It can be alarming to find a lump in your breast. But understanding the next steps can arm you with important knowledge.
Stephanie Bernik MD
In the WebMD webinar “What to Do When You Find a Lump,” Stephanie Bernik, MD, explained the steps you should take. She talked about breast changes that need to be checked, health conditions other than breast cancer that might be the cause, whether breast self-exams are useful, and more.
Bernik is the chief of breast service at Mount Sinai West in New York and associate professor of surgery at the Icahn School of Medicine at Mount Sinai.
“If you find a mass, don’t panic. There are so many things that can be benign (non-cancerous), especially in people who are menstruating,” says Bernik. “But certainly don’t ignore a finding.”
Some lifestyle habits can reduce your exposure to estrogen. High levels of estrogen are linked to an increased risk of breast cancer and other health conditions.
A poll of webinar viewers found that 40% reduce their estrogen exposure with regular exercise. That’s followed by 27% who avoid estrogen-increasing hormone-replacement therapy (HRT).
Question: I limit my exposure to estrogen by:
- Getting regular exercise: 40%
- Avoiding HRT: 27%
- Reducing fat in my diet: 20%
- Drinking little or no alcohol: 11%
If you find a mass, don’t panic. There are so many things that can be benign (non-cancerous) …But certainly don’t ignore a finding.
Stephanie Bernik, MD
Another webinar poll asked about known risks for breast cancer. Being female was a breast cancer risk for 41% of viewers, compared to over 30% who have breast cancer in their family history.
Question: My breast cancer risks include:
- Being female: 41%
- Family history: 32%
- Starting periods early: 13%
- Being postmenopausal and taking hormone therapy: 7%
- Starting menopause late: 4%
It’s a way to check your breasts for changes. While it used to be more popular, doctors now warn against its overuse.
“The problem we have found with self-breast exams is that people tend to feel too much,” says Bernik.
“That creates a false positive. For example, if you feel something but the doctors don’t see anything, you may have to get surgery to have a tissue diagnosis.”
While it’s important to be aware of any change in your breasts, it’s also good to understand that you’ll feel the fat areas in your breasts during a self-exam as well. These may not be dangerous lumps. Feeling too much can create unneeded anxiousness for you.
“We say you should sweep your breasts in the shower. Make sure you’re not feeling anything obvious. If you do feel something, you can’t ignore it,” she says.
If you find a breast mass and you’ve been through menopause, call your doctor and schedule an exam.
“Most cancers will be in postmenopausal women,” says Bernik. “But just because you’re young, it doesn’t mean you can’t get cancer.”
If you haven’t been through menopause, wait to see if the lump is still there after your next period. If it doesn’t go away, see your doctor.
How do breast implants affect breast cancer risk?
What’s the link between stress and breast cancer?
How does breast reduction surgery affect breast cancer risk?
Implants can make some breast tissue unclear when you have a mammogram. With implants, even if they’re silicone, it’s suggested you have more mammograms. You should be adding an MRI at least every 3 years in addition to the screening mammogram and/or an ultrasound if you’re 40 or older.
Several years ago, we had textured implants that were mostly silicone. They were used because they really held their shape. While it was rare, they were linked to lymphoma. We don’t use those implants anymore. But we also don’t rush to take them out unless there’s a reason. If there is, then those implants are removed and replaced with different ones.
Stress can increase your risk of breast cancer, as it causes inflammatory reactions in your body. On a microscopic level, those factors affect cells, which raises your risk of cancer. Stress isn’t good for your body, not just in terms of breast cancer, but for every organ system.
You want to lead a healthy lifestyle by eating a nutritious diet, exercising, trying to keep alcohol to a minimum, and lowering your stress. All of these help lower your risk of cancer.
Nothing eliminates your risk of breast cancer. But if you have a genetic risk of it, you might have a prophylactic mastectomy. This is surgery that can remove a lot of your breast tissue. Through that, we can lower your risk by 90%, which is lower than the general population.
How do you know if you’re a BRCA carrier?
Does having an aunt with breast cancer increase your risk?
Why are women more likely to develop breast cancer as they age?
We screen a lot more people for BRCA than we used to because the cost of the genetic tests has gone down. You can do screening for BRCA for about $250.
Some people get the test just to know if they carry the mutation or not. But in general, the screening is recommended if you have:
- Triple-negative cancer yourself
- Male breast cancer in your family
- A history of breast and ovarian cancer
- Several relatives who’ve had breast cancer
In terms of your cancer risk related to your family history, we like to do a little probing. We ask about other cancers in your family on your father’s and mother’s side.
Just because you don’t have a first-degree relative with cancer, it doesn’t mean you don’t have a risk. You need to dive more into your genetics.
Cancers can skip a generation. So you can have a mother who didn’t have breast cancer, but she’s a carrier. She may have three sisters, your aunts, with breast cancer. You have to look at the whole story.
People are more likely to develop breast cancer as they age. That’s because as you age, you’re at a higher risk of all sorts of cancers. This is because your cells are older.
In your body, you have repair tools. There are always breaks in your DNA, but your body tends to fix those. If your body fails to fix a break in your DNA, that can cause cancer. As you age, there are more of these breaks in your DNA because your cells are older and not functioning as well.
Is there a best or worst time in your cycle to have a mammogram?
Should you get an ultrasound annually with a mammogram if you have dense breasts?
Should you have mammograms as long as you live?
We don’t usually time mammograms to your cycle. But the best time to get a mammogram would probably be on days 7 to 14 of your cycle. It’s hard to predict that because cycles can sometimes have something that throws them off. So people tend to schedule mammograms at any point in their cycle.
If you have dense breasts, your ultrasound and mammogram recommendations will vary a little bit based on what state you’re in. Some states will put a statement on the mammogram if there’s dense breast tissue. Then, you have to speak to your doctor to see if extra screening is needed.
If you have dense breast tissue, some states automatically add an ultrasound. But it does vary, so always read your mammogram. If it says “heterogeneously dense” anywhere on your mammogram, you should ask for an ultrasound as well.
If you’re expected to live more than 5 years, breast surgeons suggest we continue to screen you for breast cancer. Guidelines say you can stop at 75. But people are living much longer than that. These large-scale guidelines look at the general population and not at the person as an individual.
Even if the guidelines say you don’t need screening, you should consider doing it. Even if you’re 85. If you’re still healthy, you should continue getting screened.
Watch a replay of the WebMD webinar “What to Do When You Find a Lump.”
Watch other free WebMD webinars by leading experts on a variety of health topics.
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