A DEEP DIVE INTO THE WONDERFUL WORLD OF MAMMARIES

By Dr. Amy Jones, D.O., OBGYN

October is breast cancer awareness month and no matter their size or shape, breasts play a huge role in our lives.  So let’s explore the wonderful world of mammaries.

Each breast has six to nine overlapping sections, called lobes. Within each lobe are many smaller lobules, which end in dozens of tiny bulbs that can produce milk. The lobes, lobules and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola.

Fat fills the spaces around the lobules and ducts. There are no muscles in the breast, but muscles lie under each breast and cover the ribs.

Each breast also contains blood vessels and vessels that carry colorless fluid called lymph. The lymph vessels lead to small bean-shaped structures called lymph nodes. Clusters of lymph nodes are found in the axilla (under the arm), above the collarbone and in the chest. Lymph nodes are also found in many other parts of the body.

Among younger women, common breast problems include fibrocystic breast disease, a noncancerous condition characterized by breast pain, cysts and lumps; and fibroadenomas, small bumps of fibrous and glandular tissue that can be painful.

For older women, the concern is more likely to be breast cancer. About 1 in 8 (12 percent) of women living in the United States will develop breast cancer over the course of their lifetimes.

 

Here Are Some Quick Facts About Breast Cancer:

• Each year in the United States, more than 245,000 women get breast cancer and more than 40,000 women die from the disease. 

• Men also get breast cancer, but it is not very common. Less than 1 percent of breast cancers occur in men.

• Most breast cancers are found in women who are 50 years old or older, but breast cancer also affects younger women. About 10 percent of all new cases of breast cancer in the United States are found in women younger than 45 years of age.

 

What Are the Risk Factors for Breast Cancer?

• Being a woman and getting older are the main risk factors for breast cancer.
• Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.
• Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.

 

Risk Factors You Cannot Change:

• Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.

• Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.

• Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.

• Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.

• Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.

• Family history of breast cancer. A woman’s risk for breast cancer is higher if she has a mother, sister or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.

• Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.

• Women who took the drug diethylstilbestrol (DES), which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

 

Risk Factors You Can Change:

• Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.

• Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.

• Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk. 

• Reproductive history. Having the first pregnancy after age 30, not breastfeeding and never having a full-term pregnancy can raise breast cancer risk. 

• Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.

 

Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer and changes in other hormones due to night shift working also may increase breast cancer risk.

The truth is that most women who get breast cancer have no known risk factors and no history of the disease in their families.

That being said, there are things you can do to can help lower your breast cancer risk.

 

What Can I Do to Reduce My Risk of Breast Cancer?
Many factors over the course of a lifetime can influence your breast cancer risk. You can’t change some factors, such as getting older or your family history, but you can help lower your risk of breast cancer by taking care of your health in the following ways:

• Keep a healthy weight. 

• Exercise regularly.

• Limit alcoholic drinks to no more than one per day.

• If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you.

• Breastfeed your children, if possible.

• If you have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, talk to your doctor about other ways to lower your risk.

Staying healthy throughout your life will lower your risk of developing cancer and improve your chances of surviving cancer if it occurs.

 

Let’s Talk a Bit About Breast Cancer Screening.

Breast cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat.

There are differing opinions about when and how to screen for breast cancer so it’s important to review your risk factors with your physician.

The Breast Cancer Screening Chart below compares recommendations from several leading organizations. All women need to be informed by their health care provider about the best screening options for them.

 

	U.S. Preventive Services Task Force 2016	American Cancer Society 2015	American College of Obstetricians and Gynecologists 2011
Women aged 40 to 49 with average risk	The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.	Women aged 40 to 44 years should have the choice to start annual breast cancer screening with mammograms if they wish to do so. The risks of screening as well as the potential benefits should be considered. Women aged 45 to 49 years should get mammograms every year.	Screening with mammography and clinical breast exams annually.
Women aged 50 to 74 with average risk	Biennial screening mammography is recommended.	Women aged 50 to 54 years should get mammograms every year. Women aged 55 years and older should switch to mammograms every 2 years or have the choice to continue yearly screening.	Screening with mammography and clinical breast exam annually.

 

The benefit of screening is finding cancer early, when it’s easier to treat.  But there are risks associated with screening as well, which is why it’s important to talk to your doctor before getting any screening test, like a mammogram.

 

Risks of Screening

• False Positive Test Results - Harms can include false positive test results, when a doctor sees something that looks like cancer but is not. This can lead to more tests, which can be expensive, invasive, time-consuming and may cause anxiety.

• Overdiagnosis and Overtreatment - Tests also can lead to overdiagnosis, when doctors find a cancer that would not have gone on to cause symptoms or problems, or even may go away on its own. Treatment of these cancers is called overtreatment. Overtreatment can include treatments recommended for breast cancer, such as surgery or radiation therapy. These can cause unnecessary and unwanted side effects. Other potential harms from breast cancer screening include pain during the procedure and radiation exposure from the mammogram test itself. While the amount of radiation in a mammogram is small, there may be risks with having repeated X-rays.

• False Negative Test Results - Mammograms may also miss some cancers, called false negative test results, which may delay finding a cancer and getting treatment.

With so many seemingly conflicting recommendations it can be hard to decide if you should get a screening test. Talk to your doctor to understand the possible benefits and risks to make the right decision for you.

 

 The Take Home Message

Breasts play many roles in our lives. They give women their unique shapes. They provide sexual pleasure. They deliver life-sustaining milk to their babies.

Regardless of size or shape, we all want healthy breasts for a lifetime. The most important thing we can all do to maintain healthy breasts is to be intimately familiar with our own breasts, be cognizant of any changes that we notice and bring these changes to the attention of our doctor as soon as possible.

 

 

 

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.