Examining your breasts is an important way to find a breast cancer early, when it's most likely
to be cured. Not every cancer can be found this way, but it is a critical step you can and should
take for yourself. No woman wants to do a breast self-exam (or "BSE"), and for many the
experience is frustrating—you may feel things but not know what they mean. However, the more
you examine your breasts, the more you will learn about them and the easier it will become for
you to tell if something unusual has occurred. BSE is an essential part of taking care of yourself
and reducing your risk of breast cancer.
Studies show that regular breast self-exams, combined with an annual exam by a doctor,
improves the chances of detecting cancer early.
Try to get in the habit of doing a breast self-examination once a month to familiarize yourself
with how your breasts normally look and feel. Examine yourself several days after your period
ends, when your breasts are least likely to be swollen and tender. If you are no longer having
periods, choose a day that's easy to remember, such as the first or last day of the month.
Don't panic if you think you feel a lump. Most women have some lumps or lumpy areas in
their breasts all the time. Eight out of ten breast lumps that are removed are benign, noncancerous.
Breasts tend to have different "neighborhoods." The upper, outer area—near your armpit—tends
to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy
or pebbly beach. The area under the nipple can feel like a collection of large grains. Another part
might feel like a lumpy bowl of oatmeal.
What's important is that you get to know the look and feel of YOUR breasts' various
neighborhoods. Does something stand out as different from the rest (like a rock on a sandy
beach)? Has anything changed? Bring to the attention of your doctor any changes in your breasts
that:
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last over a full month's cycle, OR
seem to get worse or more obvious over time
Knowing how your breasts usually look and feel may also help you avoid needless biopsies—a
procedure in which the doctor takes a small sample of breast tissue and examines it under a
microscope.
Keep a journal
Some women find it helpful to keep a record of their breast self-exam on paper. This can be like
a small map of your breasts, with notes about where you feel lumps or irregularities. Especially
in the beginning, this may help you remember, from month to month, what is "normal" for your
breasts. It is not unusual for lumps to appear at certain times of the month, but then disappear, as
your body changes with the menstrual cycle. Only changes that last beyond one full cycle, or
seem to get bigger or more prominent in some way, need your doctor's attention.
If you have already been diagnosed with breast cancer, your risk of developing a new cancer is higher
than that of a woman who has never had the disease. The risk of a new and different breast cancer (not
a recurrence of the first one) is about 1% (1 in 100) per year. This means that over 10 years your risk is
about 10%. Put differently, out of 100 women who have a history of the disease, 10 will get a new
breast cancer within 10 years.
Researchers are constantly looking for new ways to reduce the risk of breast cancer coming back. They
are studying diet, stress levels, exercise, and environmental effects.
If you have a personal history of breast cancer, it's important to look at various ways that you may be
able to lower your breast cancer risk. Read information about testing to see which options are right for
you. You can also pay special attention to a number of lifestyle factors:
Maintain a healthy weight. Research has found that being overweight can increase the risk of breast
cancer coming back or the risk of a new breast cancer forming. The additional fat cells in your body
make extra estrogen. With less fat on board, there is less estrogen to stimulate breast cells. Fat cells are
also involved with other substances that might stimulate the growth of breast cells, such as insulin
growth factor. Research is under way to find out more about the possible connection between breast
cancer and these other substances.
Plus, losing those excess pounds can give you more “get up and go.” You're likely to become more
physically active, and you'll feel better about yourself.
Losing weight is hard work. But any progress you make to get your weight under control will make a
healthy difference in your life.
Start exercising. Research suggests that regular exercise can help you lower your risk of getting a new
breast cancer or of having the original cancer coming back.
Research also indicates that physical activity after a breast cancer diagnosis may improve survival. In one
study, the women who benefited most exercised the equivalent of walking three to five hours a week at
an average pace.
A review by the American Cancer Society (ACS) found that exercise provides a range of benefits to
women diagnosed with breast cancer. The benefits include improved physical fitness, higher selfesteem, and lower levels of anxiety, depression, and fatigue. The ACS recommends that women who
have been diagnosed with breast cancer exercise regularly (about four hours per week) to improve their
quality of life and physical fitness, as well as to possibly reduce the risk of developing new cancers.
Many women gain weight during chemotherapy and hormonal therapy for breast cancer. And research
suggests that exercise can help minimize or reverse some of this weight gain.
Four hours a week may sound impossible if you're a lifelong couch potato or if you're sore from surgery,
too busy with radiation therapy, or exhausted from chemotherapy. It's hard to force yourself to exercise
when you barely have enough energy to get out of bed or off the sofa!
The solution may be to start slowly, perhaps with 15 minutes a day, and very gradually increase the time
you spend exercising. It may take months for you to get up to four hours a week, but that's fine. Even
during treatment, taking short, slow walks up and down the street or around the block can be very
helpful. Then you can progress to gentle exercise, such as yoga or tai chi.
Staying physically active is the key. Short spurts of activity here and there are good. But it's even better
to sustain a physical activity over 15 minutes to an hour (or longer, if you can) and get your muscles,
heart, and breathing all working together. You don't need to run a marathon! Any exercise you do
regularly will make you feel better today and is also good for your long-term health.
Follow the American Cancer Society (ACS) guidelines for nutrition and exercise. The ACS guidelines give
you a good overview of lifestyle factors that may help lower your risk of the cancer coming back or of a
new cancer developing. Most people don't have the time to read hundreds of studies on possible links
between exercise, diet, and cancer. So guidelines from a trustworthy organization like the ACS are very
useful.
New research comes out constantly and some specific studies are groundbreaking. For instance, a study
of post-menopausal women with breast cancer indicated that a low-fat diet reduced the likelihood of
breast cancer coming back. The study is the first strong evidence that a specific diet can lower the risk of
breast cancer coming back. Stay tuned to Breastcancer.org for the latest research on how diet an
exercise can affect your risk for breast cancer.
Join a support group. Getting support through treatment, recovery, and beyond is necessary for your
emotional health and sense of well-being. Support groups are one good option.
Most women feel the need to connect with other women who've been through similar experiences—
even if they are lucky enough to have a supportive network of family and friends. Support groups also
allow you to relax in a setting with other women who are going through the same thing you are. Support
group participants can be a great resource if you have questions and wonderful listeners if you need to
vent. They are women who have “been there” and probably can suggest practical solutions to some of
your problems.
Many hospitals and cancer centers offer support groups.
At breastcancer.org, we offer our community members online support groups in the form of
the discussion boards and chat rooms. Open 24 hours a day, 7 days a week, these resources mean that
there are always other people ready to hear your concerns, provide information and encouragement,
and laugh off the small stuff.
“Stress busters” such as chat rooms and discussion boards may be important contributors to your
overall health. A study of women who had been treated for breast cancer suggests that reducing stress
may strengthen the immune system. Improved immune cell function was also found in people with
melanoma, a malignant skin cancer, who attended regular support group meetings. Researchers
speculate that one reason is that support groups help reduce stress, and that reduction bolsters the
immune system.
Though no big stack of studies clearly shows that getting support will help you live longer and free of
disease, feeling connected is certainly nicer than feeling lonely. As we better understand the bridge
between emotions and our physical health, we may discover new ways to lower the risk of breast cancer
coming back and lower the risk of a new cancer.
Consider hormonal therapies such as a SERM or an aromatase inhibitor. Stimulation of breast cells by
estrogen over a long period of time can contribute to the development of breast cancer. Aromatase
inhibitors block estrogen's effect on cells or decrease the amount of estrogen available in the body. The
main job of these medicines is to reduce the risk of recurrence of a breast cancer that has hormone
receptors (hormone-receptor-positive).
Hormonal therapies are also very good at reducing the risk of getting a NEW hormone-receptor-positive
cancer. This double benefit is very important. A SERM (selective estrogen receptor modulator) is a type
of hormonal therapy. It blocks hormone receptors in breast cells so the growth signals can't get through.
Tamoxifen is the most common SERM. It reduces the risk of breast cancer recurrence and decreases
the risk of a new breast cancer starting. SERMs also seem to help prevent or slow osteoporosis in postmenopausal women and may help lower cholesterol. However, tamoxifen's side effects must be
balanced against its benefits.
Aromatase inhibitors, such as Arimidex (chemical name: anastrozole), Aromasin (chemical name:
exemestane), and Femara (chemical name: letrozole), work by blocking a protein called aromatase that
converts a form of the hormone testosterone into estrogen. After menopause, most of the estrogen in a
woman's body comes from this conversion of testosterone into estrogen by fat and muscle cells.
Tamoxifen is the only anti-estrogen therapy approved for reducing risk in women at high risk for breast
cancer without a personal history of the disease, as well as for treating any woman with hormonereceptor- positive breast cancer. Aromatase inhibitors are only approved to reduce the risk of
recurrence in women with breast cancer and to treat metastatic disease. Clinical trials are studying the
use of aromatase inhibitors to reduce risk.
Aromatase inhibitors tend to be more effective and have fewer serious side effects than tamoxifen in
the treatment of post-menopausal women with hormone-receptor-positive breast cancer. Studies are
needed that look at the long-term risks and benefits of aromatase inhibitors compared to those of
tamoxifen. In the meantime, an aromatase inhibitor is a good choice:
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as the first choice for treatment after surgery (Arimidex)
to switch over to after two to three years of tamoxifen (Aromasin or Arimidex)
to use after five years of tamoxifen (Femara)
for women who cannot tolerate tamoxifen
Avoid products containing estrogen, progesterone, and pesticides. If you've had breast cancer, you are
not a good candidate for menopausal hormone replacement therapy (HRT). HRT is officially
“contraindicated”—considered inadvisable—in women who've had breast cancer. This is because taking
a combination of estrogen and progesterone for a few years or longer is associated with an increased
risk of breast cancer, according to a number of studies. Only a handful of small studies look at the use of
HRT in women with a personal history of breast cancer who are suffering from post-menopausal
symptoms. No solid results are available to guide a careful decision on this topic. But most experts agree
that the risks and unknown long-term effects of taking HRT probably outweigh any benefits.
The studies mentioned above all looked at hormones in pill form. Little is known about the relative
safety of vaginal creams, rings (such as Estring), gels, “natural” hormones, and herbal hormones. Your
doctor may prescribe vaginal hormones to help with vaginal dryness and discomfort. Hormone
preparations used in the vaginal mostly stay in the vagina. But a little bit of these hormones can be
absorbed into your bloodstream and get to your breasts. If you decide to use them with your doctor's
advice, try to use the lowest dose possible.
Some women who have been diagnosed with breast cancer choose to eat organic foods to limit their
exposure to any excess pesticides, antibiotics, or hormones. Keep in mind that the U.S. Department of
Agriculture makes no claims that organically produced food is safer or more nutritious than traditionally
produced food. More research is needed to determine whether organic foods are healthier for women
with breast cancer compared to food produced by other farming methods.