Perhaps the least-expected controversy concerns two nonprofit organizations—the Susan G. Komen foundation and the American Cancer Society (ACS)—who concluded jointly that breast self-examination does not work, and therefore women no longer need to do self-exams (see chapter thirteen). Instead, they suggest women should be “self-aware” and report any change. How confusing can it get?
Genetic Testing
In 2013, Angelina Jolie went public with her announcement that she carried a high-risk gene mutation and had decided to have both breasts removed. At the time, the cost of genetic testing was in the range of $4,000. Now, only a few years later, any woman can be tested for $249—and she can apply online. Yet too few women are aware of the lowered cost or even that such knowledge might help guide their health care decisions.
Why So Many Mastectomies?
There is a growing trend for women who have been diagnosed with a malignancy to choose a mastectomy, even when they are ideal candidates for saving their breast. Oftentimes this decision is based on the assumption that mastectomy will provide better potential for survival—but this assumption is misguided. (See chapter twenty-four.)
Cell Phones and Breast Cancer
Among breast care physicians and radiologists working in my field, there is a growing perception that cell phones worn for long periods in direct contact with the breast are a possible cause of breast cancer. However, like early observations from long-gone doctors about the harmful effects of smoking, this suspicious relationship has been refuted by physicians whose areas of concentration are in other fields. In fact, all suggestions of a causal relationship between cell phones and breast cancer have been laughed at by a great many doctors. (See chapter seventeen.)
AS MORE AND MORE of these breast-care controversies surfaced, I began to think, No wonder women are confused. How can I remain silent? I’ve had too many years of experience to allow these many contradictions to go unanswered.
I am admittedly at one end of the spectrum on these ongoing conflicts: My primary goal is to expand efforts to detect breast cancer at its earliest, most lifesaving stage. Although most experts would agree with me in principle, the advice some are giving women often gets in the way of this goal.
I hope the pages that follow give you the information you need to make your own decisions about how best to protect your health.
General Breast Care Guidelines by Age and Sex
For Children, Teens, and Women Under Forty
JUST AS “ONE SIZE FITS ALL” doesn’t work in clothing, neither does it work in breast care. As you’ll see in this section, different rules apply to different age groups—and what might be considered optimal care for one group can be detrimental to another.
Women in their thirties, for instance, whose breasts tend to be dense, are screened differently than their older sisters . . . and for them breast care deals primarily with the treatment of symptoms. Though we do address pain, infection, and nipple discharge, the most important issue is lumps.
While younger women are advised not to get routine screening mammograms, they are also, happily, less apt to acquire breast cancer. However, those who do find suspicious lumps are under more pressure to act quickly.
On the other hand, by age forty, women have crossed a line that divides “younger” from “older” women. While X-ray diagnosis is no longer a safety issue, the possibility of developing breast cancer is high enough to justify the expense and inconvenience of screening mammograms.
This section outlines what can be expected in women’s breast history from newborns through the years until the woman turns forty. In each age group, a discussion of possible breast concerns is followed by recommended treatment options.
NEWBORNS
Breast Lumps
Breast lumps are common in newborns. They are almost always benign and related to maternal hormones encountered in the womb. In some cases, milk can be expressed from the nipple. The effect is short-lived and the breast soon returns to normal. Referral to the pediatrician is indicated if symptoms persist after several weeks. In the rare case in which the baby has a fever and the breast is red and swollen, the pediatrician should be contacted immediately.
PRE-TEENS
Breast Lumps
Pre-teen girls usually develop a button-like prominence directly below the nipple. At first, the lump may be evident on one side only. This is a common finding in young women entering puberty. The “lump” is referred to as a breast bud. Observation is all that is required. When we see this type of lump in our office we simply inform the parents to return in one to two months if they still have any questions or concerns. Surgical removal of the breast bud will result in the failure of breast development.
Lumps that aren’t breast buds in pre-teens are unusual and require the attention of a physician. An ultrasound is the diagnostic procedure of choice for any persistent lump in this age group. An experienced surgeon, preferably a pediatric surgeon, should be involved in the decision- making process.
In select cases a needle biopsy should be performed to establish a diagnosis. Follow-up treatment will be based on the results of the needle biopsy.
Asymmetry
It is common for one breast to develop faster than the other. In most cases, reassurance is all that is required. An exam by the pediatrician is sufficient to reassure the patient and her family that all is well.
Breast Infections
Breast infections are rare in this young age group, and typically respond to antibiotics. Cases that are recurrent or unresponsive to therapy should be referred to a breast surgeon.
PUBERTY TO TWENTY
Breast Pain
Breast development and the onset of the menstrual cycle are indicators of early puberty. The pediatrician easily manages most issues of breast care in this age group. Issues such as cyclic breast pain are best handled with reassurance. In some cases, anti-inflammatories or caffeine restriction is advised (see chapter six).
