Breast Health

Published: May 28, 2014

Breast Health at Menopause

Do you need to be concerned with your breast health at menopause? Absolutely!

The breast is responsive to a complex interplay of hormones.
From adolescence through menopause, as hormones change, so does breast tissue. As estrogen and progesterone levels fluctuate, it is not unusual for breasts to become sore or lumpy, and they sometimes form cysts. The tissue also changes because of the decreases in ovarian hormones, and breasts may shrink. There could also be more fat growing in the breast and they may even begin to sag. Many of these changes are benign, but you still must monitor closely any changes to your breasts and discuss these changes with your clinician.

Breast Pain

Breast pain is sometimes linked to your menstrual cycle and it is referred to as “cyclic” breast pain as it typically occurs a few days before the menstrual cycle begins. Breast pain, however, may not be related at all to the hormonal changes. If this occurs, it is called “non-cyclic” breast pain. There are several causes of non-cyclic breast pain. These include: being overweight; having an overproduction of estrogen; having an infection; having an inflamed vein in the breast; having a breast duct that is too wide or simply resulting from having had breast surgery. It is also linked to certain medications or drugs you may be taking, i.e., oral contraceptives, hormone therapy, and others. Occasionally, it may be linked to an underlying medical condition. It’s best to see your clinician if you experience breast pain.

There are ways that you can help yourself if you experience non-cyclic breast pain. These include: decrease your dietary fat by switching to low fat or non- fat foods; reduce your caffeine intake; stop smoking; lose weight; reduce your stress and anxiety levels.

Common Benign Breast Changes at Menopause

Only a clinician can determine if lumpiness in your breasts is benign. Benign (non-cancerous) breast lumpiness can occur with aging. The lumpiness usually occurs around the nipple and areola and/or in the upper-outer part of the breasts. They may feel rubbery, firm or hard to the touch. Lumpiness is common before and during menstruation and may become more prevalent as you approach midlife (as the milk producing tissues turns into soft, fatty tissue). Unless you are taking hormone therapy, this type of lumpiness generally goes away after menopause.

There is a difference between lumps and lumpiness. Lumpiness is simply normal breast tissue. If you are unsure whether you have a lump, or lumpiness, always have it checked out by your clinician. Two kinds of lumps and cysts occur that typically start at menopause.

One non-malignant lump includes “Fibroadenomas”. These are small or large round masses that are usually painless. They are more common in women 15 to 30 years old and they may get bigger during pregnancy and smaller after menopause. They may be moveable, firm or rubbery lumps. Fibroadenomas can sometimes stop growing or shrink on their own. They can also be easily removed by surgery. Clinicians usually recommend removal to ensure they are benign.

Cysts typically occur in women in ages 30 and through their early 50s. They are common as women approach menopause. It’s important to have cysts checked out by your clinician. Many are harmless. Sometimes, cancers do appear. Cysts, however, do not increase the risk of cancer. Most research shows there is no relation between cysts and cancer.

A common cause of non-cancerous lumps, thickening of the breast tissue and cysts is called “Benign Fibrocystic Disease”. Its found more in women whose breasts are particularly sensitive to the monthly changes in hormone levels associated with menstruation. The problem usually disappears after menopause, although if you are taking hormone therapy, the symptoms may continue. Cysts can be painful and are caused by fluid trapped in breast tissue. They should be check by your clinician who may be able to remove the fluid using a syringe with a fine needle. Sometimes, they will be surgically removed.

Duct Ectasia is a condition that causes the ducts under the nipples to become inflamed and clogged. This affects as many as one in four women and it is common as one nears menopause. Symptoms are thick, green, or black sticky discharge, or a hard lump. The problem can go away on its own, or may be treated with warm compresses, antibiotics, or surgery.

A Healthy Lifestyle Means Healthy Breasts

Getting to know your breasts and promoting good breast health should be second nature to you. There are certain lifestyle choices you can make that will benefit your breasts. Here are a few tips: decrease your dietary fat and eat low fat or non-fat foods; reduce your caffeine intake; stop smoking; wear a bra that supports your breasts; lose weight; and reduce your stress levels.

Breast Cancer…How Much Do You Know About Breast Cancer?

The pink ribbon symbolizes the great fight against breast cancer.
But, how much do you honestly know about it?
For American women, breast cancer is the second most common cause of cancer death (following lung cancer)¹. The causes are unknown; there is no prevention or cure. With over 2 million women afflicted with breast cancer, it’s time to learn the critical facts about how you can reduce your risk.²

If you are a woman, you are at risk for breast cancer. That’s all it takes.
Caucasian women are more likely to get breast cancer than any other racial or ethnic group.
African American women are more likely to die from breast cancer than white women.
The median age at death for Caucasian breast cancer patients is 70 years; for African-American breast cancer patients, its 61 years.³

The older a woman is, the more likely she is to get breast cancer. Breast cancer is the leading cause of death in women between the ages of 40 and 55. One woman in eight who lives to age 85 will develop breast cancer during her lifetime.⁴

Over 2 million breast cancer survivors are alive in America today.
Of those women diagnosed with breast cancer 5 years ago, 88% of them are still alive. Of those diagnosed 10 years ago, 80% are still alive; of those diagnosed 20 years ago, 63% are still alive.⁵ Since we do not know the causes of breast cancer, we cannot prevent it.
We can lower our chances by considering our risk factors and knowing what the numbers mean. Reducing the number of risks should be part of an early detection plan.

Risk Factors and Prevention

A risk factor is anything that increases your chance of getting a disease. But, having a risk factor does not necessarily mean you are going to get the disease. Most women have no known risk factors except being a woman and getting older. Just because other family members had breast cancer doesn’t mean their disease was inherited. About 5 to 10 percent of all breast cancers occur because of inherited mutations.

Some risk factors are beyond your control. A woman cannot change the fact that breast cancer runs in her family. She can’t change her race (Caucasian women are at a slightly higher risk) or stop herself from getting older (77% of breast cancer cases occur in women over age 50). Some factors you can’t necessarily control include:

Gender- breast cancer is about 100 times more common among women than men
Aging- risk increases as you get older. About 17% of invasive breast cancer diagnoses are among women in their 40s while about 78% of women with invasive breast cancer are age 50 or older when diagnosed
Genetic risk factors- About 5%-10% of breast cancer cases are hereditary as a result of genetic mutations (BRCA1 and BRCA2 genes)
Personal history of breast cancer- A woman with cancer in one breast is 3 to 4 times more likely of developing a new cancer in the other breast or in another part of the same breast
Race- Caucasian women are slightly more likely to develop breast cancer than African American women. African-American women are more likely to die of breast cancer than White women. Asian, Hispanic and Native American women have a lower risk of developing and dying from breast cancer
Abnormal breast biopsy- Some types of benign breast conditions are more closely linked to breast cancer risk than others (ductal hyperplasia, complex fibroadenoma, sclerosing adenosis, papillomas or papillomatosis, radial scar)
Previous chest radiation- Women who have undergone radiation therapy in the chest area as a treatment for another cancer are at a significantly increased risk
Menstrual periods- women who started menstruating before the age of 12 or who went through menopause after age 55 have slightly higher risks

You can control certain risk factors by making through personal lifestyle choices. Recognize the risks that you can control including:

Having children- women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk. Having multiple pregnancies and becoming pregnant at an early age reduces risk.
Oral contraceptive use- Studies have suggested that women who use birth control pills have a slightly greater risk of breast cancer than women who have never used them. The decision to use oral contraceptives should be made by you and your physician after weighing the possible risks and benefits.
Postmenopausal hormone therapy-Long-term use of postmenopausal hormone therapy (in particular estrogen and progesterone combined) increases risk of breast cancer. The decision to use hormone therapy should be made by you and your physician after weighing the possible risks and benefits.
Breast feeding and pregnancy- Some studies suggest that breast-feeding may slightly lower breast cancer risk (especially if breast-feeding is continued for 1.5 to 2 years).
Alcohol- Breast cancer risk increases with the amount of alcohol consumed. Women who consume one alcoholic drink a day have a very small increase in risk compared to nondrinkers. Those who have 2 to 5 drinks daily have about 1 ½ times the risk of women who don’t drink.
High fat diets- Being overweight has been found to be a breast cancer risk, especially for women after menopause.

Physical activity- In one study from the Women’s Health Initiative (WHI) as little as 1.25 to 2.5 hours per week of brisk walking reduced a woman’s risk by 18%. Walking 10 hours a week reduced the risk a little more.

Improving Your Risk Factors

Breast feed
Control your weight
Get exercise
Control your alcohol intake

Screening and Prevention

Detecting breast cancer early increases a woman’s chances of survival. Screening does not necessarily mean your health care provider suspects you have breast cancer. Health care providers usually recommend the following tests for breast cancer when you don’t have any symptoms:

Screening Mammogram- an x-ray of the breast.
Magnetic Resonate Imaging- As of March 2007, the American Cancer Society has posted new guidelines recommending women who are at a “high risk” for breast cancer receives a yearly MRI screening in addition to a mammogram.
Clinical Breast Exam- physical exam of your breasts by a medical professional
Breast Self-Exam- physical exam of your breasts by yourself. Learn the normal look and feel of your breasts. Check for changes every month just as your period is ending. If you no longer have periods, do them the same day each month. Some lumpiness can be normal. If you feel any change or a new lump, ask your doctor to examine the area. See the American Cancer Society for a guide to a breast self-exam.

The American Cancer Society recommends the new following guidelines for early detection:

Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.
Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Symptoms of Breast Cancer

Mammograms can detect cancers found before they cause any symptoms. But, the most common symptom of breast cancer is a new lump or mass. It may be painless, hard or soft, rounded or with uneven edges. It’s important to have any irregularity checked by your health care provider. The American Cancer Society also recognizes these important signs of breast cancer:

swelling of part of the breast
skin irritation or dimpling
nipple pain or the nipple turning inward
redness or scaliness of the nipple or breast skin
a nipple discharge other than breast milk
a lump in the underarm area
an awareness that your breast feels heavy

See your clinician immediately if you notice any of these changes. Your clinician will determine which kind of test your need. This may include:

A mammogram
Breast Ultrasound
Magnetic Resonance Imaging (MRI)
A breast biopsy

For information on Breast Self-Exams, visit the American Cancer Society.

Learn more about Mammograms

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References
¹American Cancer Society, Breast Cancer Facts & Figures 2005-2006.

²Ries LAG, et al. SEER Cancer Statistics Review, 1975-2003. Retrieved June 2006 from the National Cancer Institute website http://seer.cancer.gov/csr/1975_2003/
Based on November 2005 SEER data submission, posted to the SEER web site 2006. On January 1, 2003, there were approximately 2,356,795 women alive who had a history of breast cancer.

³NCI SEER CSR 1975-2003; Breast Cancer, Table I-13. Retrieved March 2007 from the National Cancer Institute Website http://seer.cancer.gov/csr/1975_2003/sections.html

⁴National Breast Cancer Institute. Retrieved March 2007 from National Breast Cancer Institute website http://www.nationalbreastcancer.org/early_detection/index.html

⁵American Cancer Society, Breast Cancer Facts & Figures 2005-2006. Retrieved 30 March 2007 from http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=&dt=5

Published May 28, 2014