Ask A Doc – Diana Okuniewski, DO NOMG Women’s Health
Question: Should I do breast self-exams? What is breast “self-awareness”?
Breast self-examination is becoming a “hot-topic of discussion” among societies that make our guidelines for medical practice. It is now being said by the American College of Obstetricians and Gynecologists that breast self-exam should be encouraged for patients who are more high risk for breast cancer (patient’s with a strong family history of breast cancer, or genetic abnormalities that may increase their risk of getting cancer) and that breast self-awareness be encouraged for everyone else, but that “self-awareness” could include self-exams. The changing recommendations are because of a lack of literature that supports a decrease in mortality by women that perform regular self-exams. However, most of the expert groups do support breast “self-awareness”. This means that a woman should be familiar with what her breast normally feels and looks like. Every woman’s breasts are different and will have lumps and bumps that are normal. Also, just because your breasts feel dense, does not mean they will look dense on mammogram. If you are comfortable doing a self-breast exam and want to do them, pick the same time every month. Do a thorough check for any changes by using your fingers in a circular motion from your arm pit up to your collar bone and then you can go in circles toward your nipple to check for any abnormal lumps as well as nipple discharge. Anytime nipple discharge is seen, except when breast feeding, or postpartum, you should see your doctor as soon as possible. Breast self-awareness also includes knowing what your skin looks like on your breasts, so be aware of any skin changes, redness, puckering, or rashes.
Question: Why do I hear different opinions about when to get my mammogram and how often?
Each expert group that makes medical guidelines will interpret the literature and new research differently to make their own guidelines by weighing the risks and benefits of the entire population. For example, the American College of Obstetricians and Gynecologists, The American College of Radiology and the National Comprehensive Cancer Network still recommend yearly mammograms beginning at age 40. The American College of Physicians recommends mammograms every 1-2 years, individualize screening from age 40-49 based on risk factors, and definitely begin screening at age 50. The American Academy of Family Physicians and the U.S. Preventative Task Force recommends the same, as the College of Physicians, except screening every 2 years. Bottom line is that you should talk to you doctor about your family history to best determine when to begin mammogram screenings and how often.
Question: Do mammograms actually save lives or are they causing more cancer?
Mammograms can save lives! The odds of dying of metastatic breast cancer are one-third of what they were in the 1980s. About 50 percent of this huge decrease is due to screening and early therapies. This suggests that screening mammography both reduces the odds of dying of breast cancer and increases earlier treatment.
Question: What can I do about my breast pain?
Breast pain is usually a benign condition. Cyclical pain, fibrocystic changes and breast cysts are common causes for breast pain. It is uncommon for breast cancer to cause pain. Treatment with analgesics (Ibuprofen and Tylenol) and a supportive brassiere can be helpful for many women with breast pain. Warm compresses can also help. Believe it or not, research studies have shown that increasing caffeine intake increases painful breasts. If you are concerned about breast pain you should call your doctor to have a physical exam and history taken to see if any imaging of your breasts with ultrasound or mammogram will be necessary.