When I started this blog, one of my chief goals was to provide up to date medical information to my readers. I know it isn’t trendy or entertaining, but it is SUPER important. I’m in the middle of my 4th year of medical school, and I go into residency and eventually my own practice, one of things I am so passionate about is making sure patients are well informed. There is so much inaccurate information out there, especially on the internet…yes I see the irony. But we should all know our bodies and be able to hold our primary care providers accountable.
This first post is about breast cancer screening. If you read the title, you are probably thinking ‘Duh, we are not idiots’. I know, but if you have major attention span issues like I do, maybe you need a little reminder. I got your back. Breast cancer screening is probably one of the most confusing aspects of women’s health because the recommendations are constantly changing and different committees say completely opposite things. Like, figure it out peeps and stick to your guns.
Here is the most important information you need to know. All of the info is from uptodate, which is the primary source most medical professionals use when they are trying to figure out what the latest and greatest information is about anything and everything in medicine. It is kinda awesome.
The Bare Bones of Breast Cancer Screening:
- When to start: The recommendations vary based on who you ask. Basically, for sure you should be screening every 1-2 years for sure by the time you are 50. Based on your risk factors (do you have first degree relatives who have had breast cancer, are you a BRCA gene carrier, have you had radiation treatment to your chest, or do you have some rare tumor syndrome like Li-Fraumeni or Cowden Syndrome), you might start screening at 40 and go yearly or every 2 years. Talk things over with your primary care provider and together you can decide what would be best for you. Team work at its finest!
- When to stop: Generally between 74-75. If you are super-duper healthy, first and foremost, you go Glen CoCo; second, you may want to screen for a little bit longer. Typically we stop screening if the life expectancy is less than 10 years, but people are living longer and longer, so who knows how this will change.
- Clinical Breast Exams: Your primary care provider should be doing these every 1-3 years from the age of 21-39, and then annually after that. Where I have trained, we do clinical breast exams yearly.
- Self Exams: The recommendations for this have completely changed. Now we tell women to either do exams regularly, or don’t do them at all. If you do them sporadically, you might find what is just some cyclical breast tissue changes, and get nervous and go rush and get a biopsy. If you are concerned, absolutely go see your doctor. If you do regular exams, you will know what your normal is.
- How to do a Self Exam:
- Stand in front of the mirror with your hands at your side. Look for nipple inversion or retraction (where your nipples look like they are going back into your chest). This can be a normal variant in women, but if it is something new, it should absolutely be followed. Look for any color changes like an orangish tinge to your tissue, or dimpling, these can also be concerning.
- Lift your hands overhead and turn to the side. If the tissue has a smooth contour, this is reassuring. Again, any retraction or dimpling is what you are looking for.
- Lie down and put one arm behind your head. With your other hand, using the tabs of your middle three fingers and in circular motion, move your fingers across your breast from top to bottom, like you are mowing the lawn – I know, super weird analogy, but basically – you don’t want to miss any tissue. Make sure to also analyze the tissue up into your armpit and just to the side of it. You have this triangular piece of tissue that extends almost to your shoulder that is a very common place for masses to grow. We don’t think of it, because it doesn’t look like breast tissue, but it is an extension of it and should be assessed. Apply light, medium, and then deep pressure as you move your fingers. Switch arms and do the other side. Bumpy areas that are painful and move are generally okay. Hard areas that are not painful and do not move are not normal.
- Remember, that you do have ribs underneath your breast tissue. If you are feeling a long hard area and can follow it to your sternum or out to the side, it is a rib. Seems silly, but when you are being hyper-aware and are really concerned, you could very well think this is a mass. Rest assured, it is just bone.
- Finally, if you ever find something you are concerned about, please go see your doctor. We live in a world of better safe than sorry, and breast cancer is obviously much more manageable when caught early.
- Breast MRIs: People are getting pretty excited about this. It is more sensitive than mammograms, but there are way more false-positives, which means making women nervous about having cancer when they don’t need to be, and doing more unnecessary biopsies. For right now, this is something that is reserved people with the risk factors above (BRCA gene carriers, first degree relatives of people with the BRCA gene) – essentially for those who have a lifetime risk of 20-25% or greater.
- Abnormal Findings: When you have a mammogram, there is always the possibility that there will be something questionable. The radiologist’s job is to find anything that could possibly be cancer and investigate it further. Following an abnormal reading, you will have to have a biopsy. Fortunately, nine times out of ten, the abnormality is not cancer at all. It could be some kind of fibrous tissue, vessels, the way the image was taken, etc. Long story short, an abnormal mammogram is not always an indication of cancer, in fact, more often than not, there won’t be cancer.
That’s all folks. I know, it is a lot of information. Hopefully it’s helpful. Let me know if you have any questions!
XOXO – Emmy Lou Lou