Breast health in midlife: Have you met the girls?
Breasts can feed babies, look great in a sweater, make the occasional observer incoherent, and change fairly dramatically throughout our lives. We carry them around from puberty onwards, but sometimes it seems we haven’t been properly introduced.
We’d like you to “meet” your breasts now, get to know them intimately, so you can lavish them with love and care – and monitor any changes that might need additional attention.
What are breasts made of?
Most of us know that breasts are composed of fatty tissue, but breasts are a lot more complex than just accumulated fat.
Internally, they are also comprised of glandular and connective tissue, lobes and lobules, ducts, lymph nodes, blood vessels and ligaments. Each breast has 15-20 lobes, and inside those lobes, smaller structures called “lobules” make milk when a woman is breastfeeding. The ducts carry the milk to the nipple. Lymph nodes – which are found in several areas of our body – are part of our immune system, helping to fight infection.
Externally, you have the breast, the darker circle around the nipple called the areola, and the nipple.
Why do I need to “know” my breasts?
Breasts change as we age, as any woman who buys bras can tell you. Most of the changes are completely normal and no cause for concern. However, breast cancer affects 1 in 8 women in the US. Early detection can result in much better outcomes, so getting to know your breasts could literally save your life.*
Getting to know your breasts is basically establishing a baseline – where are the lumpy bits, how do your breasts change during different times in your cycle, how do they generally look and feel – so that deviations from that baseline are noticed right away and treated if necessary.
Knowing how important it to get to know your girls, we talked with Heidi Dishneau, MSN, ARNP, AOCNP . As an Advanced Oncology Certified Nurse Practitioner at Swedish Medical Center, Heidi is an invaluable resource for information on breast health.
What changes might women notice in their breasts as they get older?
According to Heidi, “Breast changes can vary widely as women get older. Typically the breasts become less dense post-menopausally as hormone levels decrease. This may be most noticeable only on a mammogram, and not necessarily on physical exam. Weight changes are one of the primary factors in breast changes. Some women struggle with weight gain after menopause, and this can certainly affect the breasts in terms of size.”
If breasts seem more sensitive after menopause, is that normal or a cause for concern?
Our breasts are sensitive to hormone influence,” says Heidi, “and this is usually the cause of any increased sensitivity or even breast pain. It’s normal for this to occur in one breast as opposed to both. Pain or sensitivity that comes and goes is generally not something to worry about. Pain or sensitivity that occurs in one breast and is persistent, or even increasing in intensity and/or interfering with daily activities, should be evaluated by your healthcare provider. Pain is rarely a presenting sign of breast cancer, but as with all new changes in the breasts, this should be evaluated.”
What should women do or not do to maximize breast health?
Self-exams. Heidi: “Even though the American Cancer Society has changed their recommendation in regards to breast self-exam, we still encourage women to perform routine self-exams, or as we often call it, ‘practice breast self-awareness.’ Be familiar with how your breasts look; if there are visual changes, such as new nipple inversion, these need to be evaluated. Clinical exams with a primary care provider or gynecologist annually are also important. For most women, we still encourage annual screening mammograms, but women should be discussing this with their primary healthcare provider to get personalized recommendations.”
Hormone replacement therapy (HRT). “For women of general risk, HRT use to address menopausal symptoms may be okay; however, we still recommend using the lowest effective dose for the shortest period of time. Prolonged hormone exposure does contribute to breast cancer risk. For women with personal histories of abnormal breast biopsies or strong family history of breast cancer, this risk could be even higher if HRT is used, and for many of these women we counsel them to avoid exogenous hormones [hormones originating from outside the body] if at all possible.”
Lifestyle choices. “There are limited studies addressing prevention of breast cancer. I advise my patients to maintain a healthy weight, get regular exercise, eat a balanced diet with mostly whole foods, low-fat and emphasis on high fruits/vegetable/fiber intake, low alcohol consumption (less than 3 drinks per week), and maintaining a high level of vitamin D. Some recent studies have suggested that vitamin D may have a role in breast cancer prevention, and although more research is definitely needed in this area, supplementing vitamin D is not likely to cause harm. I also recommend supplementation with omega 3s (fish oil, flaxseeds) as some early studies have suggested a correlation between the inflammation-reducing properties of omega 3s and cancer risk reduction. As I tell all of my patients, even if these early studies later prove to offer little benefit, there are relatively few downsides to supplementation with vitamin D and omega 3. They are usually inexpensive, and both likely offer additional health benefits.”
Alcohol, exercise, and weight management. Says Heidi, Anne McTiernan, MD, is a researcher at the Fred Hutchinson Cancer Research Center who has done a lot of work in the area of breast cancer prevention and recurrence risk reduction in relation to lifestyle. There is sufficient evidence to support the role of regular physical activity and maintaining a healthy weight, as sedentary lifestyles and obesity are known risk factors for breast cancer. She has also studied alcohol consumption, and her recent work has found that fewer drinks per week (ideally 1-2) is best for breast cancer risk reduction. In general, most of these lifestyle recommendations support good overall health in addition to impacting breast cancer risk, so they just make sense if a woman is interested in optimizing health. For women who struggle with weight management, we refer to our Swedish Weight Loss Services program. It’s important for us to have these sometimes difficult conversations in order to offer our patients options and resources for support.”
Know your (family) history. “I will also add that women should be aware of their family history,” Heidi tell us. “While less than 10% of all breast cancer can be attributed to hereditary predisposition, it is still important to know some of the ‘red flags’ for potential hereditary breast cancer, including family history of premenopausal breast cancer, breast cancer in 2-3 close relatives on one side of the family, family history of male breast cancer, and family history of ovarian cancer. That said, a recent study of about 20,000 participants found that up to 30% of people who test positive for an inherited genetic mutation that may increase their risk for cancer (including breast, ovarian, gastric, colon, uterine, pancreatic, prostate and melanoma), may not have had a family history that would be suggest traditional eligibility for genetic testing. We have several different genetic testing options available now and some with an affordable self-pay price if patients don’t meet their insurance criteria. This is an important thing to discuss with your healthcare provider.”
What tests should women get, and how often?
According to Heidi, “We recommend annual mammogram for most women. For those at high risk (history of biopsy-proven atypia, family history of premenopausal breast cancer in a 1st-degree relative, significant breast density, history of radiation to the chest as a young woman for treatment of lymphoma), it may make sense to include a breast MRI for screening, but this is something that warrants a more detailed discussion with a healthcare provider.”
What changes should a woman discuss with her doctor?
See your doctor, Heidi says, if you notice “any visual changes such as new discrepancy in size or contour of a breast, new nipple inversion, unilateral [one side only] and spontaneous nipple discharge, breast pain, or any new breast lumps.”
Ready to get to know your breasts?*
Up to 40 percent of women diagnosed with breast cancer may have discovered it first themselves. Performing monthly self-exams between regular mammograms is a good way to monitor for changes.
However, lots of women don’t do self exams. Early detection is key. But most women don’t do self-breast exams because it causes fear, or anxiety, or they’re not confident in their technique. Our goal is to inspire women to incorporate their breasts into their daily beauty ritual.
We recommend that women turn the self-exam into a positive experience, as opposed to an anxiety provoking one, by making it about skin care and self care.
Find a gentle cream to apply to neck, chest, and breasts to help skin stay healthy and hydrated. Try to avoid lots of chemicals and additives, and test the cream on less-sensitive skin first, so you know how your skin reacts.
However, know that a self-exam doesn’t replace being seen by a doc, it simply helps the three of you to become better acquainted. You should still follow the monthly regimen that your doctor suggests.”
Essential oils can help with irritability too. Read: irritability, menopause, and natural remedies for your last nerve
Learn how to conduct a breast self exam*
Remember, self examination is a useful tool, but like any tool, you need to learn to use it correctly. BreastCancer.org offers How to Do a Breast Self-Exam: The Five Steps. And because men get breast cancer too, albeit rarely, verywell health has steps men can follow to perform a male breast self examination as well.
*Self-examination, while useful, should never be considered a replacement for screening by a medical professional.
Breast cancer impacts nearly all of us, directly or indirectly. If you have an experience or wisdom to share, we’d love to hear from you. Please share with us in the comments, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group.
Have you taken our Menopause Assessment?
Join over 100,000 women to learn more about your symptoms and where you are in the menopause journey.