Breast Health- A Specialists Insight

October was breast cancer awareness month and a good time to think about breast health. Your breasts are specialised glands which go through a monthly cycle, ready to change to produce milk if you become pregnant. Because of this monthly change, your breasts are never the same. There is a constant change in breast tissue which makes us very aware of our breasts. They can be sore, swollen, lumpy, and/or burning depending on the time of month. So how do you know what is normal?

Every woman's experience of having breasts is different. It is important to learn what is normal for you and to recognise worrying changes that should be investigated. Because it is often difficult to tell what is normal when you examine your own breasts, from the age of 40 years onwards you should have a breast check with your GP.


IMAGING

Mammogram is the best breast screening tool that we have. 3D tomography is a 3 dimensional mammogram and is the gold standard. You should have your mammogram just after your period finishes as your breasts are less tender at this time. Breast screening normally starts from the age of 40 onwards and other types of imaging are added in if necessary. What age you start having breast imaging and which type of imaging depends on your family history and breast type. Your GP may be able to work this out for you or there are specialty breast units or breast specialists who will give you a comprehensive check and work out a personalised plan for your breast health. If you are less than 35 years of age and have a symptom, we usually start with ultrasound and add other imaging as necessary.



BREAST DENSITY

Your breasts are made from fatty tissue and glandular tissue. More fatty tissue makes them easier to examine by mammogram; more glandular tissue makes them more difficult to read with mammogram alone. Every woman should know her breast density. Sometimes you need to ask.

A     < 25% of your breast tissue is glandular
B     25-50% of breast tissue is glandular
C     50-75% of breast tissue is glandular
D     > 75% of your breast tissue is dense glandular tissue


If you have denser breasts(C,D), you will need more imaging to check them properly such as mammogram and ultrasound or MRI. You may need more regular imaging, for example once a year. Denser breasts tend to be more painful and lumpy with the cycle but hold their shape better as you age.

If you have less dense breasts (A,B), you may just need a mammogram and you may only need imaging every two years, but it depends on your history which includes your family. Less dense breasts are often less painful and lumpy and easier to image however they droop more as you get older.

Breast density decreases once you go through the menopause as hormones no longer act on the tissue.



SELF-EXAMINATION

Breast checks are important for your breast health and part of this is getting to know your breasts. Examine your breasts once a month, just after your period has finished if you are still having periods, in the shower when you are soapy. Use a flat hand and compress your breast against your rib cage with a circular movement to get to know what your breast feels like.

Are your breasts dense, soft , lumpy , nodular? Everyone's breasts are different. Once you know what your breasts are normally like, you are more aware of changes that are unusual.

WARNING SIGNS - these should make you see your GP for a check up:

Changes in breast tissue?
Is there a new lump?
Is there a new thickening?

Change in your breast appearance?
Has your breast appearance changed, is its profile different?
Has it shrunken, pulled in, developed dimples?
Has it become red?

Changes in normal cycle pain?
Has your breast become unusually painful?
Has the pain been prolonged through a normal cycle and continued into the next cycle?

Changes in the nipple?
Has the nipple appearance changed?
Has your nipple become itchy, flakey, rashy?

Do you have nipple discharge? (without squeezing!!)
Especially bloody nipple discharge and discharge from one nipple only

You are looking for changes in your breast that are different from your normal.



CHECKLIST FOR BREAST HEALTH

• Monthly self examination
• Yearly GP breast check from age 40
• Mammogram+/- ultrasound - from 40 onwards, talk to your GP about when to start
• Know your breast density


Knowing your breasts and having a plan for surveillance empowers you to take care of your breast health.