Learning about Breast Cancer
- Dr. Robin Hall was diagnosed with breast cancer less than a year after both a mammogram and an ultrasound showed no signs of cancer. And it was her right breast growing larger than her left that let her know to go back to the doctor.
- Hall had dense breasts, so it was a breast ultrasound that ultimately found her cancer when a mammogram couldn’t.
- If you are at a higher risk for developing breast cancer, you should begin screening earlier. Risk factors for breast cancer include: being a woman, age, family history of breast cancer or a genetic mutation such as BRCA, having had a prior biopsy on an abnormal area, radiation exposure, lifetime estrogen exposure, not having a child before age 30 or never having children, obesity, drinking alcohol and lack of exercise.
- Signs and symptoms of breast cancer can include a breast lump or thickening that feels different from the surrounding tissue; a change in the size, shape or appearance of a breast; changes to the skin over the breast such as dimpling; developing a newly inverted nipple; peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin; and redness or pitting of the skin over your breast like the skin of an orange.
- Screening for breast cancer is typically done via mammogram. The American Cancer Society (ACS) says women should begin yearly mammogram screening for breast cancer at age 45 if they are at average risk for breast cancer. The ACS also says those aged 40-44 have the option to start screening with a mammogram every year, and women age 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
- One of our experts suggests patients with dense breasts get ultrasound screenings in addition to mammograms for the best results.
Hall, 63, discovered she had atypical hyperplasia after finding a lump in her breast when she was 38. This put her at a higher risk for developing breast cancer in the future despite not having a family history of the disease.Read More
RELATED: How to Avoid False Positive Cancer Results in Women With Dense Breasts: Ultrasounds Used in Addition To Mammograms
Another mammogram still showed no signs of cancer, but a follow-up ultrasound finally revealed the truth: a 1.5 inch cancerous tumor in her breast.
“I feel extremely fortunate that we caught it when we did, especially as fast as it was growing and how big it had already gotten in that short period of time,” Hall explained.
When You’re Getting a Mammogram, Ask About Dense Breasts
Women with dense breasts like Hall can, unfortunately, have a harder time with breast cancer screening. Dr. Linda Pak, a breast cancer surgeon/oncologist at NYU Langone’s Perlmutter Cancer Center and clinical assistant professor of surgery at NYU Grossman School of Medicine, suggests patients with dense breasts get ultrasound screenings in addition to mammograms for the best results.
“Ultrasound screening is a very helpful supplemental method of imaging, to be used in addition to a mammogram, for women with dense breasts. Increased breast density can make tumors more difficult to see on mammograms,” Dr. Pak told SurvivorNet in a previous interview. “Ultrasound can detect additional cancers that are not seen on mammography.
“Therefore I recommend a supplemental screening breast ultrasound in addition to mammography for all patients with dense breasts.”
For treatment, Hall underwent a double mastectomy because she was at high risk for getting cancer in her other breast followed by breast reconstruction. She didn’t need chemotherapy or radiation.
Hall is, thankfully, doing well today, and she’s on a mission to share her story and educate others about breast cancer.
“If I had not been in the know and just done a regular mammogram and then just trusted that, I would not be in a situation I am right now,” she said. “I can’t tell you how many women in my practice over the years — and I’ve taken care of tens of thousands of patients in that period of time — say, ‘I’m not worried, we don’t have a family history.’ But what people don’t know is 85% of breast cancer is sporadic, meaning you don’t have a family history.
“The two biggest risk factors for breast cancer are: No. 1, being a female and No. 2, aging. So as we get older, all women are at an increased risk.”
In addition, Hall wants to urge others to look at their bodies in the mirror once a month to keep an eye out for any possible changes to their breasts.
“That’s super important,” Hall said. “You don’t necessarily have to feel a mass, but if you see that one breast is getting larger than the other and it wasn’t always that way; or if you see the skin puckering or dimpling; or if one nipple is pulling inward and the other one isn’t — anything that’s different about one than the other, even if you just had a normal mammogram two or three months ago, you still need to get it checked out.
“Also, ask for an ultrasound, especially if you have dense breast tissue.”
Understanding Your Breast Cancer Risk
The risk of developing breast cancer varies greatly from person to person, so it’s important to discuss your specific risk level with your doctor. That being said, there are some important risk factors to keep in mind.
Major Reduction in Cancer Risk by Following Old Standbys Diet and Exercise
In a previous interview with SurvivorNet, Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center, laid out several risk factors for breast cancer including:
- Being a woman: Women are at a higher risk for breast cancer, though men can get the disease too.
- Age: “Breast cancer becomes increasingly more common as women age,” Dr. Comen said.
- Family history: “Some people think that breast cancer is only inherited through genes on the mom’s side,’ Dr. Comen said. “But it can also be related to genetic mutations that could be found on the father’s side.”
- Having had a prior biopsy on an abnormal area: “There are different markers, that if a woman has had a biopsy, it’s important that she talk to her doctor about whether those markers are lending themselves to an increased risk of breast cancer,” Dr. Comen said. If you’ve had a biopsy that indicated atypical hyperplasia, for example, you are at an increased risk of breast cancer. Atypical hyperplasia isn’t cancer, but it is a precancerous condition that describes an accumulation of abnormal cells in the milk ducts and lobules of the breast.
- Radiation exposure: Cancer survivors who’ve had radiation to their chest are at an increased risk of breast cancer.
- Lifetime estrogen exposure: “About 2/3 of breast cancer are driven by the hormone estrogen,” Dr. Comen said. “So, that means if a woman has had her period at an early age and started to go through puberty at an early age, at seven, eight, nine, and potentially a later age of menopause, means that her lifetime of having had menstrual periods and being exposed to higher levels of estrogen is higher, and therefore her risk of breast cancer is slightly higher.”
- Not having a child before age 30 or never having children
- Drinking alcohol
- Lack of exercise: “While there’s more research to be done in this area, it looks like if a woman is not exercising, she may also increase her risk for breast cancer,” Dr. Comen said.
Alcohol Can Increase the Risk of Developing Breast Cancer
Know the Signs of Breast Cancer
It’s always important to stay on top of any changes to your health and address them promptly. Signs and symptoms of breast cancer can include the following:
- A breast lump or thickening that feels different from the surrounding tissue
- Change in the size, shape or appearance of a breast
- Changes to the skin over the breast, such as dimpling
- A newly inverted nipple
- Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
- Redness or pitting of the skin over your breast, like the skin of an orange
It’s important to keep an eye out for these symptoms while remembering that having one or many of them does not necessarily mean you have breast cancer. Regardless, you should always speak with a doctor right away if anything ever feels off or you’re experiencing one or more of the signs listed above. You never know when speaking up about your health can lead to a very important diagnosis.
Learning about Breast Cancer Screening
Screening for breast cancer is typically done via mammogram, which looks for lumps in the breast tissue and signs of cancer. The American Cancer Society (ACS) says women should begin yearly mammogram screening for breast cancer at age 45 if they are at average risk for breast cancer. The ACS also says those aged 40-44 have the option to start screening with a mammogram every year, and women age 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.
When Should I Get a Mammogram?
For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, a genetic mutation known to increase risk of breast cancer such as a BRCA gene mutation or a medical history including chest radiation therapy before the age of 30. Beyond genetics, family history and experience with radiation therapy, 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.
In a previous interview with SurvivorNet, Dr. Connie Lehman, chief of the Breast Imaging Division at Massachusetts General Hospital, said people who hadn’t reached menopause yet should prioritize getting a mammogram every year.
“We know that cancers grow more rapidly in our younger patients, and having that annual mammogram can be lifesaving,” Dr. Lehman said. “After menopause, it may be perfectly acceptable to reduce that frequency to every two years. But what I’m most concerned about is the women who haven’t been in for a mammogram for two, three or four years, those women that have never had a mammogram. We all agree regular screening mammography saves lives.”
RELATED: Check Your Breasts Today, and Once Every Month; Survivor Giuliana Rancic Stresses Its Importance
It’s also important to be on top of self breast exams. If you ever feel a lump in your breast, you should be vigilant and speak with your doctor right away. Voicing your concerns as soon as you have them can lead to earlier cancer detection which, in turn, can lead to better outcomes.
Learn more about SurvivorNet's rigorous medical review process.