Breast Cancer Awareness: Insights From a Midwife

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October is Breast Cancer Awareness Month, so I wanted to provide a resource regarding the signs, symptoms, risk factors, and early detection measures. Breast cancer affects 1 in 8 women in the United States, and even though it’s not talked about enough, it also affects men. Early diagnosis is key and many times women will feel an abnormal lump on their own before their annual wellness visit. It’s imperative that you are aware of the signs to look out for, as well as the best way to examine your own breasts. Let’s jump into the details below!

Risk Factors

• Gender - Although both men and women can have breast cancer, women are 100 times more likely to have it

• Age - invasive cancer is more likely to be diagnosed in women over 55

• Race - Diagnosed more often in White women, but that could be more indicative of access to care and health insurance. When Black women are diagnosed, it’s usually in a later stage, which shines a light on the health disparity that is present.

• Family History - Your risk increases if you have an immediate family member with breast or ovarian cancer, especially if they were diagnosed before 50.

• Personal History - If you have/had cancer in one breast, your risk increases for having it in your other breast.

• Menstrual/Reproductive History - Starting your periods before 12, menopause after 55, having your first child after 30, or never having a child increases your risk for breast cancer.

• Gene Mutations - BRCA1 and BRCA2 gene mutations can increase your risk.

• Dense Breast Tissue - can make it more difficult to detect a lump. If your mammogram shows that you have dense breasts, your provider should consider ordering an ultrasound.

• Lifestyle Factors - Lack of physical activity, poor diet, and frequent alcohol use can increase your risk.

• Radiation to Chest - Receiving radiation to the chest area before 30 can increase your risk.

Signs/Symptoms

• Lump in the breast area - can also be found in the underarm area

• Change in skin texture or enlargement of pores of the skin (orange peel’s texture)

• Nipple tenderness

• Change in the size/shape of the breast that can’t be explained

• New onset asymmetry - one breast is swollen or one breast is shrunken

• Nipple turned inward

• Dimpling on the breast

• Skin becomes scaly or red

• Nipple discharge - bloody or clear

Early Detection

As I mentioned earlier, it makes a huge difference when breast cancer is detected early and therefore, treated early. Once it spreads, it becomes more difficult to treat and the survival rate greatly decreases. Here are some ways to increase your chances for early detection.

Self Breast Exams - I always advise that women are familiar with their breast and know what is normal for them. No one knows your body better than you, and you will be more aware of a change before anyone else. The research is controversial and some people don’t recommend self breast exams. They feel that it leads to panic and unnecessary testing. However, I don’t think there is anything wrong with learning your body and in my experience, women are the first to realize something is wrong and are motivated to come in for a visit. You can perform the exam once a month.

• In the shower - Raise one arm behind your head and use pads of your 3 middle fingers to feel the entire breast and armpit area with light, medium, and firm pressure. You can go in a parallel pattern up and down the breast or a circular motion. Many lumps are found in the armpit area so don’t forget to check there.

• In front of mirror - First, look with both arms at your side then raise them above your head. Notice any dimpling, nipple changes, swelling, asymmetry that is new. Lastly, put hands on your hips and flex your chest muscles, looking for dimpling, puckering, or changes.

• Lying down - Repeat the same procedure as you did in the shower. Raise one arm above and behind your head and use pads of 3 middle fingers to check breast area and armpit. Sometimes you can feel a lump laying down that you may not feel standing up, and vice versa.

The more you examine your breasts, you will know what’s normal. Don’t focus so much on whether something feels like a lump or not, focus on whether it feels or looks different.

Clinical Breast Exams - This is done once a year by your healthcare provider during your wellness exam. Your provider is trained to find abnormalities in the breast and often can find a lump that you weren't even aware of. If your provider finds something suspicious, they can refer you for further testing. If you find something suspicious at home during your self breast exams, you can always go in to see your provider, who will then conduct a clinical exam.

Mammogram - For women over 40, mammograms are recommended routinely every 1 to 2 years. If you have a family history, then screening may start at 35. Mammograms are a special X-ray that can detect lumps that may not be felt on exam, which is why they are recommended even if your manual breast exams are normal. You are exposed to a small dose of radiation during the mammogram, but not enough to cause breast cancer, as some people believe. Mammograms are safe and can even save your life by detecting something abnormal. Depending on the results of the test, your provider may order a follow up ultrasound, MRI, or biopsy to make a more informed diagnosis.

These detection measures are in place to hopefully lead to early treatment if needed. Timing is truly everything and can make the difference between survival rate.

Are you familiar with your breasts? If not, I urge you to start examining them regularly so that you are aware when something isn't right.

xoxo, Global Midwife

Disclaimer: This is only to be used for educational purposes, not as medical advice. Always check with your individual healthcare provider.