How Self-Exams Can Help with Early Detection & Understanding Provider Bias
- Journalist Amy Robach—who previously had stage 2 invasive breast cancer, and underwent a bilateral mastectomy (removal of both breasts) and chemotherapy to treat it and reach remission—has revealed she felt “shame” when she learned she had breast cancer, as her doctor questioned how she didn’t notice the lump in her breast.
- Her story highlights the importance of early detection, advocating for your health, and not feeling shame when it comes to your body.
- SurvivorNet experts recommend performing a monthly breast self-exam to look for anything unusual because it can help catch breast cancer. Talk to your doctor if you notice one or more of the following symptoms: a new lump in the breast, unusual sagging, new swelling in the breast, changes to the nipple (such as puckering), flaking or redness in the breast or nipple, discharge (including blood) coming from the nipple and pain in the breast.
- It’s also important to understand that while your doctor has undergone years of training and practice, she or he is ultimately still human and may come with their own set of biases that can impact how they treat patients.
- To combat these biases, known as provider biases, and really get the most out of your interactions with your doctor, you should provide her or him with plenty of information about your life and ask plenty of questions when things aren’t clear.
Robach and Holmes spoke with Breast Oncologist Dr. Elizabeth Comen on their most recent podcast episode about the 51-year-old’s experience with a doctor that left her feeling ashamed when she didn’t notice the lump in her breast.
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She continued in the podcast, which a video clip of the interview was shared on her podcast Instagram page, “I’m sure that wasn’t an intention to be mean, but to feel shameful about your cancer was a whole new level for me in that moment.
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After recounting how she felt when she was diagnosed, Dr. Comen responded, “That’s horrible. I’m so sorry that happened to you. And also, I think women feel shameful about their bodies … even for their normal bodily functions, let alone if they have a cancer diagnosis. And that pervasive shame absolutely gets in the way of every aspect of women’s health care. I’m sorry.”
After thanking Dr. Comen for understanding, Robach added, “Well, it was a lesson. Just an experience to learn from and grow from.”
Robach then recalled how Dr. Comen points out in her book, “All in Her Head – The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today,” that the anatomical terminology for the external genitalia of females was previously called “pudendum,” which derived from the latin word pudēre, which means “to be ashamed.”
Dr. Comen explained further, “Well there’s all sorts of language, and language has become so important with respect to the subtle cues that we give women and the not-so subtle cues. But in multiple different ways we are taught to shame or ignore multiple parts of our bodies.”
Getting to Know Your Breasts with Self-Exams
In regard to doctor-patient relationships, Robach said she often looks up to her doctor as “God” as if she “doesn’t know anything, and they know everything,” something her brother didn’t like as he would urge her about the importance of second opinions.
“My brother would always say, ‘Amy, second opinions, third opinions, and if you don’t like how someone is talking to you, or treating you … by all means get another doctor,” Robach added, pointing out how Dr. Comen said something similar in her book.
“I needed him to say that to me for me to feel like I could, because when you don’t know, and you know you don’t know, you think, ‘Well, that other person’s gotta be telling me the truth.'”
Robach’s Breast Cancer Journey
Robach’s cancer journey began after being encouraged by Robin Roberts during a segment on the morning show. Like Roberts, who also learned of her cancer diagnosis while undergoing a self-exam, Robach underwent a mammogram on the program to promote breast cancer awareness.
Robach’s screening led to her diagnosis of stage 2 invasive breast cancer. She also learned cancer had spread to her sentinel lymph nodes. After her tumor was detected, she underwent a bilateral mastectomy (also called a double mastectomy), where both breasts were removed. Following the procedure, Robach underwent six months of chemotherapy. Luckily, her treatments helped her reach remission.
.@ABC News anchor @arobach opens up about the lessons she learned while battling breast cancer in 2013: "Realize how precious time is and no one is guaranteed a tomorrow." 💗 https://t.co/9BUBbAnKcD pic.twitter.com/aCkglXFn8p
— Good Morning America (@GMA) October 29, 2020
Robach also discussed a few of the trials and tribulations you undergo as you take on cancer.
Her cancer journey strengthened her compassion for others. She says she developed a new kind of compassion that wasn’t possible before her experience with breast cancer.
“Cancer is something that has changed my life forever, something that I will always live with,” Robach expressed at the time. “There’s anger at first because you’ve lost security, and you’ve never had it to begin with. None of us have security, but you are grieving this loss of security because we all feel like there’s tomorrow.”
“We all feel like there’s another day. When you get to something like this, you’re angry that you lost that. That’s been taken away from you. From that anger, I think, grew compassion and empathy,” she added.
She also considers that loss of security one of the gifts that cancer can bring, saying, “You truly can feel other people’s pain in a way that you couldn’t have before.”
Provider Bias in Healthcare
It’s important to understand that while your doctor has undergone years of training and practice, she or he is ultimately still human and may come with their own set of biases that can impact how they treat patients.
In Robach’s case, she felt shamed when she didn’t find the lump in her breast that turned out to be cancerous. For others, women it’s not unusual to be ignored at the doctor. And the same goes for many groups of people, including Black people, older people, the LGBTIQA+ community, and anybody who is lacking on education and money.
To combat these biases, known as provider biases, and really get the most out of your interactions with your doctor, you should provide her or him with plenty of information about your life and ask plenty of questions when things aren’t clear.
To better understand how you should approach conversations with your doctor, SurvivorNet previously spoke to Dr. Dana Chase, gynecologic oncologist at Arizona Oncology.
According to Dr. Chase, physicians, like many of us, can be a bit biased when seeing patients. Dr. Chase makes clear that these biases are rarely sinister, but rather unconscious and more subtle.
Avoiding Provider Bias – Is Your Doctor Understanding You?
Dr. Chase says, “We have certain beliefs that we don’t know about. We might look, for example, at an older woman, and just by the way she looks we might make certain assumptions, and we might not even know that we’re making these assumptions.”
Sometimes, these assumptions can lead to differences in the care that doctors provide. That is the point at which you, the woman, should advocate for yourself and clear up any misconceptions the doctor may have, says Dr. Chase.
“Say things to your doctor like, ‘I may not seem healthy because I’m 92, but I want you to know that I play tennis three times a day,’ ” she explains. This type of discourse can be really helpful when building a relationship with your physicians and even more important when it comes to creating a treatment plan.
To sum things up, Dr. Chase says, “In order to avoid situations where potentially the doctor is making assumptions about you that you don’t even really know about, reminding yourself to tell the doctor who you are, to explain your life situation, I think is really important.”
Provider Bias in Healthcare: How To Change The Dynamic
Clearing up misconceptions is important, but so is understanding what your doctor is telling you, says Dr. Chase. In order to do so, she advises women to speak up and ask questions when they don’t understand something.
“It’s never a bad thing to ask for something to be repeated, or to ask the doctors to explain it in different terms.” So next time you go to your physician, we think you should feel empowered to speak up, both so she or he understand you and you understand them.
Being Your Own Advocate
It’s important to practice, something many SurvivorNet experts often recommend, being your own biggest advocate.
“Every appointment you leave as a patient, there should be a plan for what the doc is going to do for you, and if that doesn’t work, what the next plan is,” Dr. Zuri Murrell, director of the Cedars-Sinai Colorectal Cancer Center, told SurvivorNet in a previous interview.
“And I think that that’s totally fair. And me as a health professional that’s what I do for all of my patients.”
WATCH: Why advocating for your health is important.
Getting a second opinion is another way to advocate for your health.
Doctors do not always agree on whether your symptoms might warrant further testing. It’s during moments like these that having a second or third medical professional’s opinion might be able to catch something before it worsens.
Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute supports patients getting multiple opinions.
“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care, because finding a doctor who is up to the latest information is important,” Rosenberg previously told SurvivorNet. “And it’s always important to get other opinions so that you can make the best decisions for yourself in consultation with your care providers.”
WATCH: Cancer Research Legend Urges Patients to Get Multiple Opinions.
All About Breast Self-Exams
Breast self-exams (BSE) are a simple yet important self-check method that involves observing and feeling the breasts for any changes or abnormalities.
While they are not a replacement for professional clinical exams or mammograms, BSE can serve as an essential first step in monitoring breast health and detecting any potential concerns, SurvivorNet’s experts explain.
Breast Cancer: Introduction to Prevention & Screening
These type of exams play a crucial role in early detection and diagnosis of potential breast conditions, including breast cancer. By performing regular self-examinations, you become familiar with the normal look and feel of your breasts, making it easier to identify any unusual changes. Early detection of breast cancer can vastly improve treatment outcomes and the chances of successful recovery.
While BSE alone isn’t a guarantee for early breast cancer diagnosis, it serves as a supplementary tool to other screening methods, such as clinical breast exams and mammography.
Here are some key reasons why breast self-exams are important:
- Familiarization with your breasts: Regular BSE helps you understand how your breasts normally look and feel. This knowledge makes it easier to identify changes or abnormalities as they occur.
- Early detection: In some cases, a breast self-exam might lead to the discovery of a lump or other change that could indicate breast cancer or another noncancerous condition. The earlier a problem is identified, the better the chances for successful treatment.
- Empowerment: Taking control of your breast health by performing regular self-exams can empower you and foster a sense of awareness, responsibility, and confidence regarding your well-being.
- Routine health monitoring: Incorporating BSE into your monthly self-care routine helps establish a consistent health-monitoring practice, making it more likely that you will notice any unexpected changes.
It’s important to remember that BSE should never replace professional clinical exams or mammograms. Instead, view these self-exams as a complementary practice to maintain optimum breast health and ensure early detection in case an issue arises. Don’t hesitate to consult your doctor if you notice any changes or abnormalities during your self-examination.
How To Perform Breast Self-Exams
The optimal time to perform a BSE is about a week after the beginning of your menstrual cycle when your breasts are less tender and swollen. If you don’t menstruate, choose a consistent day every month to perform the exam.
Here’s a step-by-step guide to performing a breast self-exam:
- Observe in the mirror: Stand in front of a mirror, undressed from the waist up, with your arms relaxed at your sides. Examine your breasts and nipples for changes in size, shape, or color. Look for any dimpling, puckering, or redness on the skin. Then, raise your arms overhead and examine your breasts from all angles, including with your hands on your hips.
- Palpate while standing: While standing or sitting, use the pads of your three middle fingers to gently press on your breast tissue, moving in small circular motions. Cover your entire breast, from the collarbone to the top of your abdomen, and from your armpit to your cleavage. Apply light, medium, and firm pressure as you examine each area, feeling for any changes or lumps.
- Examine your nipples: Gently squeeze your nipple between your thumb and index finger. Check for any discharge, and if present, note the color and consistency. Make sure to examine both breasts.
- Palpate while lying down: Lie down flat on your back with a folded towel or small pillow under your right shoulder. Place your right hand behind your head. With your left hand, follow the same palpation process as in step 2, covering the entire breast area. Repeat this process for your left breast, placing a towel or pillow under your left shoulder and switching hands.
Remember, the goal of a breast self-exam is to familiarize yourself with the normal appearance and feel of your breasts. This familiarity will make it easier to detect any changes that may occur, allowing you to take prompt action and consult a doctor if necessary.
Also keep in mind that some changes are normal and may not indicate a serious issue, but it’s always better to be proactive and discuss any concerns with a healthcare professional.
You should consult with your doctor if you notice a new lump, nipple changes, dimpling or puckering in breast appearance, unusual breast or nipple pain, or redness/swelling of the breasts.
When to Screen for Breast Cancer
The medical community has a broad consensus that women have annual mammograms between the ages of 45 and 54. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
WATCH: SurvivorNet expert, oncologist Dr. Ann Partridge discusses the challenges of diagnosing and treating treating aggressive breast cancers in young women.
For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
Women with a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
WATCH: Understanding the BRCA gene mutation.
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
RELATED: Is Genetic Testing Right for You?
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.
What To Ask Your Doctor
If you have been diagnosed with breast cancer, you may have questions about how to keep your strength through treatment. Here are a few questions to help you begin the conversation with your doctor:
- What treatment will I be receiving?
- What side effects are associated with this treatment?
- Are there steps I can take in my daily life to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do you have recommendations for someone who doesn’t particularly enjoy exercise?
- Can you recommend a dietician who can help me with healthy eating tips and maintaining a healthy weight?
- I’ve been having trouble sleeping, do you have any treatment recommendations?
Contributing: SurvivorNet Staff
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