Who should get a breast exam?
Dr. Negar Golesorkhi, breast surgeon: There are three types of exams. The first is a self breast exam, next is a clinical breast exam, and the third is a mammogram. A self breast exam is recommended for any woman 20 years or older and should be done on a monthly basis. A clinical exam is one that’s done by a physician and should be performed on ladies 20 to 39 years old at least once every three years; for ladies 40 years and older, once every year. In addition to that, women older than 40 should be getting an annual screening mammogram.
How and when should I give myself a breast exam?
Golesorkhi: The recommended time of month that a woman should be doing a self breast exam is a week after she has finished her period. That’s when there is less hormone fluctuation in the body and your breasts won’t feel so lumpy and bumpy. If you’re already post-menopausal, just pick a time—the first day of the month, let’s say.
Dr. Stephanie Akbari, breast surgeon: Everybody has lumpy, bumpy breasts. We’re looking for a change on top of what is normal for your breast tissue: an area that is bigger, different from the rest of the breast tissue and the other side, an area that’s firmer, and puckered or red skin. You can do the exam in the shower or while lying down, by putting one arm up over your head and using the other hand to examine.
What are some new ways to prevent breast cancer?
Dr. Neelima Denduluri, medical oncologist: It’s really about going back to the basics. We’re excited that we know who is at higher risk so we can tailor better imaging and treatments, but we still can’t forget what Grandma told us. In the 1930s to 1950s, my grandmother was outside hanging clothes and getting her vitamin D. If she was going to her sister’s place, which was a few blocks away, she walked there. So those are all things that I think as Americans we don’t do as much as we did 50 to 80 years ago. I think what we need to do as a community is encourage one another to eat better, exercise more, and supplement with vitamins partially, but really we should be able to get it by how we live daily.
Tell us more about the new breast density law [which was passed on July 1].
Akbari: Virginia was the third state in the country to pass a law that mandates that radiologists who read a mammogram and see that there is dense breast tissue add a sentence or two on the letter that you receive stating that you have dense breast tissue and mammography may not be the perfect imaging tool for you. In other words, you might need something extra done, whether it’s an ultrasound or an MRI. Connecticut, Texas, Virginia, and New York are the only states that have passed this law. There are bills on the docket for 21 other states. The idea is to allow the public to understand that mammograms aren’t perfect. When somebody has dense breast tissue, the X-rays have a very hard time penetrating that tissue, which shows up as white on a mammogram. And cancer shows up white, too. The only downside of the law is there are no requirements for insurance to cover the extra costs.
Is soy or almond milk healthy?
Denduluri: It’s a complex question. There’s some data that shows women who have been exposed to soy early in life, especially in Asian countries, have a decreased risk of being exposed to breast cancer. And recently a friend of mine published a study that showed that women who have daily intake of soy may be at decreased risk for recurrence [of cancer]. But other data shows that soy acts like estrogen, and two-thirds of women with breast cancer feed off estrogen. So I tell women: everything in moderation. We don’t know if some of the protective effect of soy is just because that woman is eating less red meat. So don’t go out of your way to avoid soy, but at the same time don’t go out of your way to eat ten servings of soy each day. And regarding almond milk, there’s absolutely no data I know of that says we shouldn’t have almond milk.
How can I tell if I am vitamin D deficient and how often should I get checked?
Denduluri: You can have your vitamin D level checked through your primary care doctor or oncologist. In women who have normal vitamin D levels and live a healthy lifestyle, there is no reason to keep checking. With women with breast cancer, we do generally check it because about one-third of women with breast cancer have vitamin D deficiency.
Is there more radiation associated with 3D mammography than with a regular mammogram?
Akbari: Yes, there is slightly more radiation with 3D mammography than standard 2D mammogram, but not so much that you’d want to skip it. You certainly would want to add that to your treatment if you have dense breasts. Radiation that you get from a mammogram is less than [you would get] flying on an airplane from here to California. If you keep that into perspective, it really is a small amount that over your lifetime does not increase your chances of developing breast cancer.
What are the best cancer-fighting foods?
Denduluri: All fruits and vegetables. For example, orange vegetables like carrots. They can possibly reduce the risk of head and neck cancers. Make smoothies—just don’t add sugar. It’s interesting because our fat cells produce estrogen, and two-thirds of women with breast cancers are driven by estrogen. So maintaining an ideal body weight helps that part of the equation.
Is there any connection between breast cancer and birth control pills?
Dr. Molly Sebastian, breast surgeon: Not really. As we know, fertility wanes from age 35 on, and the average age for menopause is 50. It’s younger women who are taking birth control pills. But in that age group, the ovaries are so active that the little bit of hormone that people take from birth control pills is kind of a drop in the bucket compared with what’s going on in their body. At that point, we don’t see a real relationship between use of birth control pills and breast cancer.
Did you miss this breast cancer awareness event? Visit Well+Being’s roundup of breast cancer events in October, featuring cancer screenings and yoga classes throughout Washington.