Frequently Asked Questions
Should I continue my estrogen?
Answer: The lay and professional literature is full of controversy concerning estrogen replacement therapy and an increased risk for developing breast cancer. Yet the literature also suggests that estrogen replacement therapy is somewhat protective against the development of heart disease, osteoporosis and more recently Alzheimer and colon cancer.
By convention only, we recommend that patients with breast cancer discontinue their estrogen replacement therapy. At present, we have no scientific data to support this practice. Likewise, patients with atypical intraductal or atypical lobular hyperplasia should consider discontinuing their estrogen replacement as they are at increased risk for developing breast cancer.
Two large studies, the Harvard Nurse Study and The New York Life Insurance Study enrolled tens of thousands of women. One study indicates that if you have taken estrogen longer than five years, you might be at slight increase in risk for developing breast cancer. The other study indicates that if you have taken estrogen longer than ten years, you might be at slight increased risk for developing breast cancer. Both of these studies, however, indicate that the positive benefits of taking estrogen far outweigh the risks.
What does breast cancer feel like?
Answer: 78% of the time, most breast cancer feels like a hard rock or frozen pea in the breast. The other 22% of the time it feels like an area of rubbery thickening. Comparing one breast to the other is helpful in breast self-examination and both breasts should be similar.
What is a positive family history of breast cancer?
Answer: A positive family history for breast cancer usually means immediate family members or first-degree relatives: mother, sister or daughter.
When is the best time of the month to do breast self-examinations?
Answer: In pre-menopausal women, the best time
to do breast self-examination is generally a week after your menses. In
post-menopausal women, pick a day of the month to do breast self-examination
such as the first day of every month.
Why are my breasts so lumpy?
Answer: Most women complain of "lumpy"
breasts. Anatomically, the breast tissue is arranged in groups, called
lobules (like the petals of a flower). These separations in the breast
tissue can cause the breasts to feel lumpy. In addition, the breasts are
quite nodular (lumpy) at the edges of the breast tissue. Comparing the
breasts on self-examination, as well as examining in a radial or starburst
pattern, should be similar.
Can the smallest cancer be found by breast self-examination?
Answer: No. Women who routinely do breast self-examination can pick up a mass when it is about one-half inch is size. Mammography can pick a malignancy about three years sooner than it can be felt. However, mammography is not 100% accurate. It is only 85% accurate and breast self-examination is an important part of early breast cancer detection.
Do mammograms damage my breasts?
Answer: No. While mammograms are not pleasant, they are effective in detecting 85% of breast cancer. Compression must be used to stabilize the breast, spread the internal structures, and allow the use of a lower dose of irradiation. Some tenderness may occur after mammography, which generally responds to Tylenol. To decrease the chance of discomfort, it is suggested to have mammograms after the onset of menses when your breasts are less tender.
Why can't I have an ultrasound instead of a mammogram with dense breasts?
Answer: Unfortunately, sonography does not replace mammography, even in dense breasts. Sonography cannot see microcalcifications, which is one of the findings that may be suspicious for breast cancer and can be seen only with mammography.
I have fibrocystic breasts. Am I more likely to develop breast cancer?
Answer: No. Ninety percent of women have fibrocystic changes yet only 13% of women develop breast cancer. Fibrocystic changes are considered the normal condition of the breast and therefore not predisposing to breast cancer. If however, you have benign proliferative breast disease; intraductal hyperplasia, atypical hyperplasia or lobular carcinoma in-situ (still benign!) you are at increased risk for developing breast cancer and may be a candidate for increased surveillance, chemoprevention or prophylactic bilateral mastectomy.
What causes me to have cysts in my breasts?
Answer: Ninety percent of women have fibrocystic changes in the breast and therefore it is not a disease. One theory is that the normal cyclic changes that the breast undergo on a monthly basis, for years, is responsible for the development of cysts. These changes generally resolve with increasing age as the breast tissue is replaced by fat.
What causes breast tenderness?
Answer: In premenopausal patients, the breasts are hormonally responsive, like the uterus, and cycle on a monthly basis. The breasts increase in size and volume by 50% prior to the onset of menses. This increase in size and volume likely causes inflammatory changes causing the associated breast tenderness. Tenderness usually begins a week or two prior to the onset of menses and generally resolves within the week following menses.
In postmenopausal patients, breast tenderness is usually
constant and more likely is related to arthritic changes and may respond
to anti-inflammatory agents such as, aspirin, Advilâ or Celebrexâ,
How concerned should I be about breast tenderness?
Answer: Breast tenderness is benign 90% of the time. It sure brings our attention to our breasts, however. Breast cancer is generally painless.
What can I do about breast tenderness?
Answer: For pre-menopausal women, vitamin E (400 units per day) and caffeine avoidance (coffee, tea, chocolate, or caffeine containing soft drinks) have been effective in reducing breast tenderness in 68% of women in three to four months. Evening Primrose Oil (three times per day, herbal) is effective in reducing breast tenderness in 95% of women. In extreme cases, another medication available by prescription called Danazolâ may be effective in reducing breast tenderness but most women decline when they learn that hirsuitism (growth of facial hair) may be a side effect.
Post-menopausal women with breast tenderness often benefit from anti-inflammatory agents such as, aspirin, Advilâ or Celebrexâ, etc.
When is nipple discharge of concern?
Answer: 70% of women will have periodic nipple discharge. The nipple discharges that should be of concern are the ones noted spontaneously in your gown or bra, from a single breast and bloody or serous (clear yellow, like urine). Bilateral (from both breasts), cloudy green or yellow fluid, from multiple ducts (10 to 15 ducts open at the surface of the nipple) is usually benign. Although you may want to have any nipple discharge checked by your physician for your "peace of mind."
Many of my relatives have different types of cancer. Does this increase my risk of developing breast cancer?
Answer: Generally, no. There are, however, cancer families, which are at increased risk for developing cancer but not necessarily breast cancer. Genetic markers for increased risk for developing breast cancer, BRCA 1 and BRCA 2 are associated with increased risk of developing other epithelial malignancies such as ovarian or GI malignancies. Genetic testing needs to be done to detect these specific changes.