For breast cancer survivors and their loved ones, October’s Breast Cancer Awareness Month can be the source of complex emotions. It is both a time to shed light on issues surrounding the disease, and a painful reminder of how far we still must go in our battle against it—especially when it comes to pushing the research forward in areas like advanced or metastatic breast cancer. How every survivor (or cancer warrior, as I prefer to think of myself) experiences Breast Cancer Awareness Month is deeply personal and completely valid. For my part, as a young breast cancer survivor, I like to think of this month as a time to promote better education around topics including risk factors and screening, as well as how we can best support those who have been recently diagnosed with breast cancer. Here’s what I want you to know about breast cancer awareness:
The monthly breast self-exam has fallen out of favor in recent years, with many medical organizations no longer recommending them due to questions about their overall efficacy in early cancer detection. Having said that, as the American Cancer Society states, “this does not mean that these exams should never be done.” For women of average breast cancer risk, I personally still believe in the value of the breast self-exams, for many of the same reasons I encourage my patients to pay close attention to things like their menstrual cycle.
It’s important for you to become familiar with the unique feel and appearance of your breasts, so you’ll recognize if there are any sudden issues, such as changes in skin texture like dimpling, puckering, or bulging. Other signs to look for include changes in your nipple position, redness, soreness, or swelling in the breast. You’re the only person that spends all day, every day with your body, and therefore you are in the best position to observe any changes that might signal a problem that’s worth taking a closer look at.
There are lots of resources you can use to learn how to correctly perform a breast self-exam , including your gynecologist, primary care doctor, or your Parsley Health physician, all of whom should be able to demonstrate the technique for you. You’ll want to perform your exam at the same time of the month, preferably a few days after your period ends. If you do not have regular periods, pick a time each month that will be easy to remember.
A lot of people think that if they don’t have a family history of breast cancer, it’s not something they have to worry as much about. Unfortunately, that couldn’t be further from the truth. Only about 5-10 percent of breast cancer cases are related to inherited genes—what you might think of as “hereditary” cases. In those cases, we often talk about inherited mutations in two genes: BRCA1 and BRCA2. Recent studies suggest that 72 percent of women who inherit the BRCA1 mutation, and 69 percent who inherit the BRCA2 mutation will develop breast cancer by the age of 80. BRCA1 and BRCA2 mutations also increase the risk of other types of cancers, most notably ovarian cancer, but also fallopian tube cancer, and peritoneal cancer. It’s important to note that a family history of breast cancer doesn’t necessarily mean that you have the BRCA1 or BRCA2 mutations (many people do not), and BRCA1 and BRCA2 mutations are not the only genetic mutations that can potentially lead to inherited breast cancers, although they are the most common.
Genetic testing is available for the BRCA1 and BRCA2 gene mutations, typically using DNA from a blood or saliva sample. Understanding the results of these tests and their limitations can be complex however, which is why it’s very important to discuss with your healthcare provider whether this type of testing is right for you. Additionally, a genetic counselor specializing in cancer genetics should support you through this entire process and is best equipped to help you interpret the results of your testing.
While rare, men can also get breast cancer. Male breast cancer accounts for less than 1 percent of all diagnosed cases of breast cancer. Men at any age can be diagnosed with breast cancer, although most cases are diagnosed after the age of 50. Risk factors for men include diseases associated with excess estrogen in the body, radiation exposure to the chest, and a family history of breast cancer. The BRCA mutation also appears to play a role in some instances of male breast cancer, with what appears to be a greater risk in men who inherit the BRCA2 mutation.
Among individuals who do not have a family history of breast cancer, one of the biggest risk factors is age; 85 percent of breast cancer cases are in women over the age of 50 . Breast cancers diagnosed before the age of 40, like mine, only account for 5 percent of overall breast cancer cases. Other risk factors include a history of certain benign breast conditions , dense breast tissue, and lifestyle factors including drinking alcohol . Understanding your risk factors can help you to take steps to get appropriate screening for your particular risk level.
Maybe you haven’t started getting annual mammograms yet, or maybe you’re confused about the differing guidelines for mammograms among major health organizations. Your doctor can help you determine when you should begin regular annual screening, and what type of examinations or imaging is appropriate for your risk level. What’s right for someone with an average risk of cancer might not be aggressive enough for someone with a family history of breast cancer.
Depending on your risk level, the density of your breast tissue, or certain findings during an annual mammogram, doctors also use MRI or ultrasound. In recent years thermography, a test that uses an infrared camera to detect patterns of heat and blood flow near the surface of the body, has been promoted by some as an alternative to mammography. However, thermography is not approved by the FDA as a primary tool in the detection of breast cancer, and it should not be used in place of regular mammography.
While it is true that there are limitations to mammography and mammograms are not 100 percent accurate in detecting all cancers that might be present, mammograms remain the gold standard in breast cancer screening. Additionally, the timing of your mammogram may also be important; newer research indicates that getting your mammogram at the beginning of your cycle may improve the accuracy of your results, since your breast density may be lower during the earlier part of your cycle.
It can be difficult to know how to support someone you love after a cancer diagnosis. I have personally been on both sides of the equation; I have struggled to find the right way to support a loved one with cancer, and I have also been a person with a cancer diagnosis who needed support. In my experience, the absolute best thing you can do for your loved one is be there and be available to listen.
That also means actually hearing the person with the cancer diagnosis when they are asking for a particular kind of support. Everyone copes with this journey differently, and what you might think would be helpful if you were in the situation might not be what your loved one needs at any particular moment. Make yourself physically and emotionally available, be prepared to listen, and hold space for your friend, relative, or partner to express their fears as well as celebrate their cancer victories and milestones.
During my cancer treatment, I found an incredible amount of strength in the unwavering support of my husband and family. From filling my freezer with my favorite, nourishing and healthy comfort foods to joining me on walks while I built my strength back up, just having them by my side was a very significant part of my experience.
Being on the receiving end of a breast cancer diagnosis is an intense, overwhelming place to be. One thing I wish I had known when I was diagnosed with breast cancer in 2016 is how important it would be to be kind, gentle, and patient with myself. A cancer diagnosis is really a process, or a journey, and it’s one that can feel extremely daunting at the very beginning. But like any journey, every step you take forward represents progress.
I also personally believe finding a community to share our journey with can be very helpful. You may feel very isolated and even angry after a cancer diagnosis; but guess what—there’s actually a whole group of others out there, just like you, and they want to talk about it. Find a space that aligns with your individual needs, where you can connect with other people going through this experience—social media in particular has made this easier than ever. For me, that group was the Young Survival Coalition, but for you that might be another group that you feel best represents your situation.
Finding a community can also mean finding the right treatment team. While it’s absolutely true that urgency and time sensitivity are a part of a cancer diagnosis, you still deserve a treatment team that makes you feel seen and heard. Don’t be afraid to get a second opinion —doctors are actually completely used to this and your current doctor may even be able to help refer you to another specialist. Also remember that breast health, like any other part of our body, is multifactorial. There is so much that you can do beyond the initial phases of your cancer treatment to support breast health, and that’s something a comprehensive care team can help you with.
In the months after my initial breast cancer treatment, integrative medicine and functional medicine became an increasingly bigger part of my story. Integrative medicine isn’t right for everyone, and you should always discuss any additional therapeutic modalities you want to explore with your oncology team to make sure they’re safe and appropriate for you. Looking at resources beyond your conventional treatment team can provide valuable additional support, and also can play an important role in the period after your treatment.
We often think of our cancer treatment as a distinct period of time, after which things will “go back to normal,” but you may find that normal looks and feels very different than you imagined it at the beginning of your journey. This experience can be difficult but know that there’s a world of resources and support available for you to discover both during and after your treatment.
Dr. Jaclyn Tolentino is a Board-Certified Family Physician with a collaborative, holistic approach to practicing medicine. She holds a subspecialty certification in Hormone Optimization, has received extensive training in Functional Medicine through the Institute of Functional Medicine, and additional training in oncology nutrition.