Breast Health - Detective & Preventive Strategies
The month of October shines a very impactful light on Breast Cancer Awareness. As the month comes to an end, it’s important to note that your awareness of your body, including your breasts, should be ever present.
Breast health should be viewed in 2 distinct categories - Detection and Prevention.
Detection
Breast Exams -
Breast exams should be done regularly for you to develop an awareness of your body and understand the terrain of your breasts. I recommend performing your exams in the shower, while soaping your body. Take 30-60 seconds to run your hands with awareness, noting the difference in texture between your breasts and anything unusual other than breast tissue. Feel the complete breast against the backdrop of your ribs.
An analogy that can be helpful is to feel over your mattress with a sheet on your bed. Then feel it again with a couple of soft-cooked peas under the sheet and then again with a couple of hard dried peas. The background is the mattress, which has a fairly even feel. We run our hands over this background to look for any distortions in that even feel. The soft-cooked pea would be what fibrocystic breasts feel like and are often associated with pain if pressed on too hard. The hard pea feel is usually not painful and could be a benign fibroadenoma that moves around the breast, or a malignant tumor which needs to be brought to the attention of a physician.
Although some in the medical field have stated that breast exams are not useful, I believe that when done regularly, it can be very useful to bring awareness to what is happening in your breast. Try examining them during various parts of your cycle if you are menstruating and note the difference. What about examining your breasts when you have had too much dark chocolate or coffee?
End your breast exam by feeling around the nipple and areola while looking at your breasts in front of a mirror with elbow bent and hands at your low waist, thrusting out your chest. Do the nipples look like they are in equal position? Is there any retraction or puckering of the skin? If you note any new retraction or puckering this needs to be brought to a physician’s awareness.
Mammograms -
This is best summarized by the US Preventive Services Task Force, that sets guidelines for all screening procedures based on worldwide data. In your 40s, begin with getting a baseline mammogram and then follow the screening guidelines (this is not to say that if you feel a lump you should avoid getting a mammogram until a certain age):
“The Task Force reviewed research studies on screening mammography. The final recommendations summarize what the Task Force learned about the potential benefits and harms of breast cancer screening:
(1) The value of mammograms increases with age, with women ages 50 to 74 benefitting the most. The best balance of benefits and harms happens when screening is done every 2 years.
(2) The decision to start breast cancer screening before age 50 is an individual one, and women in their 40s should talk with their doctors about the benefits and harms to determine whether screening is right for them.
(3) There is not enough evidence to determine the effectiveness of screening in women ages 75 and older.
(4) There is not enough evidence to determine the effectiveness of screening with 3D mammography.
(5) There is not enough evidence to determine the effectiveness of additional screening with other methods for women with dense breasts who have had a negative mammogram.”
Prevention
There is so much emphasis placed on detection and not enough energy is given towards how to prevent breast diseases. Here is what I teach my patients:
Weight - the best indicator for higher risk is an increased waist circumference and obesity. Waist fat is an estrogen manufacturing factory, among other hormones. While estrogen itself is not bad for us, in combination with fat and inflammation, it can lead to bad outcomes. Doing all you can to maintain your waistline and overall weight with a goal BMI (body mass index) between 22-25 is ideal. This is achieved by a healthy diet, eating in a circadian fashion and not eating too much. Exercising regularly to oxygenate tissues, getting proper sleep and managing stress are also very beneficial.
Keep alcohol serving size to less than 3 drinks per week.
Pay attention to the role of caffeine and theobromine from tea on your breasts. This will not only make you breast aware but also will allow self-regulation of the consumption of these products.
Avoid wearing bras with underwires. Most companies make bras without an underwire that work quite well. They may need to be changed every 2 years, but who doesn’t like new bras?! The wires cut into your fat layers and disturb the free flow of lymphatics which is required for your immune system to survey the breasts and remove toxins.
While showering, lift your arms up and soap them from hands to shoulders, using a gentle brushing movement. This helps lymph drainage of your arms towards your underarms. Repeat this from breast to underarm on both sides.
Restrict your use of birth control pills for as little time as possible. It is also helpful to have your children before the age of 28, as this is protective for breast cancer, especially if your weight is also kept in check.
If you have had any trauma to your breast pay extra attention to that breast. Take more time for lymph drainage and other preventive strategies. Breast cancer can happen more frequently in breasts that have suffered trauma. One study in 2002 found it plausible, though many other reports debunk this. I suspect that the former is more likely especially if it is trauma from sexual assault.
I often neglect to mention the avoidance of smoking in my practice, as I do not encounter too many patients who smoke. Smoking is truly an independent risk factor, not only for breasts, but for many other cancers in the body. If you smoke, please get help. It is a hard habit to quit and requires the help of the community around you as well as aids such as drugs for a short time.
Diet is especially important! Here are some extra tips:
The data is quite clear that unaltered soy products, such as soaked and cooked soybeans, tempeh, firm tofu and soy milk not only prevent breast cancer but can also be used once you have breast cancer diagnosed to downregulate estrogen’s growth effect on tumors. So eat up and avoid isolated soy protein, such as what is found in soy protein powders.
Turmeric, green tea and all the cruciferous vegetables are very protective against inflammation and breast cancer. Include these foods in your daily diet.
While you are trying to lose weight and have fibrocystic breasts, try using any of these strategies:
use one capsule of vitamin E 400 IU with tocotrienols per day or GLA-gamma linoleic acid 50-240 mg per day from evening primrose oil or borage oil capsules
eat 3 TBSPs of flax meal per day
use a combination of products to downregulate estrogenic effects such as resveratrol, curcumin, ginger or boswellia.
Do your best to get at the very least 40 grams of fiber in your det. This should include soluble fiber from whole grains and legumes and insoluble fiber from fruits and vegetables.
Prevention of constipation will also help the proper elimination of estrogen metabolites. Make sure you are staying regular, doing everything you can to help with this.
I must end with the many ways to manage stress. I have seen women who do everything right but are stressed from caretaking or their jobs and adding to it their stringent self-care. I find that making meditation a daily habit is helpful in managing stress, as is taking time for yourself in a loving way without feeling it to be an extra burden.
I hope that this article has made you pause and reflect on your own breast care habits. Adding these small habits to your daily life can make for giant changes in your health. If you would like to discuss your specific needs, Katie and I are available for consults at any time.
