Ask the Experts… four leading surgeons on what you need to know about breast cancer detection

These are all common universal questions asked about breast cancer detection around the world – and with over 2 million patients diagnosed with breast cancer every year, there’s never been a more pertinent time to ask them.

During a recent visit to our UK office, we invited our wider Endomag team to ask their questions around detection to four experienced physicians and hear their advice and top tips.

Among the esteemed panel for this open discussion were:

• Allison DiPasquale, M.D. from Texas Breast Specialists
• Anne Peled, M.D. from Sutter Health
• Ms Anushka Chaudhry from The Great Western Hospitals NHS Foundation Trust.
• Michael Alvarado, M.D. from UCSF

Here’s what they covered over the course of the 30 minute session:

Q) When is the best time to self check your breasts?

Often, the best time to check is in the shower and just take a couple of minutes to note any changes. The shape and feel of your breasts can fluctuate based on factors such as hormones, so the more frequently you do it, the more you’ll become aware of what is an expected change versus an abnormal change.

For example, you may find there are some frequent differences that occur relate to your menstrual cycle and pregnancy can play a part in changes too.  Hormone replacement therapy (HRT) can also impact on the way your breasts feel.

Changes are not just limited to women though, and we are seeing more cases of breast cancer diagnosis in men too. It is important that men are familiar know with what their pecs and chest tissue feel like to notice those changes too.

If you are ever in doubt, you should visit your doctor to get checked out.

Q) Does family history of breast cancer increase your risk of breast cancer?

Unfortunately, there is a correlation. A woman’s risk of breast cancer is higher if they have a direct relative or multiple family members on either side of the family who have previously had breast cancer.

There are ways to assess your risk including online tools, which can be useful to give a general assessment but they shouldn’t be used in isolation. If you are concerned about hereditary risk, always follow up with your GP.

Q) Is genetic testing an accurate predictor of whether I'm likely to get breast cancer?

Genetic testing has so far proven to be a good predictor of your risk, and can help you to be more aware of your breasts and manage your risk.

If you’re having a breast check, your doctor should ask you about genetic testing, but if they don’t then make sure to ask them about it.

Q) Do contraceptive pills increase your risk of breast cancer?

There are no contraceptive pills that we are aware of that have any impact, and no data to support such claims.

Q) What are the risks of getting breast cancer if you take HRT?

This is a really difficult one. The best advice we can give is that it is important that you get as much information as you need around this, so ask your GP to talk with you about the numbers, so you can make an informed decision. As a patient, you shouldn’t be afraid to question the suggestion of stopping HRT.

Finally, be conscious of how long you are taking HRT for and whether or not there is an increased additional risk as a result of family history of breast cancer. Weigh up the risks and benefits to you, as quality of life is the most important thing.

Q) Other than a lump, what are the other symptoms should I look out for?

60% of patients with breast cancer present with a lump, but there are a few other things that you can look for.

Most notably, other visual changes to the breast can be a cue to get a second opinion. Get to know what your breasts look look like by regularly standing in front of a mirror and understanding what’s normal for you.

Other things to look out for might be:

•   Changes in the size or shape of your breast.
•   Any nipple discharge, particularly bloody discharge.
•   A change in the look or feel of your skin, such as puckering or dimpling.
•   A change in the appearance of your nipple, including if it has sunken.

 Despite some claims, breast pain is not usually a symptom of breast cancer. Once again, the key thing is that if you think something doesn’t feel right, always go and get it checked out.

Q) Do male breast cancer patients present with the same symptoms as female patients?

While it is much less frequent for men, typically they will have similar breast cancer symptoms to women. The most common symptoms for a man is being able to feel a mass or nipple discharge.

Q) How much of a difference does it make to find the cancer early, versus late detection?

It’s really important to find breast cancer early, in order to better treat it. Breast imaging is super important in that regard, and early screening through mammograms can be vital in saving lives.

If you’ve previously undergone genetic testing and are shown to be high risk, your results could qualify you for increased screening and checks to more closely monitor potential developments. 

Q) Do dense breasts make it harder for surgeons to detect cancer?

Dense breasts can make detection more difficult, but the screening method being used can also play a significant role in that difficulty. While mammograms are the go-to method, we can often adapt to other imaging to achieve the most accurate screening for patients.

In the US, we use a breast density score to help guide us, and it might surprise you to know that actually most young women have dense breasts. This isn’t something to be alarmed about.

If you have dense breasts and are due for a breast check-up, speak to your doctor as they may recommend a different screening approach.

Q) What do you do to help reduce patient anxiety?

The most important thing here is to set expectations around timings. Often the time between taking the biopsy and getting the results can be the most stressful, as patients can often fear the worst.

To patients, breast cancer feels like an emotional emergency, but medically there is often time, and it won’t be as urgently necessary to remove the suspicious cancer as you might think.

We tell people to slow down, learn about their options, do the necessary tests and undergo all the imaging you need. There is so much information to take in and the most informed patients tend to really benefit from this approach.

For those patients requiring surgery, why not frame the day of surgery as something not to dread but to celebrate? One example is to welcome them on their “cancer-free day”. With this approach, you often see their anxiety disappear straight away.

>> Find out more about early breast cancer detection here (cancer.org)

NOTE: All advice within this article has been provided by health care professionals and not Endomag. Please do your own research too and consult with your doctors before making any decisions on your treatment.