All About You & Your Breasts

By Dr. Ng Char Hong, Consultant Breast Surgeon, Breast Care Centre of Excellence, Sunway Medical Centre

There is no other body feature that symbolizes femininity in society more than a woman's breasts. But apart from that milestone moment of buying her first bra, breasts do not feature heavily as part of a woman’s total health. Most women only develop an intimate relationship with their breasts later in life, when they breastfeed their children or reach an age where they begin to screen for breast cancer. In fact many have come to equate breast cancer screening with breast health.

As you enter your 20s, 30s, 40s and 50s, your breasts change along with the rest of your body. Some women worry that their breasts are too big or too small or not firm and youthful as they once were. In childbearing years, women may wonder whether breastfeeding will affect the shape of the breasts. After menopause, a woman might be more concerned about breast cancer risk. But here is the one thing that every woman wants – healthy breasts for a lifetime.

Breast health through the decades

In your 20s - The habits you develop now can help reduce your lifetime risk of developing breast cancer.

1. Get a clinical breast exam and become breast aware. A clinical breast exam is a physical breast exam performed by a medical professional. During your 20s, a clinical breast exam and discussion about your overall health and personal risk factors is a good way to take stock of what’s “normal” for you. Do clinical breast exams yearly in your 20s and 30s. Perform monthly breast self-exams to be familiar with your breasts so that you will notice any small changes which you’ll want to bring to the attention of your doctor.
2. Find out if you are high risk. If breast cancer runs in your family, you’ll want to discuss with your doctor a personal plan for understanding your risk. For example, you may want to consider being tested for the BRCA-1 and BRCA-2 gene mutations, which are linked to an increased risk of breast cancer.
3. New moms should breastfeed for at least six months. Some studies suggest that breastfeeding may slightly lower breast cancer risk, specifically for women who breast feed for one and a half to two years.  A study released by the Fred Hutchinson Cancer Research Center showed breastfeeding six months or longer reduced breast cancer risk by 20 percent.
4. Exercise and eat right! Exercising at least 30 minutes per day, whether it’s by walking, biking, jogging, dancing or any other physical activity can reduce your breast cancer risk by about 20 percent. Plus, it’s a habit that is good for your bones, joints, heart and overall health. Eating healthy means limiting your intake of red meat to four ounces per day on average and avoiding processed meat.

In Your 30s - Cultivating breast health awareness is key in this decade. Fortunately, in the 30s, breast problems tend to be benign (noncancerous). Although breast cancer rates for women in their 30s are still pretty low, it’s time to start monitoring your breasts for changes. Younger women commonly experience fibrocystic breast disease, a broad term that is characterized by breast pain, cysts, and noncancerous lumpiness. Breast pain can be cyclic, coming with menstrual periods, or it can be more persistent. Fibroadenomas can also affect women in their 30s. These rubbery lumps made of fibrous and glandular tissue aren't cancerous, but they can hurt. If they're bothersome, they can be surgically removed.

In addition to continuing the healthy habits you cultivated in your 20s, there are a few more things you can consider:

1. Get a clinical breast exam and become breast aware. Continuing to receive clinical breast exams yearly while in your 30s.
2. Evaluate your risk to determine a plan of action. Monitor your own breasts for changes and report any concerns to your doctor. If you’re in a high risk group due to family history, your doctor may want you to start getting annual mammograms or MRIs.
3. Keep stress in check. A recent study of women under 45 found that exposure to several stressful life events, such as divorce or death of parents, were associated with breast cancer. Cultivating happiness and optimism boosts your natural defense against illness. Simply adopting a “don’t worry, be happy” mantra won’t protect you from cancer, but a positive outlook will help you stick to all the other good habits you’ve developed, contributing to an overall healthy lifestyle.

In Your 40s - When you hit 40, you really need to start being vigilant about your health. At this point in life, breast cancer rates start to increase with one third of breast cancers in Malaysia diagnosed in women in their 40s. Cysts are the most common type of breast lump seen in women during their 40s, although cysts can develop at other ages as well. These fluid-filled sacs aren't cancerous, but they can be painful. Doctors can drain or surgically remove them. Cellular hanges like atypical ductal hyperplasia may also begin during this decade. These abnormal cells in the milk ducts increase a woman's chances of breast cancer.

In addition to eating right, exercising and limiting stress, remember to do the following:

1. Schedule an annual mammogram and clinical exam. Women age 40 and older should get a mammogram and a clinical breast exam every year. Also, stay familiar with your own breasts: If you notice any changes, tell your doctor about them immediately. Chances are good that any changes you notice, such as fibrocystic breast changes, are harmless, but it’s still essential to have anything new or unusual checked out.
2. Avoid unnecessary exposure to cancer-causing substances. This includes radiation and chemicals. Make sure that any physician who orders an x-ray for you, especially high dose types like CT scans, knows how many other x-rays you’ve had. Unless it’s an emergency situation, you should ask if there are alternative examinations for your situation, such as an ultrasound or MRI. Your doctor will help you weigh the relative risk of momentary exposure to radiation versus not having an X-ray or CT scan that may be medically necessary. Scientists have identified over 200 potential breast carcinogens. Opt for foods and products containing mostly natural ingredients.

In Your 50s and Over - As menopause hits, the risk of developing breast cancer continue to rise which is why women in their 50s need to be more vigilant than ever about breast health. After menopause, breasts become less firm, less tender and less lumpy. While harmless lumps may come and go with the menstrual cycle in younger women, any new lump that appears after menopause requires a doctor's prompt attention.

In addition to continuing to receive biannual mammograms, eating right and staying active, there are a few additional habits you can pick up to reduce your risk of a breast cancer diagnosis.

1. Maintain a healthy body weight. A healthy weight is a body mass index (BMI) of 25 percent or less. Research has shown that being overweight or obese (specifically in post-menopausal women) increases your risk, even if you put the weight on as an adult. Additionally, overweight women had lower breast cancer survival rates and a greater chance of more aggressive disease than average weight or underweight women.
2. Avoid or limit hormone replacement therapy (HRT). Hormone replacement therapy definitely increases breast cancer risk, although for women with major menopausal issues, doctors at the Fred Hutchison Cancer recommend limited courses of HRT for no more than five years.

Being breast aware

Whatever your age and the size and shape of your breasts, it is important to take care of them. Breast cancer is the most common female cancer in Malaysia, so look after your breasts by being breast aware. Being breast aware is an important part of caring for your body. It means getting to know how your breasts look and feel so you know what is normal to you. You can feel more confident about noticing any unusual changes.

Changes that you should look for are changes in size or shape, lumps that feel different from the rest of the breast tissue, changes in skin texture such as puckering or dimpling, swelling in the armpit or around the collarbone, constant pain in the breast or armpit, redness or a rash on the skin and/or around the nipple, the nipple becoming inverted or changing its position or shape and any discharge that comes from the nipple without squeezing.

The best chance for cure is when breast cancer is detected and treated early. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis of a woman with this disease. A woman who is breast health aware is a woman well-acquainted with her breasts and her health, and empowered to be more vigilant about breast cancer, to seek treatment and to triumph against it.