive breast cancer, is deemed to be at a higher risk for developing breast cancer. Those women should have regular mammograms following treatment of these conditions along with regular self examination and clinical examination. Depending on the number of factors that increase a woman’s personal risk for developing breast disease, an individualized testing plan may designed to provide the best chance to detect any problem at the earliest possible stage.

Breast Cancer Risk Assessment Tool

The Breast Cancer Risk Assessment Tool estimates a woman's risk of developing invasive breast cancer. The tool is NOT for use by women who have a diagnosis of breast cancer or a medical history of ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS). Click the link below to assess your risk of breast cancer.