Breast Cancer Awareness: Recommendations from a Certified Nurse Midwife

October is more than just the beginning of the holiday season; it’s also Breast Cancer Awareness Month. This annual campaign emerged in the nineties to educate, empower, and shed light on a disease that affects millions of families worldwide. The symbol for breast cancer awareness is a pink ribbon, which represents those who courageously fight breast cancer while inspiring hope, as well as the people/businesses who publicly support the movement. In this blog post, pH-D® Feminine Health and I will discuss what breast cancer is, risk factors, signs/symptoms, the importance of early detection, and recommendations for women currently in treatment or post treatment for breast cancer.

 Breast Cancer Explained

Breast cancer is a type of cancer that begins in the cells of the breast. The disease occurs when abnormal cells in the breast multiply and form a tumor. If left untreated, these cancerous cells can spread to other parts of the body. It is a complex disease that is categorized into several stages to detail the extent of the disease’s progression. The higher the number, the more the cancer has spread. The five stages of breast cancer are as follows:

 Stage 0 - The disease is only present in the ducts and lobules of the breast and has not spread to the surrounding tissue. This is also called noninvasive cancer or “in situ”.

 Stage I - The disease is now considered invasive as cancer cells are present in normal breast tissue. The tumor is less than 2 cm in the breast or the tumor is present in the lymph nodes of the breast without being present in the breast tissue.

 Stage II - The tumor is 2 - 5 cm in the breast, cancer cells have spread to 1 - 3 lymph nodes, or the tumor is larger than 5 cm in the breast without spreading to the lymph nodes.

 Stage III - The tumor may be any size but the disease has spread to 4 - 10+ lymph nodes or the chest wall, causing swelling of the breast.

 Stage IV - The tumor may be any size but the disease has spread to other organs and tissues, such as the bones, lungs, brain, or liver. This is also called metastatic breast cancer. 

Who Is at Risk?

After skin cancer, breast cancer is the most common type of cancer diagnosed in women in the United States. About 1 in 3 of all new female cancers each year are due to breast cancer. Here are some factors that can increase the risk of developing breast cancer:

 Gender - Although both men and women can have breast cancer, women are 100 times more likely to have it.

 Age - Invasive breast cancer is more likely to be diagnosed in women over 55 years old.

 Race - Breast cancer is diagnosed more often in White women, but that could be more indicative of access to care and health insurance. When Black women are diagnosed, it’s usually in a later stage, which shines a light on the health disparity that is present.

 Family History - The risk for breast cancer increases if someone has an immediate family member with breast or ovarian cancer, especially if they were diagnosed before the age of 50.

Personal History - Having cancer in one breast increases the risk for developing it in the other breast.

Menstrual/Reproductive History - Starting menstrual periods before age 12, menopause after age 55, having first child after age 30, or never having a child increases the risk for breast cancer.

 Gene Mutations - BRCA1 and BRCA2 gene mutations increases the risk for breast cancer.

 Dense Breast Tissue - This can make it more difficult to detect a lump on mammogram, causing a delay in diagnosis. A breast ultrasound can be ordered in addition to a mammogram.

 Lifestyle Factors - Lack of physical activity, poor diet, and frequent alcohol use can increase the risk for breast cancer.

 Radiation to Chest - Receiving radiation to the chest area before the age of 30 can increase the risk for breast cancer.

 Signs/Symptoms

 It’s imperative to be aware of the signs and symptoms, as early detection is key! Breast cancer mortality (deaths) have decreased over the years due to earlier detection, individualized treatment, and increased awareness of the disease. A new mass that is painless and hard with irregular edges is MORE likely to be cancer. However, breast cancer can also present as a soft, round, tender, or painful mass. Here are some general signs to look out for:

 Lump in the breast area - can also be found in the underarm area

 Change in skin texture or enlargement of pores of the skin - resembling an orange peel’s texture

 Nipple tenderness

Change in the size/shape of the breast that can’t be explained

New onset asymmetry - one breast is swollen or one breast is shrunken

Nipple turned inward

Dimpling on the breast

Skin becomes scaly or red

Nipple discharge - bloody or clear

Tools for Early Detection

As mentioned earlier, it makes a huge difference when breast cancer is detected early and therefore, treated early. Once it spreads, it becomes more difficult to treat and the survival rate greatly decreases. Being aware of the above signs and symptoms, as well as regular screenings, can help women detect breast cancer early and start treatment as soon as possible. Here are some ways to increase your chances for early detection:

 Self Breast Awareness - Routine self breast exams are no longer recommended, but it’s important for women to be familiar with their breasts and to know what is normal for them. No one knows your body better than you, and you will be more aware of a change before anyone else. Don’t focus so much on whether something feels like a lump or not, focus on whether it feels or looks different. If you notice something different with your breasts and the surrounding areas, go in to see your healthcare provider right away.

 Clinical Breast Exams - This is done once a year by your healthcare provider during your wellness exam. Your provider is trained to find abnormalities in the breast and often can find a lump that you weren't even aware of. If your provider finds something suspicious, they can refer you for further testing. If you find something suspicious at home before it is time for your annual exam, you can always go in to see your provider, who will then conduct a clinical exam.

 Mammograms - Mammograms are a special X-ray that can detect lumps that may not be felt on exam, which is why they are recommended at a certain age even if your manual breast exams are normal. You are exposed to a small dose of radiation during the mammogram, but not enough to cause breast cancer, as some people believe. Mammograms are safe and can even save your life by detecting something abnormal. Depending on the results of the test, your provider may order a follow up ultrasound (recommended if you have dense breast tissue), MRI (recommended if you have a strong family history), or biopsy to make a more informed diagnosis.

For women between the ages of 40 - 49 with average risk, they can decide to start mammograms once a year OR once every 2 years.

 For women between the ages of 50 - 74 with average risk, it is recommended to do routine mammograms once a year OR once every 2 years.

 For women over the age of 74 with average risk, they can decide to stop routine mammograms. Women who are HIGH RISK (immediate family member with breast cancer, known BRCA mutation, first-degree relative with known BRCA mutation, radiation to the chest between 10 - 30 years of age) should start mammograms and breast MRI’s once a year at age 30 or 5 - 10 years before earliest diagnosis in family.

Recommendations for Women in Treatment for Breast Cancer

Women who are currently receiving or have received treatment for breast cancer may experience menopausal symptoms, such as hot flashes, night sweats, mood changes, irritability, brain fog, vaginal dryness, and pain with intercourse. These symptoms can be triggered by chemotherapy, preventative ovary removal, or the discontinuation of hormone replacement therapy due to having an estrogen-dependent breast cancer. Here are a few tips for improving quality of life while either going through or just ending treatment for breast cancer:

 Nutrition - Focus on whole and unprocessed foods that can decrease inflammation in the body. This includes fresh vegetables, fruits, whole grains, lean protein, and healthy fats. Consuming calcium in the diet can also help to protect bone density.

 Movement - Engaging in gentle, yet regular movement, can help to stabilize mood, improve brain fog, and lower inflammation. Walking and swimming are low impact options. Light resistance training, such as yoga or using resistance bands, can also help to protect bone density.

 Cognitive behavioral therapy - This technique can help to cope with hot flashes/night sweats, as well as improve sleep.

pH-D Feminine Health Holistic Menopause Support - Can be incorporated into your daily regimen to help promote the reduction of hot flashes, night sweats, mood swings, irritability, and brain fog.

pH-D Feminine Health Boric Acid Moisturizing Suppositories - This is a holistic solution that reduces vaginal dryness.

pH-D Feminine Health Vaginal Moisturizing Gel - Helps to improve the elasticity of the vagina with boric acid, hyaluronic acid, and Vitamin E. This product helps the vagina retain moisture, promoting the reduction of dryness and discomfort.

 Breast Cancer Awareness Month serves as a reminder that we all have a role to play in the fight against breast cancer. Whether you're educating yourself, supporting a loved one, or contributing to the cause, your actions can have a profound impact. Breast cancer is a formidable opponent, but knowledge, early detection, and support can help us stand up to it!