Don’t wait until it’s too late: Doctors advise on breast screenings, self-exams

Breast cancer is the most common form of cancer worldwide. In the United States, about 12.9% of women will develop it at some point in their lives. For Breast Cancer Awareness Month, two local doctors spoke with the Lewiston Tribune and Northwest Public Broadcasting about how patients can reduce their risk of breast cancer and safeguard themselves against a late diagnosis.

Dr. Sallee Jones is a surgeon at St. Joseph Regional Medical Center in Lewiston, Idaho. She focuses on breast cancer and benign breast disease. Her biggest piece of advice to patients? Never delay mammograms.

“I’ve seen too many people who put something off for months at a time because they were afraid of the mammogram even though they felt something in their breast. Some people have discomfort during the mammogram, some don’t,” Jones says. “The discomfort you will feel is nothing compared to delaying a diagnosis.”

Women with an average risk of breast cancer are advised to get annual screening mammograms starting at age 40, as well as annual clinical exams.

Sometimes, Jones says, patients delay mammograms because of lapses in insurance coverage. “I hear this all the time, ‘I switched my insurance. And I didn’t get it for two years, because I didn’t have insurance coverage.’ [But] there are organizations that can help with that, too,” says Jones. “Don’t let that be an excuse.”

Factors such as a family history of breast cancer, genetics and previous exposure to radiation are a few of the factors that can all affect a patient’s risk of developing breast cancer.

Patients can influence some risk factors. Patients who binge-drink, live a sedentary lifestyle, are obese or have unhealthy diets may increase their risk of breast cancer.

Patients who are considered high-risk, which is a status determined by a doctor, are recommended to get clinical exams and annual mammograms starting at 10 years younger than the age at diagnosis of the youngest person with the disease in their family, Jones says — but no younger than 30-years-old.

According to Breastcancer.org, anyone assigned female at birth should have a breast cancer risk assessment by age 25, which will help determine when it’s best to start having screening mammograms.

High-risk patients may also qualify for additional services, Jones says, including genetic counseling, annual MRIs in conjunction with mammograms, and risk-reduction therapy with a medical oncologist.

Patients should also be familiar with how their breasts feel normally, so it’s easier to detect abnormalities, says Dr. Byron Wright, a surgeon specializing in breast cancer at Tri-State Memorial Hospital in Clarkston, Washington.

“Breast self-exams should generally begin early in a woman’s life, once adulthood has been reached,” he says. “The idea [is] to become very familiar with how your breast normally feels, so that if an abnormality does arise in the future, it can be more easily and earlier detected by the patient.”

Despite some misconceptions, Jones says, monthly breast self-exams, or “breast awareness” checks are a valuable tool for everyone.

“A lot of people will say, ‘Well, Sallee, my breasts are lumpy anyway, it’s not worth it.’ But it is worth it, because then you know what’s normal for you,” she says.

Breastcancer.org provides an in-depth guide for self-exams, but generally, Jones recommends patients check once a month, one week after their period.

They should start by looking in the mirror with their hands on their hips, and check for protruding masses, asymmetry, dimpling, or retracted nipples, as well as any fluid coming from the nipples.

After that, Jones recommends lying on the floor with one arm extended above the head. With the opposite hand, patients can check each breast, moving in a circular motion.

“Don’t use the tips of your fingers. Imagine if you had a marble underneath a towel, and [if] you use the tips of your fingers, you could kind of move that marble around all day and never find it,” she says. “Use the pads of your fingers … and roll the tissue underneath you so that marble can’t escape the tip of your finger.”

Men can also get breast cancer, though they account for only about 1% of diagnosed cases. Usually, breast cancer in men presents as a lump around, or in close proximity to the nipple or areola.

“[Breast cancer in men] still occurs with a high-enough regularity that men should be made aware that they, too, can develop breast cancer,” Wright says. “So men, just like women, should check this area of the body with some regularity, be aware of how the area normally feels and bring any concerning changes to the attention of their health care provider.”

Tenderness around breast tissue can also be indicative of breast cancer, or of gynecomastia, which is benign.

“If that comes on, they need to have a mammogram,” Jones says. “A lot of times, men think that mammograms aren’t for them, or that’s not feasible, but that’s not true. We do mammograms and ultrasounds on them all the time.”

Despite its prevalence, breast cancer has a high survival rate. According to Cancer.Net, the average five-year survival rate for women in the U.S. with non-metastatic invasive breast cancer is 90%, and the average 10-year survival rate for women with non-metastatic invasive breast cancer is 84%.

“Breast cancer is a very treatable and highly curable disease,” Wright says. “Optimal outcomes rely on increased awareness, widespread screening and early-as-possible diagnosis followed by the appropriate application of a patient-specific [management plan].”

Above all, Jones says, if a patient thinks they may need a screening, they shouldn’t wait.

“I have people who I see, and they ended up with advanced breast disease, and now they’re not only dealing with the disease itself in the treatment, but now they’re dealing with, ‘Oh my gosh, why did I wait so long?’ And it just adds another component of the emotional aspect of cancer. So denial will help no one.”

More information about breast imaging and other breast health services at Tri-State Memorial Hospital and St. Joseph’s Regional Medical Center is available at tristatehospital.org/womensimaging and sjrmc.org/breast-imaging-center.

Sun may be contacted at rachel.sun@wsu.edu or on Twitter at @Rachel_M_Sun. This report is made possible by the Lewis-Clark Valley Healthcare Foundation in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News