October means many things: the real start of Fall, a nudge that the holidays are just around the corner and the year is headed toward the finish line. In October, we also see the reemergence of the pink ribbon, a reminder that breast cancer can affect anyone, and the fight to find new treatments and its cure is not over.

While genetics and environmental factors can play a role in diagnosis, there are preventable actions, such as early screening, that can help detect any abnormalities. When it comes to breast cancer prevention, one of the best things a person can do, is stay proactive with self breast exams and screenings with a doctor.

Renée Quarterman MD, FACS, chatted with TheGrio about some of the most common questions you may have about breast cancer, including the best age to begin screenings, the proper way to examine yourself, and external factors that Black women in particular should consider. “If a Black woman is diagnosed with breast cancer, it is imperative that she educate herself about her diagnosis and all of her treatment options, as some studies are showing that Black women with breast cancer in the US are not being considered for some of our newest technologies and therapies,” she advised. Dr. Quarterman is also the Co-Editor of  Breast360.org a patient-centered website created by the American Society of Breast Surgeons. The site is a great resource for anyone looking to delve deeper into questions about breast health.

WHEN SHOULD A WOMAN BEGIN BREAST CANCER SCREENINGS?

Dr. Quarterman: New information supports looking at a woman’s specific risk factors for breast cancer, including her family history, when advising about when to begin breast cancer screening.  Some women may actually start screening later than age 40, but experts agree that all women should start surveillance by age 45.  It’s important that a woman discuss her starting age with her doctor.

WHAT DETAILS IN PARTICULAR SHOULD ALL BLACK WOMEN, REGARDLESS OF AGE, BE AWARE OF IN REGARD TO BREAST HEALTH?

Dr. Quarterman: Lifestyle lifestyle lifestyle: low sugar, low fat, high fiber diet; minimal alcohol, keep BMI in normal range, don’t smoke.  Start these habits now.

All Black women must understand that researchers are JUST NOW making concerted efforts to look at and include women of color in studies about breast health and disease.  This means that our treatments and our breast health recommendations, while miraculous and undoubtedly effective for all women, may have better effects for WOC as more information is gathered and therapy can be better tailored to them. For instance, we’ve learned that all WOC have younger average ages of onset of breast cancer versus white women, which means that all WOC should probably start screening at age 40.  Black women are more likely to develop a more aggressive form of breast cancer (triple negative) that is harder to successfully treat. All WOC are more likely to die of breast cancer compared to white women.

And unfortunately, we live in an age where breast cancer may not be the first thing a doctor considers when a WOC has a breast complaint.  So WOC must be vigilant themselves and demand a full breast evaluation, with imaging, when they have a breast concern.

Black women are more likely to be overweight or obese, which increases breast cancer risk.  A healthy lifestyle and weight control are therefore important. What’s great is that breast specialists are increasingly aware of differences between Black women, other WOC and white women regarding breast disease. The patient must encourage her doctor to openly discuss her diagnosis and treatment options in full.

CONSIDER GENETICS AND MEDICAL HISTORY

Dr. Quarterman: If a woman’s mother was diagnosed with breast cancer before age 40, or if a woman has a genetic mutation that is associated with breast cancer, then she should start her own screening earlier than age 40.  A woman with a history of chest wall radiation for lymphoma should also be considered to begin screening early. If the reason is her mother’s history, for example, a woman should begin screening 10 years younger than her mother’s age at diagnosis.

HOW DO I PROPERLY EXAM MY BREASTS?

Dr. Quarterman: First of all, it’s important to know the updated information: self breast exams are not reliable ways to detect breast cancer. Imaging (mammograms, ultrasound, MRI) is the gold standard.  Many doctors, myself included, still do encourage women to examine their breasts. This is because breast texture changes with a woman’s hormonal cycle and it’s important for a woman to know the normal terrain of her breasts and how that terrain changes over days, months and years.  A self exam takes no more than five minutes and should be done at the same time every month. After about three months, most women are experts at what is normal for them. It’s important to do self exams to 1) know what is normal and 2) to be proactive with your doctor, letting her know that what she feels on her physical examination is long-standing or new to you both.

There are three parts to an exam. The first is to examine your breasts in the mirror.  Which breast is larger? Any pulling or changes in the nipples? Look with your hands on your hips and overhead. Any change/asymmetry?

The second part is to feel the breasts in the shower or bath, when the skin is slippery.  Any masses? Finally, lie on your back with one arm behind your head. Use the pads of the fingers of the opposite hand to feel the breast as it’s spread out, more even.  Choose a spiral or an up-and-down pattern to feel the entire breast, ending with squeezing the nipple.

If you see or feel a new finding or get any nipple discharge, see your doctor.  And rest assured that most things a woman finds on self exam are not cancer.

WHAT ARE SOME OF THE MOST COMMON CAUSES OF BREAST CANCER?

Dr. Quarterman: Biggest: being a woman—estrogen! Aside from that: family history, cigarettes, alcohol (we now know that even one drink a day can increase risk), obesity, stress, a diet high in sugar and/or fat.

PEOPLE SOMETIMES FORGET THAT BREAST CANCER CAN AFFECT MEN AS WELL. PLEASE SHARE ANY INSIGHT ON THIS.

Dr. Quarterman: If you have nipples, you have breast tissue. Annually, fewer than 1% of breast cancer cases are in men.  Men with known genetic mutations are at increased risk. Men with a strong family history of breast cancer (women and men) may be at increased risk. Most breast masses in men are not cancer, but it’s important to have any breast changes fully evaluated (including imaging).  Most cases of male breast cancer present as hard lumps that pull the nipple in and possibly change the overlying skin.

The treatments for male breast cancer are the same as for female breast cancer.  Stage for stage, the outcomes are equivalent. Unfortunately, male breast cancer may present later because men are not bombarded with instructions to examine their breasts.