Breast Cancer: What do I look for?

Cancer. It’s a terrifying word. And breast cancer is the most common type of invasive cancer for women. British Columbia is now the first province to provide women and their doctors information about their breast density after a mammogram screening. You may be wondering, “Why does my breast density matter and what does it mean if I have dense breasts?” I’ll get to that, but first let’s discuss breast cancer, in general.

One in Eight Women

With approximately one in eight women being diagnosed with breast cancer in her lifetime, it is the second most common cause of cancer death in women—after lung cancer. The good news is, survival rates have improved dramatically since the late 1980s. Men can also get breast cancer, but it is much less common, making up less than one percent of all breast cancer diagnoses.

Part of the reason for an increasing number of breast cancer survivors is that we are finding and assessing breast lumps earlier on in the disease.

What Do I Look For?

If you are experiencing any of the following symptoms, see your doctor so you can be assessed.

  • Feeling a lump or thickened tissue in your breast or armpit.

  • Pain in the armpit or breast that does not change with your menstrual cycle.

  • A change in shape or size of your breast not related to your menstrual cycle or pregnancy.

  • The skin of the breast looks like the skin of an orange, i.e. pitting, dimpling, or change in colour.

  • Changes in the appearance of the nipple, like a rash or scaling skin or it appears sunken or inverted.

  • Discharge from the nipple.

It may be scary to find these changes, but don’t put off seeing your health professional about it because early detection improves outcomes.

While the Canadian Task Force on Preventive Health Care does not recommend breast self-examinations for women do not have a higher risk of breast cancer and who are aged 40 to 74 because they state that these self-examinations do not save women’s lives and can lead to unneeded tests, it is very helpful for a woman to know how her breasts normally look and feel so she can more easily notice changes. And for women who are at higher risk, self-exams can be valuable.

Higher Risks

So, how do you know if you are one of those higher risk individuals? Note that not all the risks are equal in their effect, but here are some of the factors that can be at play.

  • Age: As we age, our risk increases.

  • History: A history of breast cancer increases our likelihood of having it again, as do some types of non-cancerous (benign) breast lumps, like atypical ductal hyperplasia(ADH) or lobular carcinoma in situ(LCIS).

  • Genetics: Risk increases for those who have close relatives who’ve had breast cancer, and for women who carry the BRCA1 and BRCA2 gene. Women of Ashkenazi Jewish decent are more likely to carry these BRCA genes.

  • Reproductive history: Estrogen exposure can increase breast cancer risk. Women who started their periods early or ended them later in life have more exposure, as do women who have pregnancies later in life or no pregnancies. Prolonged use of birth control pills or certain hormone replacement pills also have increased estrogen exposure.

  • Dense breasts.

  • Other: Alcohol consumption, obesity, and physical inactivity are also associated with higher risk.

  • Possible risks: Smoking and second-hand smoke, higher birth weight, and night shift work may also raise the risk, but these factors are less clear.

Dense Breasts

Breasts are composed of fat, connective tissue, milk ducts, and glands. When there is more connective tissue, glands, and ducts than fatty tissue, the breasts are termed dense, and this is a trait that is inherited. Breast density has been shown to decline with age but increase with hormone therapy.

JAMA (Journal of the American Medical Association) Oncology research paper found that breast density is the strongest risk factor for breast cancer in both pre-menopausal and post-menopausal women.

The increased risk appears to be two-fold. One is that dense breasts cause a higher risk of producing cancerous cells. Researchers think that it’s from the presence of more cells in the dense tissue, as well as more interaction between the cells that line the mammary ducts and the surrounding tissue. The second cause is that dense breast tissue and cancer both show up as white on standard mammograms, so it’s hard for radiologists to find cancerous tissue. It simply doesn’t show up as easily because there is less contrast.

Dense breasts may need more follow up and alternate mammograms, such as 3-D mammograms, or ultrasounds to show tumours.

Nineteen U.S. states already require women to be told if they have dense breasts, but it is not yet clear what you are supposed to do if you are told you have dense breasts. One of the study’s co-authors states, “Not everybody with dense breasts is going to get cancer. There are people with dense breasts that are not at high risk.”

Prevention for All

Certain risk factors are out of your control—age, family medical history, breast density, and genetics. But you can take the reins in other aspects of your health.

As with most disease prevention and health optimization, it’s important to maintain a healthy weight, eat nutritious foods, limit or avoid alcohol, exercise regularly, and don’t smoke. If you fit the high risk profile (if you know your breast density, you can take this risk calculator quiz, do monthly breast self-exams, have your doctor examine you yearly, and get breast assessments done.

Foods and supplements that are high in anti-oxidants can help to lower the risk of many kinds of cancers, as can supporting a healthy immune system.

Japanese red reishi mushrooms have a wide range of health benefits including supporting a balanced immune system, providing adrenal support as an adaptogenic, and they have been shown to help suppress tumour growth. Reishi contains more than 400 known compounds, with the best-known ones being triterpenes and polysaccharides, both of which have shown anticancer effects.

When it comes to something like cancer prevention, it’s comforting to know that there are some things we can do to help protect ourselves.