Breast awareness: no one knows your breasts as well as you do

For most women at average risk, Cancer Care Ontario (CCO) recommends a mammogram every two years from age 50 to age 74 to screen for breast cancer. Women ages 40 to 49 are advised to talk to their doctor about mammography to decide if they would benefit from screening.

However, breast health begins before age 40: CCO advises women of all ages to be breast aware. Although breast self-exams are no longer recommended, every woman can know her own breasts: how they look and feel, and what is normal for her.

“Breast awareness means knowing what your breasts are like, and if you notice something new, that’s when you should see your doctor,” says Dr. Pamela Lenkov, staff physician with the Henrietta Banting Breast Centre at Women’s College Hospital. “Most breast concerns that people see their doctor about fortunately are not breast cancer, but even though we know that, it should still be brought to a doctor’s attention.”

Some examples of breast changes that should be investigated include:

• a lump, either in the breast or in the armpit
• nipple changes, including (but not limited to):
  • new discharge – especially bloody discharge – from the nipple
  • surface changes on the nipple or surface irritation that does not heal
  • a nipple becoming inverted, or turning inward
• new skin changes, including (but not limited to):
  • redness on the breast that was not there before
  • puckering of the skin on the breast
• change in the contour of the breast, such as an area that looks swollen

Breast pain is extremely common, and almost never indicates breast cancer. However, if you have new breast pain or pain that you are concerned about, Dr. Lenkov suggests bringing it to your doctor’s attention. “It’s very unlikely to be breast cancer, but it should be evaluated at the very least by a clinical breast exam,” she says.

Dr. Lenkov stresses that this list is not comprehensive: these are examples of breast changes, but any change in your breasts is worth investigating, although it may not specifically fit into one of these categories. Additionally, even if a patient’s breast issue is vague, Dr. Lenkov recommends letting the doctor know.

“Even if a patient has a sense that something has changed or is somehow different, I respect it even though it’s likely not going to be something serious,” she says, noting that women know their own breasts best. “As a doctor, I have to respect that my patient is the one who wears those breasts, and the one who knew from being breast aware to bring this to a doctor’s attention.”

Most breast issues do not turn out to be cancer. However, in those rare cases that are cancer, early detection may mean a better outcome and more treatment options. Breast awareness enables women to recognize changes in their breasts and have them checked out.

“If there is something that has changed, that was not there before, or that has evolved, see your doctor,” Dr. Lenkov says. “It doesn’t matter if it doesn’t fit into a category of a lump or nipple discharge or skin changes. Those are just examples of breast changes a woman would want to have looked at. But the bottom line is, if you feel that something has changed, you should have it assessed by your doctor.”