Throughout the course of our lives, our breasts will naturally go through changes — fluctuating with our menstrual cycles, pregnancy, stress and the many phases of menopause. However, because hormonal shifts happen in different ways for all of us, it’s of paramount importance to know when something is unusual and/or needs to be examined by a physician.
Most of the time, there’s nothing to worry about — it’s just our body sharing its wisdom and informing us about what’s going on. But other times, as many of us have unfortunately experienced firsthand, these changes can be signs that something isn’t right. And as we know, the earlier breast cancer is diagnosed, the better it usually is for our prognosis. For information on screening and mammograms and the most critical changes to watch out for, see our guide to becoming more breast aware below.1
When are changes in our breasts normal?
There are four phases in our lives when our breasts change due to the fluctuation of two hormones found in our bodies – estrogen and progesterone.
- When we enter puberty and our breasts begin to develop, it’s common to experience an aching or tingling feeling in our chest area, as well as tender nipples – these are all normal symptoms.
- Throughout our reproductive years, hormonal fluctuations regulate our periods and often cause changes to our breasts, making them feel heavier, fuller, more tender and even lumpy. Once our period ends each month, however, these symptoms typically recede.
- We also experience breast changes during pregnancy, most notably in size, but also symptoms that include sensitivity, tingling or soreness (especially in the nipple area). Whether pregnant or not though, from our mid 30’s on, our breasts begin to age, and both glandular and fibrous tissue disappears turning into fatty tissue.
- Last, during perimenopause and menopause, estrogen levels drop, causing our breasts to change in size, feel softer, sag and potentially present with tenderness or lumps (often cysts).1
How do we check our breasts?
No matter what age, size or shape we are, it’s important to get to know our breasts. Look at them, check them regularly and become familiar with your personal, regular fluctuations so that you can better access what is and what’s not normal. A good time and place to check our breasts are in the shower, ideally at the same time of the month, each month. Place one hand behind your head, and with the other hand, press three fingers into a breast with light pressure, and move them in concentric circles from the areola outward, making sure to cover the bust, armpits and collarbone. If something feels abnormal, it’s always a good idea to contact a doctor and schedule a checkup.1
What changes should we look out for?
Again, everyone’s breasts are different, so take time to become aware of what’s unique to yours. Is there a change in the size or shape? A lump that feels thicker than the rest of the breast? Visible skin puckering or dimpling? Redness or rash around the nipple? Is the nipple inverted, or has it changed in shape or position? Does liquid come out from the nipple without squeezing? Is there consistent pain in your breast or armpit? Swelling in the armpit or collarbone area? If you answered yes to any of these above, please consult your doctor. Most changes are benign (non-cancerous), but it’s mind-settling to know why these changes are occurring.1
Should we get breast screening?
Regular breast screening (mammograms) can detect breast cancer before any signs or symptoms appear, and the hope is that if we are going to receive a diagnosis, it can be caught when the cancer is still localized. A mammogram can also help us become aware of changes that could become cancerous in the future, years before physical symptoms arise. However, mammograms aren’t 100% reliable and can miss certain cancers. If your gut tells you something isn’t right, persevere and request different tests until you get a clear answer.1
According to the American Cancer Society, breast cancer is the most common type of cancer in the United States, with 268,670 new cases expected in 2018, making up 30% of all new cancer diagnosed in women. Breast cancer death rates have declined 39% from 1989 to 2015 amongst women, and the progress is attributed to improvements in early detection through screening tests. 2
Are there any risks with breast screenings?
Each time we get a mammogram, we are exposed to a very small amount of radiation, which could slightly increase our risk of developing cancer over time. That said, the radiation exposure from mammograms is as low as the amount we’re exposed to during longer air travel1 (i.e. the longer we are on a flight, the more radiation we receive. The higher we’re in altitude, the higher the dose of radiation)4. And some cancers diagnosed through breast screenings may not develop further or grow (such as DCIS), Many doctors are now able to evaluate one's individual risk and determine personalized screening protocols.
The difference between average vs high-risk women?
When talking about screening, we're considered to be at average risk if we don’t have a personal risk of breast cancer, a strong family history of breast cancer, a genetic mutation known to increase our risk of breast cancer, or haven’t had chest radiation therapy before the age of 30.3. Women between the ages of 40 and 44 have the option to start getting mammograms once a year. When we’re 45 to 54, it’s typically recommended to get mammograms every year, and once we’re over the age of 55, many doctors suggest that we can switch to having mammograms every other year.3
For women who are at high risk of breast cancer, often the recommendation is to get annual MRIs and/or mammograms starting around age 30. High risk can be defined as a strong family history (increase our chances by 20-25%) – which can include carrying the BRCA1 or BRCA2 gene mutation (identified through genetic testing), have a first-degree relative (parent, brother, sister or child) who carries the BRCA1 or BRCA2 genes – or has had chest radiation therapy between the ages of 10-30 years, or has Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes.3
It’s important to note that the American Cancer Society (ACS) advises against yearly MRIs for women who are at a lifetime risk of breast cancer that’s less than 15%. But for women who have a history of breast cancer or extremely dense breasts, it becomes a personal choice since there’s not enough evidence to know for sure if that’s ideal. In some cases, MRIs and mammograms can both be done, as each can detect cancers that the other may not.
Clinical and breast self-exams.
Whether you've been diagnosed with breast cancer or not, clinical breast exams should be performed regularly by a healthcare professional who is trained to recognize abnormalities and warning signs. Monthly, we should also become familiar with how our breasts normally look and feel, so we can report any changes to our doctors right away.
How to reduce our risk of breast cancer.
Still, to this day, the exact cause of breast cancer is unknown, but we do know that as we get older, as females, our risks increase. However, if we stay on top of our health, we can slightly reduce our risk by:
- Eating a well-balanced diet with plenty of organic fruits and vegetables (limiting our intake of saturated fats)
- Maintaining a healthy weight, especially post-menopause
- Regular exercise
- Not smoking
- Not drinking alcohol over the recommended weekly amount
- Avoiding exposure to radiation and environmental pollution
- If we have children, breastfeeding
- If we need hormone therapy, limiting our dose
“The only thing we have to fear is fear itself. So, the only thing to really be afraid of is if you don’t go get your mammograms.” – Cynthia Nixon