Steps to Breast Health

Illustration by Gloria Dilanni

There’s no getting around the fact that some of the risk factors for breast cancer, such as genetics and age, are out of our control. But there are steps you can take to maximize your breast health and minimize your chance of developing breast cancer.

1. Look in the mirror. Many of us rush through our daily routine with nary a glance at our unclothed body. Make it a habit to regularly pause and take a look in the mirror, says Rebecca Kwait, M.D., F.A.C.S., medical director and breast surgeon at Core General Surgery and Exeter Hospital’s Center for Breast Health. Look for subtle changes in the shape of your breasts or nipples, as well as discharge, and rippling, dimpling or redness in the skin. “Know what you’re starting out with,” Kwait says, so that you have a baseline for comparison if something changes.

2. Perform self-exams. Unfortunately, “a lot of women don’t do self-exams,” Kwait says. For some women, especially those with lumpy breasts, a self-exam can be anxiety-inducing, but regular self-exams will help you notice a lump that feels different from the others, or a firmness in the breast that previously did not exist. Perform your self-exam at the same time each month or at the same time within your menstrual cycle, and if something doesn’t feel right, tell your doctor right away.

3. Know your family history. “Having a mother or sister with breast cancer doubles your own lifetime risk of breast cancer,” says Michael DeLeo, M.D., chief medical officer at Foundation Medical Partners in Nashua and a fellowship-trained radiologist who specializes in breast and oncologic imaging. Talk to your doctor about your risk and whether you should consider closer monitoring.

4. Get an annual, clinical breast exam. Less than 10% of breast cancers are detected through clinical breast exams, Kwait says, “but when they are, those tend to be more aggressive.” If your healthcare provider does not routinely perform a clinical breast exam as part of your annual check-up, do not feel bashful about requesting one, she says.

5. Get a yearly mammogram. Numerous studies have shown that mammographic screening results in a highly significant decrease in breast cancer-specific mortality, Kwait says. For older women, especially, screening is well worth the time and temporary discomfort. “For example, women ages 60-69 who had mammograms had a 33% lower risk of dying from breast cancer compared to women who did not,” DeLeo says.

Go for 3D screening (also known as tomosynthesis), a technology that is available at many New Hampshire hospitals and that provides valuable imaging particularly of dense breasts. While dense breasts are common and normal, women who have them face a breast cancer risk that is 1.5 to 2 times higher than that of women who do not have dense breasts, DeLeo says.

Guidelines vary regarding the scheduling of mammograms, DeLeo says, but many medical groups recommend that women of average risk have a screening mammogram every year starting at age 40.

6. Talk to your doctor. Incidence of breast cancer is high; within the average population, one in eight women will develop breast cancer in her lifetime. But many women face even higher risk due to a number of factors such as the use of hormone replacement therapy, which can fuel breast cancer growth, DeLeo says. Ask your doctor whether you are at elevated risk and if you should have supplemental screening.

7. Lead a healthy lifestyle. The main lifestyle factors for breast cancer that women can control, Kwait says, are weight, body mass index (BMI, a measure of body fat), physical activity, alcohol use, smoking and hormone replacement therapy use. Obese women have a higher risk of breast cancer than women who are not obese. “Even just a 5-10% weight reduction in women who are overweight can significantly reduce their risk for breast cancer,” Kwait says.

As for alcohol consumption, if you’re wondering how much alcohol is OK, experts say to drink alcohol in moderation or not at all, which means women should have no more than one 5-ounce glass of wine, one 12-ounce beer or 1 ounce of spirits per day. Also note that “you can’t bank your drinks,” DeLeo says. “You can’t not drink for say, three days, and then [overindulge] the following day. It doesn’t work that way.” 

How to perform a breast self-exam

Women should perform a breast self-exam once a month, preferably at the same time within their menstrual cycle, says Rebecca Kwait, M.D., F.A.C.S., medical director and breast surgeon at Core General Surgery and Exeter Hospital’s Center for Breast Health. Not sure how to do it? Lying down, use the first few finger pads of the hand that is opposite the breast to make concentric circles, or to make a sweeping pattern across the breast from the outside toward the inside or from the inside to the outside of the breast — whichever way enables you to check all of the breast tissue. Feel for lumps and bumps and changes in your breasts over time, and gently squeeze each nipple to check for discharge. If you notice anything worrisome, contact your doctor.

For more information about breast health, see breast360.org, the website of the American Society of Breast Surgeons Foundation. Also see the Susan G. Komen website at ww5.komen.org.